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At the heart of general practice since 1960

We have a year to save general practice

The whole of the NHS will be affected if drastic action is not taken to protect GPs before 2015, predicts Dr Peter Holden

The combination of Government pay policy and spiralling workload has left GP morale at rock bottom.

Some 60% of GPs are considering early retirement and 40% would actively discourage relatives from joining the profession. This rot must be stopped, and before it becomes terminal.

I predict if nothing is done, within three months we will see the first practice bankruptcies, and by the autumn it will become nigh on impossible to secure a GP locum cover for holidays or study leave placing the public at risk from exhausted doctors.

In early 2015, routine waits for a GP appointment will exceed three weeks and winter pressures may push this out further. Partners will be forced to reduce drawings yet again but, by then, GP practices will be no longer financially or operationally able to pick up the workload dumped on them by hospitals.

In 12 months’ time outpatient waiting lists will mushroom as unresourced work is handed back to secondary care. Bed-blocking will reach a critical point over the winter seizing up the hospitals completely.

By the time the next contract comes out, I suspect 5-10,000 GPs will seek early retirement unless there is radical change.

This nightmare scenario can be avoided, but only if the Government and others take immediate action.

Firstly, ministers and NHS England need to have an honest conversation with the public so that it understands that basic general practice services at £70 to £75 per patient a year are economically unsustainable.

Patient expectations have been stoked up by politicians to demand of choice of appointment time, extended hours and a seven-day service, 12 hours a day. If I truly operated a small business then there are 71 patients who are a complete financial loss to my practice and from a commercial perspective ought to be delisted immediately, but because I am a good doctor, I don’t.

Next, the Government needs to fully reimburse legitimate GP practice expenses and prevent unfunded activity landing in GP’s laps. Some GPs have had no take-home pay for several months and practices have been serially starved of funding for expenses inflation since 2004. General practice has consistently delivered more with less, and become a victim of its own success.

If NHS England had more imagination, MPIG could be bought out for £235m, pending an urgent rapid thorough root and branch review of general practice financing. The DDRB would be told not be allowed to pursue its current non-policy on practice expenses and to make an emergency determination before Christmas.

Lastly, we must staunch the haemorrhage of GP retirement and encourage greater participation rates amongst qualified GPs. Some 28% of GPs are over 58 and the time bomb is ticking.

Deaneries must modify their policies requiring UK-trained GPs to undergo a year’s unpaid retraining to re-enter general practice after as little as two years out of the UK.

The Government briefs against us in the media, and so nobody wants to become a GP any longer. Ministers must stop deliberately allowing confusion of turnover with profit and blaming everything on an ‘overgenerous’ 2004 contract - conveniently forgetting that it was a 14-year corrective pay deal endorsed by the DDRB, in return for doing a 52.5 hour week.

But GPs are guilty, too. Doctors have abrogated their leadership and managerial roles. We no longer teach medico-legal affairs, finance or management skills during GP training as we did 25 years ago, and too many colleagues do not understand the responsibilities of a liberal self-governing profession, let alone running their practice. This also has to change.

We have just a few months to save general practice and thus the NHS from implosion. We must act now.

Dr Peter Holden is a Matlock GP and a member of the GPC for 33 years. The views are his own.

Readers' comments (100)

  • Well said, whole hardheartedly agree with respect to training issues. Part of the obsession with communication skills has been at the cost of business and clinical knowledge sets.

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  • John Glasspool

    Hmmm... GPC member for 33 years? Well Peter, this has all happened on your watch then, and you and GPC bear most of the responsibility. The BMA should have started industrial action long before now.

    Please don't talk about morale being low. HMG love that. They know that most people won't fight in those circumstances. No one cares about GP morale unless it results in people like Jill and I leaving early.

    Our morale is fine!

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  • Yes, every cloud has a silver lining. I am only 49 but I am making plans to leave General Practice early. The possibilities of what I can do are endless. I may have a lot less money but at least I won't have the unbearable burden of trying to make things work in a thankless NHS.

    I feel much happier now that I have made my decision. If people like me are leaving then who will be left ?

    Those younger than me can emigrate, those older can take early retirement. If my age group is choosing to do anything BUT the NHS then you have a huge problem in the offing.

    Better be quick if you want to change our minds, before we become too rusty ever to get through the ridiculous hoops to rejoin.

    I cannot think of much they could do now. i think they have left it too late. After all who would trust them now?

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  • well said

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  • Well done to successive governments. A big pat on the back deserved for all concerned. Keep up the good work. Keep letting more and more people into the uk, don't build any more hospitals or gp surgeries and flog an ever reducing number of gp's to the point of near exhaustion. Very well done! I do love the nhs!

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  • Peter, here in NI profit is £ 60 per patient. The Govt claws back £ 30 in various forms.
    We have slightly more than 6 consultations on average per patient year. That is £ 5.00 per consultation. Factor in the ever burgeoning and mostly completely useless form filling and tick boxes at 40 %, you are left with a profit of £ 3.00 per consultation.
    All the A* at GCSE and A levels and the years of training and the threat of litigation for £ 3.00.
    Do you really wish people to become GPs for this sum. No matter how much we may like the NHS and no matter how altruistic we may be, there is a point at which it becomes untenable.
    GPs going bankrupt seeing 40+ patients a day. Well, Peter, whose fault is that?
    If. like the musketeers, one for all and all for one, we should all resign from the NHS, rather than see our hard working colleagues go under.
    £ 8.00 per consultation take home [ including paperwork] is the minimum. Otherwise, follow the dentists. They have shown us how.

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  • The GPC has to ask itself this question - if a GP sees 40 + patients a day and still goes bankrupt because of the DOH going back on its promises, whose fault or problem is it ? Does the GPC have a duty of care to its members ? Or it sufficient to wring hands and say ' Oh dear, the DOH has all the aces'
    We had a guy checking our medical equipment for 5 hours the other day. His bill was £ 900!! when are we going to stand up as a profession and say enough is enough? When is the GPC going to ballot re resignation from the NHS.
    Pensions, MPIG, seniority are just some issues.
    GPs going bankrupt is because the GPC is bankrupt re ideas.

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  • Too late !

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  • OK Gloves Off

    Where were you lot on 21 June 2012?

    You cannot subcontract sanctions to the GPC YOU have to be prepared to take them and the law does not allow me to tell you what when where how

    YOU need to learn to say no just like I have and mean it

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  • You lot need to know that GPC cannot ballot independent Contractors f r sanctions and NOR can the BMA YOU have to learn to be business men. We can give you the tool but YOU have to use them

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