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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)

  • 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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