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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)

  • 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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