David Starkey was on Question Time last night. He was offensive, and took apparent pride in it. He was opinionated, which is fine, but was stupid with it, which is not. And he was also just plain wrong the vast majority of the time.
Nowhere was this more apparent than when he discussed NHS GPs. His claim was GPs now work 9 to 5 for more than £100,000 a year and do not give a damn about their patients. No one really challenged him, least of all the Lib Dem's Jo Swinson or John Redwood from the Tories, because both have to believe this true if they think GPs can now manage the NHS.
And he's wrong. This is something I know about. I am married to a part time, 3 day a week, GP. I, of course, think my wife is special, but actually her work rate seems similar to that of the many GPs I know.
The day starts early even when not in to do the 7am surgery. She and her colleagues are in before 8. They take over from the night service at 8. That's the first Starkey myth shattered. Surgery start times vary - as does patient demand. Many will be seeing patients by 8.30.
They'll see more than 30 patients each in surgery a day. The doctor on call - seeing emergencies - will often see many more.
My wife's practice covers a number of large old people's homes. Some have 100 beds. Most require what are in effect ward rounds several days a week. Starkey does not see that, or realise that this is work GPs now do instead of hospitals. And there may be four home visits a doctor each a day as well. They have responsibility for all calls for home visits until 6.30 when the night service takes over. The last home visit is often well after 7 as a result, and often on the way home - which is frequently not until after 8. Another Starkey myth shattered.
And then during the day there are referrals to write, transfer of patients into hospital to negotiate, test results to check and follow ups to arrange. And there are repeat prescriptions to do. Starkey moaned it takes 2 days to get one. Yes, for good reason. He may well, given his age and likely blood pressure, be on many drugs. A repeat prescription is not a matter of printing and signing: it may involve a medication review, a check that the patient does not need to be called in, a reflection on whether the mix of drugs needs to be changed, and usually a vist to the notes and an entry needing to be made. Oh yes: GPs need to document all they do on the way as well, in detail. Perhaps he'd like all that foregone so he can get a repeat printed in a couple of minutes.He wouldn't be happy with the risk he'd take though. Repeats can take well over an hour, every day.
And yes, there's risk. Starkey doesn't lie awake at night wondering if the patient is all right. He doesn't call in in the morning to check people he saw yesterday are still alive, having lost most of the night wondering what the diagnosis is, and having read late into the night to understand the complex co-morbidities they have presented. Because, unlike Starkey's view of the world, medicine is complicated and uncertain, and there's no time for that reading in the day.
After that there are also people to manage in the practice. And management decisions to be made. And the rest of the NHS to deal with. And sometimes colleagues are on holiday and it gets tougher.
But he'd like GPs to be on night duty as well. So they do 12 or thirteen hours a day, as is normal, and then stay up all night on call and then do 12 or thirteen hours the next day. That's simply not safe. It's not even possible. But Starkey wants it anyway.
Now yes, I agree GPs are well paid. But they're also human beings: often now working at the limits of what is humanly possible. That's why they're well paid. And pay was increased because people would no longer do the job. That, by the way, is happening again right now.
Starkey made his comment without appraising himself of any of this, In that sense his comment was like his history, evidence light or even evidence free. But it's his type of soundbite that is destroying the NHS.
And The Tories and Lib Dems believe all this - because they think GPs can also run the NHS between all this. Or rather they either think this and are wrong or know this and are setting GPs up to fail so the private sector can be invited in.
Either way, Starkey showed himself to be a nasty, stupid and utterly ill informed man.
The trouble is, Starkey's thinking is the basis for Tory NHS policy. And that's really worrying.
PS I'm talking about the NHS in King's Lynn Town Hall at 7 tonight and tomorrow at the Forum, Norwich, 11 am.
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Beautifully put, Richard. I’ve posted on FaceBook.
My girlfriend is a nurse and was spitting feathers at this. It’s a similar perception that people have of teachers, where they think it is 9 until 3.30 with long holiday, forgetting all about the planning, paperwork, marking, reporting, running clubs and societies, meetings, training etc.
A very blinkered mindset.
And France was a bad example of liberation?? For a historian he has a remarkable ability to select the least apposite examples to illustrate even his half way decent points.
So how much does your wife earn? It sounds like it should be a lot.
She’s a two thirds GP
David Starkey says full time GPs earn £100k
You can work it out
So what?
My wife is paid. Is that a problem for you?
And before you say it – of course that means my household has above average income. I have never denied it. Indeed, I’ve always been quote open about such things, including what my wife does
My fiancee is a newly qualified GP (as of yesterday). On top of paying back the money she had to borrow to get her qualification in the first place (pretty much double the minimum deposit for an average house), she now finds herself having to find GMC fees of roughly 5 grand, after tax; realistically 8 grand off her salary, just to work legally. Plus she has no savings from paying back fees to pay it up front, so she’ll likely have to borrow that or pay it on drip (with interest).
That is, of course, assuming she can even find a job.
Glib comments about GPs salaries make me wall-punchingly angry.
Paul
Tax relief is available on GMNC fees!
Good luck to her finding a job
Read the BMJ!
Of course it’s not a problem. I know a couple of GP’s and whilst they earn over £100K I don’t have a problem with that at all as they are good GP’s who have a genuine interest in the health of their patients.
However I would suggest that not all GP’s are as dedicated as your wife (or my friends) and perhaps those GP’s do not deserve to be so handsomely remunerated. Which is the same in many walks of life.
i wouldnt worry about it – that guy came across as completely unconnected to reality
although given other posts on this blog which are connected, is a GP really “worth” £100k a year?
Yes
I am not sure why David Starkey, once labelled the rudest man in Britain, is given air time on any subject other than historical analysis. I did not see the programme, actually I do not bother to record it because I feel that it is formulaic and not grounded in evidence. I attended a presentation in Cambridge by Guy Standing on his book about the precariat – a much more interesting discussion. It is unfortunate that Starkey lives in Norfolk and is frequently at the Kings Lynn Festival.
David Starkey shouldn’t be given time on historical analysis either. Another historian only interested in the glamour of the monarchy and the international court – the ruling class rather than the social history of the common peasants.
Precisely
Bingo. A forelock tugger hiding behind a brash exterior.
What I don’t understand is if GPs are so profligate and do not offer patients what they want or need, (yes I did notice the nodding heads of LibDem and Conservative MPs) then why are they the very people to all of a sudden be in control of the entire budget so they can do what they like and claim even bigger rewards? After all if we are spending too much in the NHS now who are the people giving access to it – it isn’t the managers (bureaucrats) they are supporting the demand created by GPs!
Or is this the LibDems and Conservatives already in blaming mode for the privatisation of the NHS. They cannot wait for the GP pushing this forward to reap the rewards so they can tear them down and invite the private sector in.
Maybe the GP backlash on the Bill is because they relaise that if they look betond the end of their wallet chain they see that it is them that the government really wants to open competition up to, like the french system where they ‘are paid half as much and are open 24hrs a day’. The most money to be saved int he NHS (bearing the amount needed to be saved is way more then the total wages of every manager in the NHS) is the profits, pension, working times of the GPs!
It did not take the Conservatives long to turn from saying GP’s of the saviours of the NHS to then attack their Union and working practices. In fact lansley seems to be doing it vertually in the same sentance in every interview!
GPs have the highest confidence rating of any professional group in the UK
Starkey picked the wrong target
Again
Indded he did. It comes to something when a footballer makes someone of such a high opinion of themselves, look so ill educated. He then had the audacity to say he spoke of GP’s to answer the question which was nothing about GP it was just the group he wanted to attack for being overly profligate.
If he thinks they do such a bad job why was he supporting them being the ones in charge of the entire budget?
Your wife loved the bit about women dealing with heart not head too, I know he is a historian but to live in such a timewarp is truly staggering!
I’m more concerned however at the self satidfied nodding of those on his side of the panel?
I pitied the Labour candidate who just sat there looking so bemused that a large part of the audience was supporting a bill that puts power in the hands of the people they were baited into loathing. (Mind you I don’t pity her too much after all the Labour Party did start the whole process of privatisation – it’s a pity now that a large majority of that which they did has been discredited even in Nick Cleggs letter the current government want ot expand and deregulate).
I sense someone, preparing to take on a union in pension negotiations, readying themselves for battle?
Because they cannot do medicine and money at the same time.
So it is either a 24 hour day, 10 day week, or give the money work to those who do money work.
Which, when you think about it, is what they are supposed to do.
The work will go to the likes of capita et-al.
And what happens to patient data, that ever-so-valuable data that the drug companies are just itching to get hold of ?
He has no concept of what we (GPs) do. To start, getting into med school is an achievement in itself. Then 5 years unpaid training, (minimum) 5 years post-grad (usually more) with long hours, hard work and high pressure with huge consequences.
That 9 to 5 – actually can be 8-8 – (plus meetings, study at home) and a non-stop responsibility to the care of our patients. They come first and foremost in our thoughts and deeds, regardless of what Starkey maintains. We are a vocation, not a job. Rant over.
And if we are better paid than others, I make no apology, we work damn hard for it (although from experience his numbers are wrong and don’t consider professional fees, indemnity, courses etc)
i have no beef with healthcare professionals in this country who do a fantastic job, but “And if we are better paid than others, I make no apology, we work damn hard for it” that quote unfortunatly could probably be used by any high paid person.
Respectfully, I disagree
It’s a lot tougher being a GP than partner in the Big 4
I understand your viewpoint, but have to disagree with the implication that we are greedy/overpaid. We are well rewarded for what we do and I feel the nature of the job justifies that.
Personally, I wanted to be a doctor since I was small and money doesn’t drive me. If I knew I would earn less I would work all the same. Besides, compared to (for example) city finance managers or politicians (bearing in mind expenses paid for rather than taken from earnings and lack of necessary qualification period) we are not THAT highly paid. It suits a divide and rule agenda (some feel the government has this) to label doctors as greedy.
You are right
“that quote unfortunatly could probably be used by any high paid person.”
Even footballers????
Whilst I don’t dispute your account of what your wife does, my local GP surgery in Torquay is much closer to Starkey’s than yours. Doors shut at half five. Absolutely no out of hours surgery, and nothing at weekends.
And there is no question that GPs now work less hours than they did a decade ago for an awful lot more pay.
And he is also right about the BMA just being one massive unreformed trade union, albeit an immensely powerful one. It is certainly no better than the Law Society or ICAEW.
Respectfully – of course it shuts at 5.30 – unless it does GPs couldn’t get the paperwork for the last patients of the day done
A GP’s job does not end when the patient leaves the room. For heaven’s sake be realistic
And if GPs have done 55 hours in 5 days why do you think they should work the weekend too? Do you think that humanly possible?
That kind of comedic perception is applied by such people to many public services: it is always wrong. GP’s have strong professional bodies, and are able to resist, with public support. Other groups much less so; and this kind of travesty translates to destruction of service through “accountability” (for which read pointless pieces of paper and micromanagement devised by people who know nothing about the work)
I doubt Mr Starkey has ever done a day’s work in his life comparable to that done every day by GP’s: or teachers: or social workers
I am sure you are right about Starkey’s experience of hard work
Whatever one thinks of Dr Starkey’s abrasive nature, he was born with two club feet and grew up as an only child to desperately poor working class parents, got into grammar school and obtained a 1st at Cambridge, all at a time when homosexuality (which his parents despised him for) was taboo, becoming one of the world’s leading historians. He was a lecturer at the LSE for over 25 years (I don’t know if you count that as hard work, or a “real job”).
I think it is fair to say he has done it the hard way. You don’t have to like him, but I find his story difficult not to admire.
In which case his prejudices are even harder to forgive
I am a GP. I start work at 8 am and often stay until 7 (not 9-5!) Once a week I stay until 9pm to see patients who work and can’t get here in the day. I work out of hours every thursday after work 8-11pm. I see about 200 patients a week and for each one make often difficult decisions about their health. It has taken me 5 years at medical school (unpaid, took out a 20 grand loan) followed by 5 years as a junior doctor learning the ropes. We are doing more and more in local GP surgeries compared to a few years ago because we practice preventative medicine much better now and we are doing work that used to be done in hospital (diabetes care for example). People are living longer, healthier lives. We are the most efficient part of the NHS doing 90% of the consultations and are admired the world over for our efficiency and quality of care.
I love the job I do and it is a privilege to be a trusted part of my patients lives. I just wish people would end the constant GP bashing in the media and (inaccurate) obsession with our incomes. You have an excellent, dedicated workforce of GPs who are fairly rewarded for a difficult and important job.
Hear, hear
i dont think anyone is denying that GP’s dont work 9-5, apart from Starkey. the question is whether GP’s should be paid £100k+ a year. GP’s dont have a monopoly on working long hours with a lot of responsibility, i would imagine there are plenty of other jobs where people are working long hours under a lot of pressure and are paid far less for their troubles
Name one
Name one where facing death of those you deal with and the emotions that come with it is a normal part of the days work – without any support at all
have you ever imagined for one moment what the wear and tear of that is?
Try, please
Then say why you think people will do the job for a lot less
And why bankers are worth so much more
I must say I would have thought the BBC had had enough of Starkey by now. I know I have.
I find him borderline racist, overtly misogynist, frequently ill-informed, a poor debater (he overrules and talks over people rather than engaging with them) and, at best, a mediocre contributor to his own specialist field.
What does he offer on these panel discussions? I suppose he annoys people, so they talk about it. But it’s a childish sort of way to fill airtime.
I could never be a GP, long hours, huge responsibility and what hasn’t come through, but I am sure must be the case, emotionally draining.
I earn 150k, 50k more than a GP. I am an IT consultant. I work long hours, but it isn’t hard graft. I feel a little guilty about that, but no shame. I didn’t go to university. But have worked for 25 years to get here, starting on 3,500 per year in 1984. Perhaps I am overpaid, perhaps others are underpaid.
Its not the 100k salaries that upset me, its the 20k salaries for really hard jobs. We should be looking to see salaries increased, not a race to the bottom. The current argument about these salaries seems to focus on greed. I would say we should be looking at the hardship and fixing that.
I agree
Doctors are at least fairly paid
Teachers aren’t
Some nurses aren’t
Care workers are massively underpaid
We could go on, and on
100k for a dedicated, sensible, effective GP may be good value. 250k for an entrepreneurial GP partner is questionable at best. Would anyone be surprised to hear that when I reach consultant level hospital practice in 2 years I can expect 73k rising to 100k after 10 years? This is after completing a PhD, gaining access to the specialty against very high rates of competition & 6 years higher surgical training. Oh and I’m a transplanter, so no private practice. Either our hospital consultants are woefully underpaid or a significant proportion of our GPs are overpaid; I suspect the latter.
I entirely agree with you – £250k is massive overpayment for a GP
You are absolutely 100% right
And such ‘enterprise’ at the expense of the state is wholly unacceptable
As is GPs owning private supply companies and as also is the practice of GPs dispensing
I’d add my wife does neither. Just for the record.
“Name one where facing death of those you deal with and the emotions that come with it is a normal part of the days work — without any support at all”
I think you are overdoing the sob story on how the poor old GP constantly faces life and death situations.
This is rarely the case – they are not A&E surgeons – the clue is in the name, they are generalists and anything remotely outside that sphere is referred to a specialist. Of course, that is not to deny they have human feelings just like anyone else. But I think it is fair to say that someone like an oncologist will over a career become fairly sanguine about someone who has cancer. They have seen it all before. My experience is that doctors come over as no more stressed than many other professionals and people in managerial roles.
Some GPs might work long hours (many don’t) – but come on, 8.30am – 7pm is hardly earth-shattering. I know many people who work much longer than that, and I think in many managerial/professional roles in the West End and City of London and other city centres those hours would seem pretty tame. City lawyers often work all nighters when a deal is approaching and regularly till 1 or 2 in the morning when it is “quiet”. They often sleep in the office. With huge sums of money involved, deadlines and liaising with people across the globe I can imagine that would be just as stressful as an old biddy with the flu. I wouldn’t do a job like that for £500k, let alone the £70k which many City lawyer friends of mine earn.
In addition, it is fairly easy to find part-time GP vacancies so doctors don’t necessarily work a full time week as generally understood, maybe 20-30hrs instead. In many fields this is impossible,
A hospice worker arguably faces a far more unpleasant job for a lot less pay – and yet I seriously doubt anyone believes they should be earning £100k p.a.
But I think the way you justify high salaries for GPs on account of the stress is wrong – you know, as well as I know, that they command high salaries on account of their skills. And actually I think £100k for the skills a doctor requires is not unreasonable and can be justified. But you ignore that because that would allow your betes noire such as lawyers and accountants to justify their high salaries as well, even though they are just as skilled as doctors.
Teachers are well paid BTW, especially for the holiday entitlement. Yes they might mark books outside school but these out of hour duties are no more in total than many other employees do. Most teachers are well within the top 15% of earners, many in the top 10%.
Just about everything you say in here is prejudice, not fact
I leave others to read your prejudice
And leave you with this thought – if teaching is so well paid why is it so hard to find good teachers?
And why can no teacher afford a house in London now? Is that what you consider sustainable?
I’m sure that shortly after the coalition seized power, Starkey was on Andrew Neil’s politics programme(this week or whatever its called) saying that low paid people and benefit recipients should not be allowed to live in London. Like Neil, Starkey is a vile unpleasant reactionary.
I find David Starkey makes for bloody good TV. Contrary to what someone said above, he is a good debater. He is independent-minded. The other panelists just trot out the party line. There should be someone like him on every QT, from whatever political persuasion, otherwise it just becomes a party political broadcast.
He is not stupid, he is a highly intelligent man as his academic record testifies.
And he was quite right to challenge the audience, which panellists should do more of. The guy who suggested an economic embargo with China was clearly being moronic and Starkey was quite right to pick him up on it. He said it was an “absurd remark” and that the gentleman should “think, man”. What’s wrong with that? What other comments were more appropriate when someone says something as silly as that?
Do historians think Starkey can think?
GPs do have a cushty number at the expense of the tax payer. A friends brother is one (partner in a practice, earning over £100k, lovely area of Devon, not some inner-city stress zone). When the revised contracts came out under the last government they sub-contracted all out of hours care (as most [all?] GPs did) and their practice clubbed together some of their extra funds to employ a locum so that they can all work part-time to boot. I work in the City and to earn 6 figures there you really need to sell your soul, cancel holidays, change plans, always be on call in addition to the extremely long hours and weekend working (the “value” of these respective roles is the subject of a whole other thread though ). For the money they earn they really don’t have a difficult time – especially when compared to their colleagues of similar qualification working in hospitals.
Oh and don’t GPs just act as a referral service? Something wrong with your ears? Refer to ENT specialist. Found a lump? Refer for biopsy. Feeling depressed? Refer for counselling. Oh and occasionally prescribe anti-biotics when you can be sure it’s not just “a virus”.
When did you last counsel someone about dying?
And then have to deal, emotionally, with the fact they have?
And then visit their bereaved spouse? Without any support yourself.
Or sit helpless whilst someone talks of losing their home an all you can give is an anti-depressant?
Or deal with the child who is being abused?
And so much more. But you want them to also work 24 hours a day.
Candidly – the callousness and small mindedness of your attitude reveals all we need to know about the City, where your net contribution to well being is likely to be negative
I believe it is now called “End of Life Planning”
It is one of the more unpleasant aspects of medical care, that all patients die.
It is what people get who have chronic ailments with the inevitable end.
It has been found that many people need to be acquainted with the problems their illness will give to them and what they need to do before things get too bad.
Been there, had that done to me.
Is this the same David Starkey who accused David Cameron of having “absolutely no strategy” for running the country (http://www.bbc.co.uk/news/uk-politics-15158057 )? On exactly who’s side is he on? His own?