I am intrigued that the government is saying that it is going to ensure GP services are supplied by people's normal doctors seven days a week, twelve hours a day, with the over 75s guaranteed access to their own personal doctor, and all that for an annual cost of £50 million.
To put that in context, that's £2,000 a doctor - maybe the cost of upgrading them all to the secure email system they're all supposed to consult on in the future.
Politely, this is nonsense. Now, I admit my expertise in this area is second hand as I am married to a GP, but I have as a result seen the detailed workings of a number of GP practices over the years and have discussed GP services with a wide range of doctors. There are three obvious points to make.
First, the proportion if NHS resources going to GPs is already falling, significantly. It is now less than 9% of all resources when it was over 10%. So the service is already underfunded.
That is compounded by increasing demand. I can remember only fifteen years or so ago when an average of four consultations per patient in a GP's list was normal: now it's over five and still rising. That is an enormous change.
Third, there is a desperate shortage of GPs to work in the existing system, largely because of the considerable demands made, long hours and massive stress.
Now please don't get me wrong: there are fat cat GPs in the existing system who treat the NHS as a market and profit making opportunity and so abuse it. And I am well aware that some GPs seem to think that a full time working week is four days, or that they need a half day off in a five day working week. For these doctors I think their time of using the system is over, and that's to be welcomed. But they're not a majority of GPs. Most already work very long hours and can physically do little more than they do now. Which is precisely why recruiting GPs is very hard indeed: young doctors rightly see little appeal in working in this way.
In that case can what Cameon and Hunt will be offering be delivered? I do not think there is any hope if it.
But more importantly, I think it would be very dangerous to try: pushing healthcare professionals beyond their limits is not a way to deliver safe care.
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Remember also that significant amounts of GP time are being lost to Clinical Commisioning Groups. Entirely the Condems fault.
Glad you’re back Richard but don’t be tempted to overdo it
There are some things that GPs can do over email. I personally would feel happier emailing my GP about something silly, then waiting to see them or not and the matter getting worse.
As for a more modern GP surgery, open times needed. Yes we need more GPs, we need more training. However it is getting silly that we can do everything we want, shop buy new cars and access financial services, yet we cant see a Doctor.
The UK is getting bigger, more people are now living here. Whether that’s good or bad, its a fact. More people need to see a Doctor. Something needs to give.
I agree they need more money, try poking the non doms a little to see who is happy to pay some tax.
As is usual the people who suggest these things seem to believe that everyone in the public sector is sitting about with nothing to do. I suspect it is because that is their personal experience of what they are pleased to call work.
Some time ago I read the McKinsey report into the health and social care service in NI:it was instructive
http://thosebigwords.forumcommunity.net/?t=47582789&p=372793340
Included in the recommendatons is
“Shifting to lower cost settings”
And
” Renegotiate or reprocure private services for less money”
That refers to GP services because they say in the same report that the funding crisis is partly because of
“Inflating cost of contracts with external service providers (primarily private
nursing homes and family health service practices such as GPs, dentists,
community pharmacists, and ophthalmologists)”
So a cut to GP’s wages is essential if we are to save the health service, apparently
But then we won’t have GPs…..
Indeed. The whole paper is nonsense from beginning to end: but it has the advantage of providing more jobs for management consultants. So that is alright
The BMA / RCGPs are always calling for more GPs – I suppose we could look at France and their numbers of GPs…
….which is about double that of the UK….but wait….GPs in France get paid about half of what a UK GP gets paid….(OECD data)
….I wonder if there is a correlation.
You may also notice the French do not work as hard…..
But why bother with details?
Glad to see you back but don’t overdo it. Yes, I know i’m not the first to say but some people do need telling twice-or even more! I just have this idea you can be a bit stubborn.
It’s same across all the public services, teaching, nursing, local authority staff, police they want more and more for no more or less pay. It’s justified by ‘performance assessment’ with the criteria set by people with little understanding or experience of the services
I won’t over do it
But I also have no clue what the rest of what you wrote is about
Sorry….
Well what Ian said fits with my experience. As I see it they started with small and weak professions such as educational psychologists and social workers: press vilification softened up the public and then a combination of financial constraint and micromanagement,implemented through targets and performance assessments, made the job impossible and destroyed any alternative voice in the form of an effective professional body,not least by imposing impossible work loads. They perfected that technique and applied it across the public service: it has only now reached medicine, for they are strong professions with well developed ethical standards and strong public support. Watch it being eroded in a scandal sheet near you today!
If that’s what was meant – yes, I agree
This is long standing practice
Fiona is right. Targets are set and then ratcheted up so that people start to crack up. The ATL a teachers union, released a survey today -on the red button BBC saying 38% had seen a rise in mental health issues among colleagues.
Indeed Fiona – I left teaching ( a job I loved) because of this nonsense. In the end I felt the paperwork and data collection was becoming the main part of the job. I now see the profession ground down and demoralised where there is very little space for creativity and challenging the status quo -the profession has been systematically undermined by successive Education secretaries whose incompetence and ignorance knew no bounds.
A relative who was living in France had cause to visit the doctor with a neck pain. After the MRI scan she was very rapidly hospitalised and operated-on for a tumour. She has nothing but praise for them, not so much for her care here after returning home. My GP here had a minor sulk when I opted-out of the care.data scam to sell details to places that sell you things. She explained that it may cause problems with later treatment, I told her that it only prevented dissemination to non-medical organisations.
I can appreciate that with funding getting scarce, along with more needing to be done with less, it may be necessary to have arrangements with off-NHS organisations in order to obtain funding, but why do they not tell people?
http://www.pulsetoday.co.uk/your-practice/special-reports/retirement/gps-letter-to-patients-explains-how-government-drove-them-to-early-retirement/20006404.article
http://www.pulsetoday.co.uk/home/gp-contract-2014/15/practices-must-implement-care-plans-for-2-of-patients-by-july-to-achieve-20000-des-payments/20006342.article
“I can appreciate that with funding getting scarce, along with more needing to be done with less, it may be necessary to have arrangements with off-NHS organisations in order to obtain funding, but why do they not tell people?”
The idea that the funds are not available is an idea that needs stamping on heavily! It is blatant nonsense.
We have a lack of funds but can spend around £4 billion for the next 20 years buying a missile system that is about as much use as an ashtray and a motorbike and enough money to finance a 5 percent cut in income tax for those that don;t need it.
Amazingly, we found over £1 trillion to bail out bankrupt banks and £375 billion to lavish them with cash which was to give then the liquidity to lend to the real economy, which largely hasn’t happened, yet we apparently can’t find the money to fund this properly.
Patent nonsense of course, but quite a few still buy it, unfortunately!
When I read this in the Torygraph on Saturday night I was flabbergasted by the insanity of it!
Firstly, part of the plan is to issue over 70y.o.’s with iPads, in order to keep them in touch with their GP. While the amount of ‘silver surfers’ may be increasing, in my home town they are a tiny minority. My parents are in their 80’s and wouldn’t have a clue. Like most of their peers they do not have internet connections, own computers or know what an app is.
Secondly as the GP section of the BMA point out the funding is £50m, not £50m per year. There is (at present)no commitment to spend that sum beyond the next election. This is a cynical attempt, by a government mindful of the potential for a complete melt-down in GP services, to stave off a disaster before the General Election.
GP commissioning is already having a disastrous effect on specialist services in the NHS (whilst at the same time passing millions of pounds into the hands of business consultants). Denied pay increases, understaffed, and pilloried in the media, NHS workers are more demoralised than I can ever remember. The health secretary now has powers to close, at will, any hospital of his choosing.
The coalition know full well that their ‘reforms’ are destroying the NHS. It was always the intention. This is simply an attempt to hide that truth from the general public until 2015.
Martin
Agreed on all counts
Richard
Martin. This morning’s BBC news interviewed a spokesperson for a GP practice, quoted as covering 200,000 people, and had £2.8M [extra] for this initiative. Pro rata for England = 250x£2.8M which is 14 times greater than the government propaganda figure of £50M.
We are well into the politics of the next election.
RM: Maybe the PM’s and Chancellor’s office are reading [your] blog for new headlines. I’ve used a couple of today’s RM blog titles as templates:
“PM demands – moral tax behavior and for those who do not conduct themselves morally will have to disclose of all their earnings. We will target those who don’t!”
“PM states – We have a choice whose voices we listen to. I say it should be those hard working people.”
Martin,I think you’ve summed the whole thing up perfectly. This so-called initiative is nothing more than PR spin to try and get the ‘grey vote’ which they’re scared might desert them as they wreck the NHS. It’s absolutely typical of Cameron to come out with this feeble, cynical nonsense. Meanwhile, yet more anti public sector rubbish published in the Telegraph today – surprise, surprise!
Here we go again…
“Hostility, defensiveness and denial. Millions suffer in silence due to public sector complaints system” (Daily Telegraph, Monday 14th April)
Is anyone familiar with the expression ‘give a dog a bad name and hang him’?
I can’t help but notice that none of the reports about this initiative mentioned that the £50m on offer is a twelfth of the sum wasted on apparently useless flu drugs, (according to the committee report), miss-sold by unscrupulous and unethical pharmaceutical giants.
I remember about thirty years ago I had an excellent dentist who worked entirely for the NHS. He was constantly complaining of cuts to the service and led a consortium of dentists in Cambridge to try to deal with the increasingly difficult situation in the eighties under Thatcher.
Eventually he gave up and went mostly private, as many did.
I wonder if forcing too much work and too little funding might be a similar attempt to make GPs go private? With scarcity they will be an enclosure for the well off, as in the thirties and before. Instead of “stuffing their mouths with gold” and good conditions as Nye Bevan did, they will stuff them with too much work and too little resources to get the opposite effect.
“I am intrigued that the government is saying that it is going to ensure GP services are supplied by people’s normal doctors seven days a week, twelve hours a day, with the over 75s guaranteed access to their own personal doctor, and all that for an annual cost of £50 million.”
Sorry, I smell a rat here!
http://www.politicshome.com/uk/article/96298/labour_david_cameron_has_made_it_harder_for_millions_of_people_to_see_a_gp_burnham.html