Most GPs have already put in a lifetime's work
There is one major aspect that both the health secretary Jeremy Hunt and BMA chair Dr Mark Porter appear to have neglected in their discussions concerning doctors’ pensions and retirement age (‘BMA hails ‘milestone’ concession from Government on pensions negotiations’).
My generation, the pre-2003 junior doctors, spent our working time in 1:3 or 2:7 on-call rotas with prospective cover. This meant for 12 weeks of the year we would work a 1:2 or a 4:7 on-call rota, for example being on call for 24 hours on Monday, Wednesday, Friday, Saturday and Sunday, finishing 5pm the following Monday. The Tuesday and Thursday would be eight-hour days, not on call. This would equate to a 136-hour week for nearly 25% of the year. The rest of the year we would average an 104-hour week. Thus over the year this would average out at an 112-hour week.
Why should a doctor be expected to retire at the same age as another public service employee who may only have worked an average 36- to 40-hour week during their career? The argument that people work overtime, and could work longer hours, is compensated by their being paid overtime at a rate usually more than their basic wage per hour.
As junior doctors, our hourly rate once we worked more than 40 hours a week was a third of our basic wage. I was the lowest-paid person working in the hospital on Christmas Day, with a rate of £2.30/hour. This was compulsory.
Back then, the Government’s argument for this draconian contract was that we were civil servants, but that we would be ‘well looked after’ when we retired, as it was then recognised that we would surely burn out before the rest of society. The added bonus was that if we made one small mistake due to our fatigue, which we had no control over, some poor patient could die and we could be sued.
In my 13 years as a junior doctor, working those hours, I would have worked the equivalent of my non-doctor friends’ 37-year career. But add on a further 23 years of a 56-hour working week as a GP (again with no option to skip the overtime) and this would be equivalent to 32 years of a non-medic’s working life. This makes a grand total of 69 years of working a ‘40-hour week’ in a very stressful, life-or-death-decision-making environment.
How many people would start working aged 16 and continue to 85 years old, in such a stressful and technically-demanding job? And now the Government wants to increase our working lifespan further!
Please think this through very carefully. I would take immediate retirement if the compulsory retirement age for doctors was increased, and I’m sure many of my colleagues aged 50 or over would do so too.
Under these circumstances the NHS would implode, due to an immediate shortage of doctors, while the NHS pension pot would take a hammering if we stopped contributing and started drawing on our, admittedly reduced, pot.
Dr Mark Saunders, Fylde Coast, Lancashire
I voted against the 2004 new GP contract as I had concerns regarding the clause allowing the Secretary of State to unilaterally alter the contract after a ‘period of consultation’ (‘GPC prepares to go to war on contract’).
A contract that can be unilaterally altered is not a contract and was never going to achieve the GPC soundbite to the profession at the time of ‘no new work without more pay’.
The current proposed changes to the contract are half baked and dangerous and likely to seriously destabilise general practice. The Government has no respect for doctors in general and the current format of negotiations and capitulations by the BMA (the pensions strike being a particular damp squib) has shown them that they can impose anything without any repurcussions from the profession. They are banking on us to moan and then get on with it as we always have done.
This needs to change. As independent contractors we do not have to accept impositions. Primary care provides the highest amount of health contacts compared to any service in the NHS and neither the Government nor the public will tolerate the prospect of having no primary care overnight.
GPs should give serious consideration to resigning from the current contract.
Plans should made for a truly independent primary care service where GPs can control their own workload offering both private services and, if the Government wants, NHS primary care services, at terms which are reasonable for us as the provider.
Any new contract should be demand based, for instance payment per patient seen. Only this will encourage the Government to take the issues of demand and capacity seriously.
Routine non-evidence-based checks and annual reviews – which many patients don’t want – seem to be increasing in our current contract, and must be removed. Patients in the main only want what is core to the contract: to be seen when they are ill.
What would the Government do if all GPs really did resign?
We need to abandon the NHS in order to save it and take control of our lives and workload. The BMA will be concerned about whether there will be enough work for all GPs in the private sector. If there is no NHS primary care service, the Government will be forced to keep some kind of primary care NHS service going.
Other issues like workforce planning also need to be considered. The Government’s agenda is to decrease pay by increasing GP numbers. There needs to some element of protectionism as there is in other countries. Limit GP training numbers to limit GP supply.
It’s time for radical changes as the current situation is untenable. But do grass-roots GPs and the BMA have the stomach for it? As I said, the BMA has to abandon the NHS in order to save it, and start looking after its members.
Dr Ahmed Nana, Leicester
I agree with the editor (‘If ever there was a time to fight…’). In response to the proposed contract change, we should boycott everything to do with commissioning, the CQC and revalidation – the lot. Only direct patient care should continue.
We may have got it wrong over pensions, but that could lull the Government into a false sense of complacency over further industrial action on this issue. As long as the punters can get in front of a doc, it won’t matter as much what the papers say either. I urge colleagues to go with the mandate, and hold their nerve this time – no stopping until they back down.
Dr Saj Afzar, Rochdale, Manchester
A simple form of action is for NHS (and perhaps all public sector) workers to take a pension ‘holiday’ for say six months, which I believe is allowed under our current schemes.
A small break would have negligible impact on the final value of pensions, employees would see an increase in take-home pay for the period of the ‘holiday’ and GPs would enjoy a bonus by keeping the element relating to their employers’ contribution too.
No patient would be inconvenienced and if our public sector colleagues did likewise, no pupil would be untaught, no benefit claim would be affected and no customs queues would develop.
However, the Treasury would be significantly inconvenienced.
Public sector pensioners receive their pensions from the contributions made by those still in work. The Government keeps any surplus. For the period of any pension ‘holiday’ pension payouts would still have to be funded, but from other sources.
I suspect this would be something the coalition can ill-afford, and it might encourage them to engage in discussions rather than issuing edicts
GPs happier than ever? Hardly
Dr Stephen Sutcliffe, Liverpool