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GPs buried under trusts' workload dump

It is time for the BMA to ballot GPs on mass resignation

We must bring back the spirit of 1966, before our workforce collapses under the strain argues Dr Una Coales

In 1966 the BMA was able to obtain undated letters of resignation from all 23,000 GPs, who threatened to go back to private practice. With this powerful negotiating tool, Prime Minister Harold Wilson and the Cabinet conceded to the BMA. The GP Charter was agreed upon, which became the Red Book, the basis of modern general practice.

However with a growing and demanding patient population and GP on calls 24/7, NHS GPs of the 1990s were getting desperate. In 2003 the GPC was mandated to negotiate a new contract. BMA allowed a ballot on the new GMS (nGMS) contract to be open to all GPs. The majority of GMS GPs were against the nGMS contract but were outvoted by GPs who would not be affected. However most did see a rise in income (though not matching PMS) and opted out of OOHs.

Since 2004, the pressure on GPs has increased exponentially. The loss of MPIG and QOF income, GP premise costs hike, reduction of GP partner drawings four years in a row, workload increases, consultation rates as high as 12 per patient per year (up from 3.5 in 2004), a consumer culture, increasingly onerous micromanagement (20 bodies or mechanisms whereby a GP or practice may be assessed, criticised and/or punished), withdrawal of occupational health support for GPs, pressure to deliver 7/7 8-8 extended access and dumping from secondary care, have all led GPs to emigrate, take voluntary early retirement, give up their partnerships, burn out, and suffer mental health crises.

The proportion of NHS funding spent on general practice has fallen to an all-time low. Practices in my area, London, are closing because of financial unviability. Alas, the profession is fragmented into sessionals, PMS and GMS GPs (unlike 1966).

A BMA ballot on mass resignation would be the opening salvo in a war. An overwhelming vote in favour would force the BMA and GPC into action.

Many GPs have begun to question whether the time is right to start charging for appointments. This needn’t bankrupt poor patients. If the NHS became fully privatised, the public may pay 100% without provision of state insurance for the poor and elderly. But many UK GPs have gone to work under the Australian system, which has a social insurance scheme the UK could copy.

Medicare reimburses 85% of the cost of a GP appointment and patients pay just 15% - that’s $36 from Medicare and $13 from the patient for a basic GP consultation. An overwhelming vote in favour of a system this like would convince DH that we have the stomach for a fight – otherwise we give them carte blanche to carry on decimating GP morale and workforce. 

I call upon the spirit of 1966 to return before it is too late. At over a million consultations a day, UK GPs have been flogged as cheap labour.

We are no longer doormats to risk our wellbeing and livelihood for £3/patient consultation, nor must patients suffer. Time to regain our self-respect before the job kills us and demand industrial action for a new contract, a 21st-century contract, one that allows GPs to transition into semiprivate GPs to treat both the poor and the wealthy side by side.

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

Readers' comments (66)

  • Hear, hear!! You go Una. Completely behind you on this one and much more. It is time that we as a profession put our money where our mouth is. For far too long its been moan, moan, moan, blah, blah, blah....BMA vote, lost resolution, then capitulate. This cycle has to be broken by real action backed by conviction. The survival of the profession demands it. In your article you highlight all the current changes adversely affecting our practice except for the issues of the pension robbery and seniority swindle. I would argue however that the most important reason for emergency action now is legacy. There is a generation of GPs currently in training who are seeing the future and deciding to opt out before they get sucked in; there are medical students in their masses who are discounting the prospect of even working as a GP; and there a teenagers who are beginning to think maybe medicine isn't for them at all. If nothing else we owe it to those potential GPs behind us and the patients they would otherwise be treating to fight our corner strongly before GPs disappear due to lack of fight, belief and fortitude.
    So good luck Una Coales, you having my full backing and support, and I hope that of many other like minded GPs and doctors who have had enough of the political skulduggery that is NHSE, DoH, CQC, NICE and SOS J Hunt.
    See you at the trenches.

    Disillusioned GP (1yr)

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  • Una Coales

    @2:13 good catch. Yes missed out highway pension robbery, seniority swindle and empty legacy. You are right. If we do nothing, we watch government starve out all NHS GP partnerships.

    Frontline troops cannot survive without funding, supplies, rest periods and to demand they fight 8-8, 7/7 against a continual and rising wave tide of consumerism, entitlement, growing population with EU floodgates wide open and global health tourism too...well how can 7,000 and dropping NHS GP partnerships survive coping with millions in WWIII on their own?

    Yes there is no legacy left when all NHS GP partnerships finally close their doors due to forced insolvency. Even now my youngest is resisting general practice despite her school matching her with general practice as a career.

    It means bright medical students who may have wanted to be GPs, are now being swayed against. Without new GPs, there is no future for the profession.

    No recruits and no legacy mean we watch the ashes of general practice disappear into the wind...as for institutions like the BMA and RCGP, membership may be severely affected if GP as a profession becomes extinct? Time to join forces and demand strike action or en masse resignation, nothing more, nothing less to save general practice!

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  • We are fighting for our livlihoods which the government is determined to steal and gift to their private medicine mates.

    Do you wish to be bankrupt despite working like a hamster ?

    They want to steal our families' assets and force us to work for peanuts for the likes of Bupa or Virgin.

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  • No Una,It will be a field day for the 'Likes of the Daily Mail' .we missed a huge opportunity of this nuclear option during the passage of the NHS bill of Lansley. General practice is at the brink of extinction,partly because of the policies of the successive governments and partly because of few of us doing the dirty work of the governments.

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  • Charging patients risks our alienating our patients, withdrawing en masse from the NHS contract leaves the Government with the headache of how to provide medical care.

    The only danger is that Virgin is waiting in the wings to set up in competition, especially with the boundary changes. This would take time for them to do so there
    would be the complete collapse of the hospital system as there would be no one to intercept the outpatient letters, act on them or act as gatekeepers. No Government would survive the chaos. Unfortunately there would be harm to patients.

    There is harm now due to the fall in care that we can give our patients because we are so under resourced that we cannot see our patients in a timely fashion.

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  • I think colleagues need to ask themselves two questions;

    The first is - Do they think primary care is viable?

    If they answer yes the second question is - How far are they willing to go to keep the NHS contract? will they sacrifice the profession, their T&Cs, their health, their family, and work for free to keep that contract?

    Realistically the answer to the first question is No - primary care is no longer financially viable. Even if there was the will to increase funding as the RCGP is suggesting it will only be a short term prop at best. If one accepts that the current model is not viable then there is a moral imperative to look into other options as Dr Coales is suggesting.

    Colleagues who fall back on 'we must think of the patients', 'its not fair on the poor', 'we are a rich nation' are all correct. Nobody wants to lose the NHS founding principles but what do you do when you accept that the current model will fail? - you have to face up to looking at the alternatives regardless of what the media or the public thinks.

    We need that honest debate on the future of primary care that Dr Una Coales has been brave enough to put forward whether you agree with her or not.

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  • I am surprised that how come most of us have not realised that this current model is no longer viable . Friends times have changed and so we wil have to change to. We either have some sort of co payment system or be ready to work for likes of Virgin ( by the way I have worked for them for last 5 years as part time so know very well how they work)
    We should give up this crap of what will happen to our patients . Do our patients really care what will happen to them or us ? Let's face the reality and accept that time has come to leave nhs unless there are some drastic changes which no politician would want for fear of losing votes ( at the end that's all they care for )

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  • Una Coales

    @10:25 if the BMA submitted unsigned resignation letters or OOHs boycott, general practice would come to a stand still for a week at most, before the PM and government caved in and gave us GPs fair pay and fair working conditions. That is why we have a trade union, to ensure doctors are not exploited, overworked, underpaid, robbed of their pension, bankrupted.

    If we do nothing, 99 surgeries will close in East London and the domino effect begins as 100,000 patients look for a GP practice elsewhere. How safe is it when a patient has to wait 2-3 weeks to see a NHS GP? What if the public knew they could pay £70 to see a private GP on the same day or next? What if we could provide a compromise, co payments as in Australia and Ireland?

    Hospital consultants need to be on our side as without GPs, secondary care is next to collapse. However this means they would then just fall back on their private practice. The problem is that not all parts of the UK can afford to provide private care as the population are mostly deprived. They will lose out.

    We must change to survive!

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  • Dr Coales, you say it like it is. I sincerely hope that your voice is heard loud and clear on the BMA Council. Having recently returned from working overseas I have been dismayed at how broken UK general practice is. The current situation is completely unsustainable as is well known by anyone working inside it. If as a society we want a 24/7 all bells and whistles 21st century health service then it needs to be paid for. The alternative is a pared-down NHS providing essential care supplemented by private care. But what you can't have is demand the former and pay for the latter. This debate needs to be blown right open into the public domain but currently there appears no political will for this to happen. If the only thing that prompts such a debate is mass resignation then so be it.

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  • Bob Hodges

    Well said Una

    At the very least this is a debate that need to be had, and had in the public domain.

    Without significant change, General Practice, and with it the NHS, has not a cat in Hell's chance of surviving the next 12 months.

    Of course, that might actually be the plan............

    Read Jonathan Reggler's paper 'The Guernsey Option' which was rejected by the GPC before nGMS. Then wonder why Dr Reggler now lives/works in Canada.

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  • Una Coales

    Thanks Robert and Bob. Sorry that should say undated signed letters of resignation. Yes we are all making a lot of noise and finally debating this. It does need to be taken to the public forum because the public need to know what happened when all NHS GP surgeries fold within a year and privatisation takes over.

    I still plan on queueing for the soapbox in a couple of weeks at the annual LMC conference in York. They'll have to drag me away, kicking and screaming. I get one whole minute to convince the conference that en masse resignation with 3 months notice to abide by NHS Eng rules or OOHs boycott (not in the contract) is needed to grind this machine to a halt and demand a better contract with fair pay and fair working conditions.

    Next is an emergency ARM BMA motion on the day in June in Harrogate. Don't hold your breath. I predict the agenda committee will attempt to block. Don't tell me why as you guys elected me to speak up for you!

    Keep bringing on the ideas. I am just doing what I am told by you. I took a long distance call from Brisbane earlier this week and listened as a former NHS GP regaled working life in Oz, at $200,000 a year and $400 a week rental for a 4 BR house, less tax, co payments and 20-30 minute GP appointments, it is very sweet.

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  • No other system is as cost-effective overall as the NHS. I don`t agree with the introduction of any form of co-payment as this will change the ethos of the NHS. Instead of talking to Australian doctors, you should talk to Australian patients. Primary care does need to attract a greater percentage of the overall funding and there is a huge opportunity for systems` improvement and better integration which can improve cost-effectiveness even more. But under no circumstances should we try to erode the spirit of the NHS which is free at the point of need-this is really special and unique and we should feel very proud about it.

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  • The BMA and GPC remain disciples of the NHS religion and I fear that they see you, Una, as Judas. As you imply they will block you, mock you and probably try to discredit you rather than listen to the membership.

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  • Took Early Retirement

    BMA = Betray My Associates.

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  • Una Coales

    @7:06 I know. However I have a mandate to represent my voters, to have doctors' backs and to make a lot of noise, so that when the last NHS GP partnership closes and the public look around and cannot find a GP surgery to register with and have to travel miles to the closest Virgin APMS, they will know we GPs of 2014 did try to warn the public, we did try to walk out of this doomed NHS GP contract, we did try to get the BMA to ballot its members on en masse resignation or OOHs boycott, we tried EVERYTHING to save both our profession and primary care for our patients.

    And when Virgin and other private providers are then handed permission to charge 100%, the public will clammer come back NHS GPs!!! We are more than happy to pay a £10 copayment to see our family GP or £100 to attend A&E, we can't afford these 100% private fees!

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  • GHOSTS OF GP PAST (found online at the Derby Gripe on-line newsletter circa 2007):

    "Patients will have to pay £16 a month for the right to see a general practitioner under plans being drawn up by the British Medical Association. The proposals amount to a wholesale privatisation of the GP service, with thousands of family doctors potentially leaving the NHS. The BMA's General Practitioners Committee is drawing up the plans as a result of grow ing frustration with intransigence from the Department of Health, which is trying to impose a new contract.

    GPs insist they are having to deal with far too many patients, with the average appointment time now down to seven minutes, and that their pay is too low. Morale among GPs is at rock bottom, with 86% voting to leave the NHS if negotiations over the new contract failed. The proposals, based on the system in Guernsey, are aimed at boosting recruitment, improving pay, increasing the amount of time they have with each patient, cutting paperwork and reducing interference from the Department of Health.

    Under the new system, adults would have to pay £16 a month in insurance to cover visits to a private GP, who would refer the patients to NHS hospitals or consultants if further treatment was needed. Insurance for children would cost £8 a month, and it would be free for those on low incomes. If they wanted, patients could choose 'pay as you go', paying for each appointment to the GP.

    The plans are being developed by a new BMA committee, the Special Advisory Group, which is looking at alternatives to the NHS. A draft report on the plans said, "There is a radical alternative to the UK method of providing general practitioner services which already exists within the British Isles. The Guernsey option would allow the General Practitioner Service to expand once again. The UK would no longer have the unhappiest GPs in Europe."

    Dr Jonathan Reggler, the member of the General Practitioners Committee who originally proposed the Guernsey option, said, "I've received very favourable support from colleagues. The majority of the General Practitioners Committee believes it is viable to run an alternative to the NHS system." The GPC is responsible for negotiating on behalf of GPs with government, and if it formally recommends the Guernsey system, it will be a critical blow to the government.

    It is certain that Alan Milburn, the Health Secretary, who has promised to keep all healthcare free, will refuse to co-operate with the new system, but doctors believe they may be able to force his hand. 'If a sufficient number of GPs in an area resign from the NHS, it will be impossible for health authorities to reallocate all their patients to other doctors. The Government will have to step in,' said Reggler."

    Disillusioned GP Partner (1yr)

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  • Una Coales

    Thank you Bob and @10:40. Wow the Guernsey option! We have been here before! Reggler went to Canada. Young GPs heading for Oz. Got another email today from a part time salaried female GP who is headed for Australia now that her psych consultant husband has secured a job there.

    Only this time, if the BMA do not act and ballot its members for OOHs boycott or mass resignation, then the entire NHS will collapse before everyone's eyes! Nurse shortage in the 1000s, A&E crisis, GP shortage, closures of GP surgeries...no turning back once the domino starts falling with the imminent closure of 99 GP surgery within the next few months.

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  • Una Coales

    Sorry for the typo, that's 99 GP surgeries.

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  • This Contract is not a Contract, as defined with IMPOSED in it. MPIG, Pensions et al tell us that the DOH just reneges on its agreements at will. Furthermore, here is the Minister stating that ' If you GPs do not accept this Contract on offer, I will impose a worse one' and he DID. That is BULLYING and we just lie back and take it. I have been in your shoes in the BMA, Una. It is so hard to get this lot to change their spots. Do you not hear them at the ARMs - 'Our NHS and we will accept anything to keep it '. Even 50% pay cuts, bankruptcies of it members imposed Contracts, bullying etc and not do anything. It is NOT our NHS. We only Contract to it. If the Contract is untenable as it has been for a few years, we have to resign.
    But, alas, we behave like spineless minnows that hide from the light.
    I will be supporting you at the ARM. Perhaps this time is right as practices face bankruptcy. Imagine seeing 40 + patients a day and still going bankrupt !!!! The system is ruptured. A new one is called for.

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  • It is about time GP's took action, I give them my full support!
    I am appalled at the way GP's are being treated, they spend years training to do their best for patients only to have to prove 'by ticking boxes' that is what they do.

    No other profession is hounded in the same way that GP's are, no other professional has to continually prove that can do their job in the way that GP's are, it feels as if there are too many megalomaniacs in power wanting to control every breath we take.
    Leave GP's to what they trained to do, care for the sick!

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  • Dr Mustapha Tahir

    Una I'm 100% with you on this. About time. Keep up the campaign for this please.

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  • Well said but said too late in my opinion. Reggler was prescient. The Profession have been 'led a merry dance' and now are at the edge of the dance floor as it were. We can strike/resign or continue with 'death by a thousand cuts', but waiting imminently to take the dance floor is the private sector. They have been given plenty of time by HMG to prepare, the legislation is all in place and we as a profession have no leverage. All we will end up doing is working as salaried for the enemy under even crappier sets of conditions than now. There is no money in the hard-working british people's pockets to pay privately so that's a dead option.
    The battle is lost and the enemy will take it's spoils. Any final twitches of resistance will receive the 'coup de grace' from HMG's mercenaries, the Fourth Estate....

    I recommend:-

    a) if you're contemplating medicine, qualify here (UK graduates are still high value goods) then clear off to anywhere but the UK!
    b) if you're early in your career, clear off to anywhere but the UK!
    c) if you're mid-career, mmm, sentiment too unpalatable to consider!
    d) if you're late career, take ARER and enjoy what's left of your life, but don't get ill and if you do,
    clear off to anywhere but the UK- to get Rx from all those UK trained graduates enjoying their careers!

    Sorry....

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  • That's a heartening post 10.50! I suppose it depends where you are- but a large proportion of patients could pay a fee to be seen. If they truly can't (are on benefits) then they can be seen for free. If they smoke or are obese they could give up 20 cigarettes worth or a visit to Mcdonalds that week to check in on their problem with their friendly realistic GP. A lot of the stuff I saw on my on call morning on Friday was utter rubbish- if they had to pay a fiver for that they may have decided to see how things went rather than "check before the weekend". They would have seen that actually things got better so positively reinforcing self-care for future illnesses. I appreciate there will be those who will stay away who are truly disadvantaged and this is the difficult group. The "I pay my taxes" or the " I fought in the war" group also - we can't just expect to get everything we want at the drop of a hat- this is not a fantasy movie. The social care system is struggling/hospitals are bursting and we end up scurrying around trying to keep a hundred plates spinning all at once! The British public need to sort themselves out. Look after your parents. They brought you into this world and you wipe your hands with them when they become dependant and expect the state and their "named GP/care coordinator" to rush out and quell their suffering/loneliness because you are too busy.
    The private companies won't have a chance at taking our patients - it costs too much they'll only be involved if they can make their defined profits- we 're just aiming to cover our increased costs and deficits imposed by the government and a select proportion of the public!
    GP partner year 2

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  • No Private Provider can see patients at £ 3.00 take home pay. There is also Health and safety, EWTD and sick and other leave. The NHS is cheap and cheaper. If we resign as we should , costs will rocket unfortunately.

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  • I don't really understand when people say 'the private sector is simply waiting in the wings to step in'...just who are they going to employ? Where is the 'army' of private sector Doctors just champing at the bit to take our place? Who and where are all these GPs??
    The truth is WE are the work force they would be trying to recruit. There are already private companies running GP practices, but they aren't any different from anywhere else..they recruit from the same pool - us. It's simple...don't work for them.

    I do suspect the out come of all of this is likly to be a concerted push by the government to rush in a privatised 'open market' ...but to be honest it's already happening.

    However WE are the work force and WE choose who we work for. In a market where demand for Drs can not match supply....prices rise....simple. I've read on other threads annoyance at the cost of locums - that just an example of a market in action. There aren't enough GPs. Bringing in private companies won't change that.

    We either do something bold now..or accept the fact that we stood by whilst general practice was gutted and did nothing. I for one stand firmly behind Una and if I get the chance I will vote for her proposal. Anything else is sticking your head I the sand. Anyone who proposing this be aware...when you finally pull your head out and take a look around, anyone with any courage who might have stood up and fought your corner will have already left.

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  • Well written Una. Completely agree with you. It is high time, we thought about such actions. It is interesting that we keep thinking about patients but even when I have pointed out to my patients, how overworked we are - they have never sympathised or said that the government needs to do something about this. We have to start working towards preserving our sanity.

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  • Una Coales

    @8:13 you are absolutely correct. How can GPs work to a government contract that may be changed at whim with 3 months notice? How can GP partners keep stressing out as to how to deliver a safe service when they are constant strain to adapt to a further detriment to the contract, what contract?

    At a time when NHS general practice is on its knees on the verge of collapse, the BMA should be much more vocal and demand drastic action of its members.

    I need a seconder for an emergency motion on the day of the ARM. If you and anyone else who will be there would like to second, third, fourth etc, please email me your name to unacoales@aol.com. In fact I am happy to start up a petition of names of grassroots GPs who want the BMA to take some much needed action to fight for fair pay and fair working conditions.

    We cannot stand by and watch patients we send in to hospital bounce back from A&E without a diagnosis, be sent back to be referred by the GP to a different department of the same hospital, have their operations cancelled repeatedly, etc.

    We must demand a change to the healthcare system. Semi private care will allow some form of government state medicare/medicaid to pay for the poor/elderly and for copayments/PMIs/self pay to keep GP surgeries solvent. We must recognise that there is a massive GP/A&E doctor shortage in the UK. For safe medicine, patients need a safe ratio of patients to GP. I can't fathom a surgery in Essex in which 8,000 patients lives and wellbeing are all dependent on one single GP! Or the amount of strain he or she must be under personally.

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  • Una Coales

    We all know. We know that it is unsafe to make pts wait 2-3 weeks for an appt especially if it is one for a DVT, cellulitis, pneumonia, perforated viscus, etc. Is it safe to rely on the lay pt historian on the phone who is battling with a receptionist to make an appt?

    In 1990 as a US med student I sat in on a Charing and Westminster NHS hospital outpatient clinic and heard a consultant explain the long waiting list for a triple bypass to a middle aged Indian man. His face was long and sad. He and the consultant knew he would die before his life saving op because of the rationing NHS wait list. And when the pt had left, the consultant turned to me sitting as an observer from the US and shared that the pt would probably die before he ever got his op.

    We all know that patients could have better care. We all know that underfunding and skeleton staff are putting patients at risk of harm. We all took the Hippocratic Oath. We all have a conscience and moral and ethical desire to protect our patients and our colleagues wellbeing.

    A healthcare system that is imposed on our patients that may risk their lives needs to be fundamentally changed. It is time to make that change, to transition into semiprivate healthcare so that no patient is denied safe and timely care.

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  • At long last we have a voice expressing our feelings. We don't need to add to these comments about the state of general practice. We are 100% behind you. Just let us know when to send our letters to you. Dr Justin Hammond and Elizabeth Sinclair.

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  • Dear Una

    Perhaps you should also collect names and email addresses of GPs who have given up BMA membership due to its lack of willingness to listen to its members or act on their behalf.

    We are all behind you...

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  • http://www.bbc.co.uk/news/uk-politics-27377978
    Hmmmm, I wonder how that will be achieved with 100million.. Politicians stop making soundbites , calculated on the back of a fag packet.

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  • Lets face it when it comes to health care politicians don't have a clue!!! Whatever party they come from. Time to take control. Mass resignation is the way forward.

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  • Una Coales

    Thank you Justin and Elizabeth. List started to bring with me to both the LMC conf and BMA ARM. Already been told to do nothing and wait to sit in an induction meeting in September. Not that I ever do as I am told as my mandate comes directly from the membership!

    @5:21 happy to also start a second list to bring to BMA House June 17 eve meeting on interactive engagement with its members, to identify the needs of its members. Email me your reasons for resigning BMA, name and reason.

    @BBC news announcement of Ed Milliband's call for 48h access to GPs. C5 news rang me and borrowed my lines for their reporter outside Parliament, too few GPs, overworked, etc. I couldn't get to Monument in 15 mins to say on tv Ed is guilty of blatant electioneering! He must be in lullaby land if he thinks there are enough GPs to offer 60 million people unlimited GP appointments in 48 hours for £3/appt.

    I shall quote MetroIndia headlines 'there is a strong drive to create instability in the NHS.'

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  • Is this Dr Coales's personal bulletin board? Another self publicist, medico- politico.

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  • Una Coales

    @5:21 I have found a reason to stay in the BMA! They now offer 24/7 BMA counselling service for GPs! Put this on your speed dial 0845 920 0169 and be put through to a counsellor immediately for a 30 minute phone session and you may book weekly sessions too or just call back daily for more counselling! This in itself may be well worth the £443 annual sub fee. There is no limit to you calling night or day whenever you feel stressed, overworked, depressed, low, etc.

    At a time when the NHS is no longer offering occupational health for GPs, the BMA has bought a 24/7 counselling service package for its members! Well done!

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  • Una Coales

    @8:11 pm how may you contribute to help the wellbeing of our fellow GPs? We are all in this 'system' together until we work out our own exit strategy. My own exit is fast approaching.

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  • Took Early Retirement

    Er... one small correction. I never took a Hippocratic oath. However, as to the rest, I agree 101% of course.

    I do love the idea of a OOH boycott, as it could be done by an unofficial e-mail campaign, and thus not attract anti-trade union legislation action, one assumes.

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  • 100% agreed with Una. I am sure BMA politicians and national politicians will be your obstacles to achieve y/our goals. In order to overcome the former why don't we say to members to cancel BMA membership (if they are not willing) and form a new trade union who can bite and fight for their members, i bet most of our BMA leaders have only few years before they retire and they simply don't care ! some of them are worse then Eds/ Cameron!

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  • Totally agreed. 110% behind you Una!

    I think the NHS is great, but actually ....clinically excellence free at the point of use, for everything, with patient choice is ridiculously unaffordable! It can only be paid for at the expense of a budget deficit, high taxes, or free labour! We know which direction the Government is going.

    And patients actually don't respect the NHS. Patients taking valuable appointments with trivial complaints, calling the ambulance instead of taking the taxi to A&E, insisting on unnecessary antibiotics, demanding inappropriate home visits, dismissing the advice of a "generalist".Common examples of patients not respecting the health care they have, but using it as a cheap commodity.

    So I think my point is this: Lets stop thinking of the "free at the point of use" NHS as the untouchable Holy Grail for which we sacrifice everything including ourselves for.

    And lets really focus on providing patients "Excellent NHS Primary Care" and we can only do this if it is appropriately funded and resourced with GPs - which does not have to be free at the point of use service, but ideally affordable to all.

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  • Una, please could you put up details of where to sign the list you've mentioned to take to the ARM etc. Having just heard Millbands 'pledge' to further decimate GP with his 48hrs pledge I have truly lost all hope of any political party to think or act sensibly with any logic about finding a solution to the current problems facing the NHS and especially primary care. You need to set a timeframe, if the BMA does not act in the way grassroots are imploring them too, then serious consideration to forming a GP union needs to be on the cards. Do not wait for them to play you, as I'm sure many of the dinosaurs (and probably some of the handpicked young bucks) within the organisation are planning to do.
    As a light aside, the closest contemporary comparison I can think to your current situation Una is Games of Thrones. It will be brutal, it will be harsh, there will be deception, there will be losses but if you remain strong and think tactically, Daenerys Targaryen Coales, you will reclaim your rightful position at Kings landing (aka Tavistock square) and Westeros (30 Euston Square) as rightful heir and ruler. So too you I say, we follow you, mother of dragons, claim your crown!!

    Disillusioned GP Partner (1yr)

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  • Keep it up Una.
    Forget the troll @ 8.11pm.
    I'm registering with the Canadian exams at present and if things don't improve sharpish I'm off.

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  • I am a practice manager.
    Can't you GPs understand that this chaos is what the government, DoH and NHS England want? They are not going to listen to you. your actions, protests and potential mass resignation are pointless. The intention, as publicly stated by them, is to deal with just 2 or 3 contractors (e.g. United Healthcare, Virgin, Boots) and not approx 10,000 practices as at present. These current conditions are to force you to either sell out your practice to one of the big firms, or try to go private and they can label you as greedy GPs. Telling Hunt or Cameron that GP land is collapsing does not make them want to fix it, it confirms their plan is working. No wonder JH is always grinning.
    I have seen the future, with the NHS dentist in my town. East European dentists and hygienists no doubt on lower wage expectations than UK dentists, jobbing through, rarely if never get to see same dentist or hygienist twice because of staff turnover, and decisions made by remote managers at some corporate HQ. You can't ever get face to face with the people making the decisions as you can with GPs at the moment. That is how patient care in GP land is going to end up, no continuity, no ability to see the person making the decisions etc. Costs will be far higher as Virgin etc won't do all the little extras that practices do for free, they will demand extortionate fees for each extra little audit or data provision and so on, and they will get it because they can threaten to walk out of the contract. Thus patients will really suffer and they will pay more for it. You could and should mobilise the public on that basis because that will hurt Cameron and Milliband. But bleating that the system is close to collapse tells them their policy is working.

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  • Another major problem that you face is that the BMA is a political lobbying organisation, not a doctors' union. The GPC overwhelmingly acts as if it's political ideological belief in the "free at the point of abuse" NHS is what the GPC exists to protect, instead of protecting its members' interests. As long as the majority of GPC senior staff believe in their politics more than anything, they will always put the free NHS system ahead of GPs.

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  • Una Coales

    @10:43 the mass resignation ballot is a bargaining tool. If we do nothing, we watch our NHS GP surgeries go bankrupt. I agree I see the BIG private giants taking over and subjecting our GPs to salaried workerbee status and it will be a case of profits over pts.

    The ballot will grind the system to a halt long enough for the public to listen to GPs and ask questions of government. Then can we offer semiprivate healthcare and keep our UK GPs who are leaving in droves! It is the only viable option against 100% privatisation.

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  • Una, the Govt knows that GPs will not risk losing their income for even a few days, so mass resignation is a bluff, and if you try that they will call your bluff with the big firms ready to step in. As usual the GPC will be completely out-smarted and out-manoeuvred by the government publicity machine, and GPs made to look the villains. Then GPs will really regret it with many not getting jobs with the new firms, (far more nurse triaging as its cheaper etc etc) and those that do getting much less pay. I appreciate that many are now struggling, but plenty GPs are still making 6 figure or nearly 6 figure profits. When a few big firms take over, GPs will be paid £60-£70k, no final salary pension, your supervisor will get daily computer reports of how long you took on each consultation and you will be given performance interviews every Friday morning and told to speed up or consider your position and be "managed out" as they put it. Your job will be gladly filled by a GP from a different land and a different ethic who thinks £60k is terrific and happily pushes patients out the door every 10 minutes regardless.
    You need to get a critical mass of surgeries in an area to simply go private, so that patients can't all just load onto the ones that don't. Making threats to govt just gets their backs up and gives them time to call their chums in the big firms to get ready. Once again you are playing into their hands, this is what bothpolitical parties, the DoH, the NHSE want you to do.

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  • To Practice Manager 3:38pm, I was just wondering why you think both parties are united on this idea? Not often that they have shared vision - do you think Labour would go down same route as Tory for General Practice and why?

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  • Because the move to force GP into the hands of a few big businesses was started under Labour. They started the involvement of supermarkets. Virgin was already taking over some practices and was poised to make a bigger move into GP when the credit crunch happened in 2008. Virgin made a public announcement that they were scaling back their proposals to open health centres, due to the economic uncertainty at the time. That was all under Labour. Which party doesn't matter, they are all politicians and politicians resent GPs independence, and the people in DoH and NHSE who want rid of independent GPs don't change.

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  • Took Early Retirement

    3.38- the big firms are just not ready- nor do they have the doctors- we do!

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  • The depressing reality is the only rational thing to do is to quit being a GP. Change is coming and there's nothing we can do about it.

    I agree with much of what 'Practice Manager 10:43am' has said but I think the idea that we can somehow mobilise the public and stop it happening is completely naive ...take a brief look at the positions of both major parties and the mainstream media, it's all been stitched up...we haven't a hope in hell.

    In the future you won't know your GP, you'll see a different person each time you visit - it most likely won't be a Dr in fact but a knowledgable and experienced nurse. When you do see a GP Dr you're likely to feel frustrated because they'll be working to fairly strict direction and they won't have much control or say over what they are allowed to offer - this will be set primarily to ensure maximum return for the shareholders in the business that owns the company running the surgery. You'll probably be able to upgrade to 'premium' though if you've got the cash.

    When you're dying and the hospital has given up on you, let's hope they haven't destroyed district nursing too...because your Dr won't know you..because the shareholders won't see profit in it. Thank God for nurses that's all I can say.

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  • 15.38 Mass resignation from GMS does not mean we all down tools and earn nothing. Before an exit strategy is considered we should work up a number of transition plans to a mixed health economy. Such plans might involve the big firms so long as appropriate terms are agreed but the private sector does not have the capability to replace the partnerships within a few months and I doubt enough GPs would sign up with them anyway. Virgin et al have struggled to profit from primary care because they have a much larger cost base and it still takes a long time to build a PFI health centre. Trying to replace us with 'practitioners' has been tried in the NHS for years with rather dubious success rates. Fundamentally there is a shortage of GPs so the power of market forces is on our side.

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