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General practice: do you buy it?

Dr David Turner writes

There are some things it is hard to imagine would take off if they didn’t already exist.

Take the car for example. Imagine there was no such thing as the private car and then somebody developed one and wanted to market it to the public today: “This metal box on wheels will cost you many thousands of pounds and will start to depreciate from the minute you drive it out of the showroom. It will then cost you about a month’s salary every year to tax, insure, fuel and maintain.

“After all of this, you will be able to sit in your polluting box and move through the centre of cities at walking pace, breathing in the fumes of the box in front of you.”

I think even Saatchi & Saatchi might have their work cut out selling that to Joe Public.

Similarly general practice, in its current form, would be a hard sell if it did not already exist: “Now, Doctor, would you like to use your own money to set up a business with some other doctors you barely know? You will have to sort out some premises for which we will reimburse your rent as we see fit. You will have to employ and pay your own staff out of your own pocket and your income will be reducing year on year.

“The person who decides what we pay you and how you are to run your surgery will have no medical qualifications of any sort and will never have worked a single day in a health care environment. Nevertheless they will be able to change the rules about how you must work, whenever they feel like it and without consulting you.”

Why is there a recruitment problem in general practice, I wonder?

There is hope though. While the NHS is being sold off bit by bit to the private sector as we speak, it still seems to me that the current model of general practice can’t be very attractive to some slick, aggressive, profit-hungry American-owned outfit looking to gobble up chunks of the health service.

What’s more, I glance out into our waiting room I see the full range of humanity seated there. Every variety of the unwashed, lice-ridden, eczematous, obese and boil-covered sit in our surgery cross-infecting each other every day.

But this makes me smile: I can’t see any of them fitting on a corporate spreadsheet either.

Dr David Turner is a GP in west London

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Readers' comments (8)

  • The corporates won't buy what we currently have. They will sanitise it and do it all remotely until we go bust.

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  • The sad thing is that if we were able to offer co-payments and keep our current crumbs of funding we could offer a fantastic service, even in poor areas.

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  • So perhaps you should just be an employee of the NHS and stop all this "independent practitioner" stuff as you clearly don't like the logical consequences?

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  • Or perhaps be a NHS manager who gets paid more, accomplishes f*ckall, and are a leach on resources better spent on frontline workers.

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  • I believe British General Practice, done well, is the best job in medicine. It combines all the problem solving intricacies with long term relationships and the job satisfaction can be fantastic. I was visiting a care home and introduced myself and was kissed on both cheeks by the matron because 10 years previously I had saved her son's life by spotting his AML behind his presenting toothache. It allows me to treat patients without being concerned about my income as I am paid a capitated amount and so only see people because I need to not because they are paying me. The business model is all wrong to attract anyone into primary care. The risks are great compared to salaried in hospital. Personal indemnity rather than Crown, buying into the business where someone else controls the payment mechanisms and has an almost perverse rational for changing it to save money in another part of the system and expect GP's just to absorb it. A pension scheme where I have to pay the employer and employee contribution at a rate determined elsewhere and an increasing demand for services that are not funded. Vilification in the press for missing a cancer diagnosis when only 1/1000 consultations may be a cancer and then MP's joining the band wagon saying it is to reduce costs as we have control of all the money! If only! The independent contractor status allows for challenge and refusal to blindly follow any central dictat, or try and fulfil political promises to get a gong!
    The role of the GP is so fundamental in society as the focal point of all health and social care. With the fall in students applying to medicine as a career and even fewer applying to be GP's the country will miss the corner stone of the NHS when it has withered due to neglect.

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  • What is the value of a doctor? In Ni, profit per patient year is £60. Factor in 6-7 consultations, paperwork, deductions for tax etc - take home pay per consult is £ 2.50.
    No private company will ever do this. But, when we do go private, because there will be no one left at current market rates, the charges will triple.
    In Dublin, it is £ 50 per patient. 3 sick children, it is £150 plus £ 50 for medication, a new patient tells me.

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  • I remember working for a PCT practice in Bradford 2700 patients which was well run and it was taken over by a much more bigger NHS practice. This same bigger practice also "won" the tender for another practice of 4000 patients but turned it down. The reason it turned down this practice was the patient demographic and the need of at least two languages. The point is the good practices will be snapped up and the so called bad practices left for the rest. The irony is the the better practice when I started was not so good due to a lack of a regular doctor which suddenly became a very good practice once there was continuity of me being there for 16 months. The government should take note that one of the cornerstones of GP is continuity which will be lost once you get profit.driven private providers in who will offer a basic service.

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  • Good general practice (most of it is good) saves the NHS a fortune. Because of lack of funding it is creaking at the moment. The corporates would provide worse care for more money which would be worse for the NHS and the country. Common sense suggests put extra resources into general practice.

    The motivation for increased private involvement is probably a result of lobbying and common sense won't apply.

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