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At the heart of general practice since 1960

Should we let GP practices fail?

Dr Una Coales

YES

The Government has decided to scapegoat NHS GPs – and we should let them. Why work ourselves to an early grave to prove the Government wrong? Why bother putting up a fuss and bothering our trade union to ballot on industrial action? Haven’t you heard ‘British GPs are the most lavishly rewarded in the world’ as quoted in the Times newspaper only the other day? We must ‘drop the moral blackmail and open all hours’, it read.

What would happen if we all resigned and allowed our practices to fail? After all, we can’t starve our children or live in our cars if we continue to accept negative monthly drawings for the sake of keeping our surgeries open.

How much worse does it have to get, before we are forced out? Admissions avoidance schemes, referral management schemes, delays, gate-keeping blockades, begging for remuneration, begging for practice lease renewals. Why not do their job for them and just put up a frontage sign that reads, ‘This NHS GP surgery is closed by the CQC due to safety reasons’?

We tried reasoning with the Government, but it didn’t work. Compromise!, we said. Allow GPs to work like dentists. But please, stop giving us money only to take double away.

But it all fell on deaf ears. It seems there is no recruitment crisis, and no funding crisis.

If we continue to work overtime for less pay, the slave master will expect this as the norm and work us harder. But if we work to rule and allowed all surgeries to fail, we would regain our lives and our self-respect. When the public sees every surgery in the country close in the run-up to the next election, it will wipe out our enemy’s chances of victory. Sweet revenge!

We would finally be in the driving seat. We could bring our old colleagues home from Australia. We could reshape the delivery of primary care on our terms – prioritising patient health needs instead of consumerism; responsibility for outcomes shared between the doctor and patients, instead of the paternalistic approach of the nanny state.

For too long we have relied on the odd brave GP sticking his or her head above the parapet on behalf of the whole profession – only to have their heads blown off in spectacular fashion.

It’s time for all of us to make a stand, side by side (not 20 feet behind the leadership). Make some Plan B income provisions and let your surgery fail.

The 2014/5 NHS GP contract is financially unfeasible, and you are all about to prove it to the public.

Dr Una Coales is a GP in south London and former BMA Council member

 

Dr Kailash Chand head SQUARE

NO

A crisis that is threatening to overwhelm GP services and force the closure of some GP practices. Pulse’s initiative is a timely reminder of these threats, which I believe politicians and the public are slowly beginning to wake up too.

The biggest issue facing vulnerable practices is that there is no one cause for this crisis. Rather there are many interconnected pressures that are coming to fruition at the same time. Patient demand is continuing to rocket and while GPs are working harder than ever before – performing 40 million more consultations than in 2008 – the sheer number of patients arriving for treatment is far outstripping GP’s capacity. Funding has been flat lining or declining for many practices for years, leaving them in the untenable position of doing more, with less.

A number of practices have faced an extra blow due to the phasing out of MPIG which from April has some practices in challenging circumstances begin to see a vital funding lifeline phased out. NHS England have acknowledged the phase-out will leave 98 practices in serious difficulty, while hundreds more will be affected to a high degree, but so far little has been done to help those GP services affected. The BMA has done a lot of work highlighting these cases to the public and the chair of the GPC marched with GPs from Tower Hamlets (an deprived area that could see a whole sway of practices close) to protest the issue. Practices in rural England, the commuter belt and at universities, are facing the same desperate fate.

As recent BMA surveys have shown, GP services are also being undermined by decaying practice buildings and a workforce crisis. Four out of 10 GPs say they are struggling to provide basic GP services because their buildings are too cramped and inadequate.  Around seven out of 10 are considering early retirement. Some 451 GP trainee places went unfilled in the most recent recruitment round – no-one wants to do this job anymore.

Overall, it is clear we cannot allow practices to continue to be undermined to the extent where some – even if a small number – are tipped towards closure. Any practice shutting would leave a damaging hole in local patient care and rip out a key part of the local community. We need to prevent this from happening.

There is a clear solution. We need to have long-term, sustained investment across a range of GP services. Practices need to be backed with proper resources, better premises and an expanded workforce. Most importantly we have to protect those practices on the edge. If we don’t, patients will suffer.

As well as the Pulse campaign, the BMA have also started Your GP Cares because of the crisis. If general practice starts to crumble then the rest of the health service will collapse, with disastrous consequences for patient care. General practice is in crisis – the Government must listen to Pulse and BMA’s campaign.

Dr Kailash Chand is deputy chair of the BMA and a retired GP

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Readers' comments (71)

  • Sorry Dr Chand but I am firmly behind Una on this one. The BMA have let GPs down time and time again. Enough with the rhetoric - it's time for some proper action that will make politicians and the public sit up and take notice. Sadly it may take more practices to fail for that to happen.

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  • The trouble is that the losses are borne personally by those unfortunate GPs. We need a fund to help them bear the costs.

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  • David Wrigley

    Dr Coales suggests GPs work like dentists - well as a GP I don't want to work like a dentist. Many of my patients do not go to the dentist because they cannot afford it. The part private/part NHS dental service is a disaster for most people and excludes many from necessary treatment due to costs.
    NHS general practice needs the funding it deserves. Year on year the government have reduced funding for gen practice from over 10% to around 7% of the NHS budget. Along with the national QIPP cuts and constant denigration of the NHS by politician and the media this is why the NHS and general practice is struggling.
    We must lay the blame in the right place and seek the funding and the service our patients deserve.

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  • What a crazy notion to want to let General Practice fail.. Oh sorry it's from the ? Still a GP who believes in making patients pay a lot. And who advises young GPs to leave for Australia. Her not so hidden agenda is to see the NHS destroyed.

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  • I am with Dr wrigley .It is time to restore the 'Jewel in crown status' for our beloved General practice.Dr Chand makes some excellent points,why we should unite and don't allow destruction of the general practice.

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  • You can not solve this crisis unless you reduce demands . You will never achieve that unless you make patients pay. Trying to educate them is hopeless case . Let the NHS fails it is way overdue.

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  • Surely we need to do both, fight to keep general practice funded but plan for the worse and recognize our political parties are controlled by corporations which have an agenda of their own

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  • Una Coales

    David Wrigley as a BMA Council Member and member of Keep NHS Public (which you failed to declare), perhaps you can let us know why the BMA Council and BMA GPC have not balloted its GP members on some form of industrial action (boycott OOHs, mass resignation, strike action) and believes instead a petition to number 10 will have any effect? Why should the government give more public funding to GPs over firefighters, police force, armed forces, education? All public sectors are being hit hard with funding and job cuts.

    Why are younger GPs heading for Australia? Perhaps because they allow GPs to be semiprivate and treat the poor as well as those who can afford healthcare.

    Perhaps you would also like to share how much is in your NHS pension pot? As younger GPs have a cap on theirs and must contribute more to cash out less at a later date. And why the BMA refused to debate a Welsh motion on potential age discrimination with the new government policy from 2015 to protect pensions of NHS doctors who turned 50 in 2012 for 10 years?

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  • Dr Chand simply states what we all know is wrong, and says funding must be restored.
    That's not a plan, that's complaining.

    What is happening to general practice is not an accident, this is what the politicians of both parties and DoH want so they can see it taken over by just 2 or 3 big firms. Politicians and DoH do not equate general practice partnerships with primary care, like we do. We think they are one and the same, but the politicians and DoH think GP partnerships are just one piece of primary care, and not a piece that they want any longer anyway. They have no interest whatsoever in saving GP partnerships, they are happy to let you, indeed make you, go to the wall.

    So Dr Chand listing the problems and saying we need more funding will have diddly squat effect. the square root of zero will be the result. Follow Dr Chand and carry on doing what you have been doing and guess what, you will continue to get what you have already got. Nowhere.

    At least una has a plan to do something, something that would make the govt and public take notice. We are not charities, we don't work for nothing, if any GP is concerned about poorer people affording private GPs they are welcome to do pro-bono work. But please stop foisting your bleeding heart soviet union system on everyone else.

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  • David Wrigley | GP Partner | 01 August 2014 0:09am
    "Dr Coales suggests GPs work like dentists - well as a GP I don't want to work like a dentist. Many of my patients do not go to the dentist because they cannot afford it. The part private/part NHS dental service is a disaster for most people and excludes many from necessary treatment due to costs."

    Please explain how every other civilised country charges to see the GP and none of them bleat about the poor being unable to afford it.
    This "free" NHS is a cult religion in the UK and people are blinded to its massive faults and cling desperately to it like they will die if the cult comes to an end.

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