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At the heart of general practice since 1960

Wanted: Candidates for thankless job

NICE comes over all Orwellian on statins and a GP job advert shows why health ministers should never miss a copy of Pulse, in this month’s Sick Notes column.

Pulse OCtober cartonn 3-Sicknotes-Online

‘I see GPs everywhere’

GP Dr Simon Ruffle made Sick Notes chuckle this month with his tongue-in-cheek job advert for general practice left in Pulse’s online comments section. It says: ‘Wanted: Graduate status candidates.’ So far so good.

‘Some 40-50 meetings a day, number to be decided by clientele. Wage non-negotiable depending on profit/expenses accounts with income set by Government and expenses by market forces.’ Hmm…

‘Additional hours non-negotiable. Quality and outcomes must be recorded. Regular personal inspection annually and five-yearly revalidation. Failure ends career.’ Sick Notes starts folding up its CV.

‘Business inspection annually and possibly by three different agencies. Personal/professional indemnity not provided, available for £7-8k.’ Covering letter now torn up and in the bin.

‘No holiday cover. Pension relief now 0%. Pension payment 23.5% of salary, rising to 29% soon. Package for seniority and experience not included. Lump sum pension now reduced, subject to further change without agreement. Retirement age to be changed at will by Government.

‘£100k+ will be quoted by agencies and media, but rarely received; no car, no personal expenses. Hours will match workload, are exempt from working time directive, but an error made through tiredness is not exempt from prosecution.

‘This attractive opportunity is usually filled by the top 5% of school achievers. Other careers are available.’

Sick Notes is going down the job centre in the morning.

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Perhaps  Dr Dan Poulter should have read this before he made a comment on GP recruitment. The Conservative health minister and former junior obstetrician presumably got overexcited after reading the first draft of the party manifesto.

‘Good news,’ he typed on Twitter. ‘1,050 more working and training GPs under this Government and more doctors choosing careers looking after patients as GPs.’

These figures may be true, but they are far from the real picture. Dr Poulter’s recent copies of Pulse must have got lost in the post, or he would know that health education leaders have witnessed the country’s worst GP training recruitment round in seven years. Or maybe he has missed the GPC paper saying gaps in the workforce are reaching ‘crisis point’, or the data that show practices in some areas waiting a year or more for a new partner. Sick Notes will post a few back issues of Pulse over to the Department of Health marked for Dr Poulter’s attention.

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OK, Now Sick Notes is confused. First, NICE publishes guidance recommending all those with a 10% or higher CV risk should be offered statins. GPs object, saying it will medicalise many more healthy people and that they don’t have the time.

Now the institute has told an influential group of MPs it does ‘not want millions more people taking statins’, despite slashing the risk threshold for prescription in half.

NICE chair Professor David Haslam told the House of Commons health committee GPs would not be compelled to prescribe the drug, saying it ‘remains a decision for patients’. OK, it is a guideline, not a tramline. That makes sense.

But then he went on to say that: ‘I do want to stress as well that NICE made it really clear that we are not saying we want millions more people taking statins.’

Made it clear? When? Why did NICE make that recommendation in the first place if it did not expect GPs to follow it? Or is this a very clever case of doublethink by the esteemed professor? Sick Notes needs a lie-down.

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Sick Notes often enjoys leafing through obscure policy and health economics journals of an afternoon. One paper this month will make many Conservative party members clutch at their pearls in horror. It found adopting a ‘simpler, less market-oriented’ health service could cut costs.

The study in the Health Affairs journal compared the US with Canada, England, Scotland, Wales, France, Germany and the Netherlands. It found administrative costs accounted for 25% and rising of total hospital expenditure in the US, which has the most highly marketised health service. Next came the Netherlands (20%) and England (16%), both of which it said were moving to ‘market-oriented payment systems’.

The lowest spending on admin was in Scotland and Canada ‘whose single-payer systems pay hospitals global operating budgets, with separate grants for capital’.

Now, there’s something to mention the next time anyone suggests Any Qualified Provider is a good idea.

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PR fail of the month: The consultant who typed ‘**INSERT TENUOUS ROYAL PREGANCY LINK HERE**’ in the subject line of a recent news release. Nice try, but we are still not going to cover your treatment for warts.

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Readers' comments (1)

  • Post Harold Shipman, PCTs have been given wide ranging strong powers not vetted by GMC,Medical Protection Societies, LMC and BMA and all professional bodies.This has led to their autocratic culture referred to by Prof David Hands and alluded to to in Prof Brian Jarmans Editorial(Both attached).Even Dr Tony Grewal medical Director of London LMC and my Medical Protection Society told me PCTs had supreme powers to destroy professionally the doctors.These powers have been abused leading to detriment in Public and patient care.

    The GMC expects a t doctor to pay £30 for train journey to Manchester despite his not being able to earn as a gP being on contigent removal by pCT for ten years; his physical ailment slipped disc and knee injury and to attend their IOP meetings.Yet In the past it has been known the IOP also in a vain way to protect the public, prevented by suspending the doctor from practicing and earning a living to be be able to make the journey.

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