Trust your doctor

The government seems to be in the process of having a fight with GPs over lengthening their opening hours. The Health minister is writing to GPs to try to appeal over the heads of the BMA, though judging by the sample taken by the BBC the GPs are behind the BMA. The GPs’ appear to have agreed to open for an additional two hours but the government is demanding three. The government has been pledging to increase GP access for some time and has been angered by the increase in the pay for GPs which can now be over £100,000.It may be popular to have GP surgeries open at times more convenient for the working population which will inevitably mean outside normal office hours. However, most people seem relatively satisfied with the current arrangements The GPs’ seem in principle prepared to do this but have suggested that if they are forced into an agreement there could be resignations from the NHS; the GPs’ also fear creeping privatisation of NHS General Practice.

Whilst cynics might suggest that the fear of privatisation stems from the danger of a loss of control for the GPs, the current model of General Practice in the UK has frequently been held up as “The Crowning Glory of the NHS,” and is widely credited with reducing the overall cost of health care as compared to for example the French system whereby patients can attend practically any doctor from any speciality.

The current system clearly has significant problems over access. One must remember, however, that the current GP contract allowing them to opt out of out of hours care for patients was introduced due to grave fears that General Practice had become unattractive for young doctors and that this would result in an inadequate number of people being willing to go into it. The new contract was indeed a great success for the GPs, and was even better than their negotiators had expected. This crisis in recruitment has been solved but that was at the expense of paying doctors more and improving their working hours.

The current government strategy may be popular with many working people. The reality is, however, that such people rarely need to attend the GP and when they do so it is usually for easy to sort out conditions. As such, for them, seeing a GP in say a supermarket as some have suggested might be acceptable; whether or not that would provide an interesting and stimulating career for a GP is, however, a very different matter. It would also run the grave risk of people seeing multiple different doctors and as such a serious and dangerous progression of an illness being more likely to occur undetected; a situation which can already occur with tragic consequences in the current system. The more chronically ill, often with complex problems are the ones who most need to see a person who knows their case well and indeed are the patients whose care will be most interesting for GPs to provide.

The other problem is one which I have highlighted previously with regard to the dentists. GP’s like dentists are self employed and unlikely as it may sound one supposes that there could be circumstances whereby GPs might at least in part opt out of the NHS as the dentists have done. It is conceivable then that the result of a government show down with the GPs might cause a partial ending of the current system. That is probably too alarmist but as I mentioned above the reason for the new GP contract was fears that there would be inadequate numbers of GPs. Whilst some rebalancing is probably possible the government might do well to remember that if they antagonise the GPs enough it could have disastrous consequences. Unless of course their aim is genuinely to end the current system and introduce private health providers to general practice; that surely is too Machiavellian?

  • feismother

    Read Dr Rant on the issue:

    http://www.drrant.net/

  • Comrade Stalin

    DR rant :

    You may have noticed that there are more letters after my name than in it. The closest you have come to letters is delivering them. Don’t tell me how to do my fucking job

    Sounds like a typical GP really.

    These people are paid a small fortune every year. In exchange, they sit in a plush office, write prescriptions and send people to hospital. I don’t mind them being well-compensated for what they do, but I’ve got a hard time with them bitching about how hard their life is.

  • New Yorker

    Roughly how much are they paid?

  • Comrade Stalin

    GPs are paid an average of around £120K.

    My recent experience of the health service here in in NI, in connection with a minor problem, has been pretty good. It would be nice to see a GP within 2-3 days, rather than within around 7 days of trying to book, though.

    I was reading Dr Rant’s blog a bit more, and I can sort of see where he’s coming from. The government is pursuing certain things, like waiting times and availability of doctors, at the expense of the overall quality of care.

  • Seems to me that of the government wants longer hours and a cut in waiting times they’re going to have to do more than make demands.

    My local practice, at Holywood Arches, is more and more like a mini hospital these days. Any time I’ve phoned up seeking an appointment I’ve recieved one within a day and the time has always been worked around my jobm either first thing or after 5pm. Maybe the Scott, Mercer, Marshall practice is the exception but I certainly have no complaints.

    I feel that the Government wants to get it’s own house in order before they dictate to other professions. How many hours a week does the average MP in Westminster work and how much good do they do compared to a local GP?

  • bollix

    The government has been pushing “access to GP at all times” line for some time now. In a recent survey, most people were generally happy with access to their GPs. however, the govt is fairly fixated with it, part of their “choice” agenda. When i got a copy of the survey to fill in, it was clear that this was agenda behind the survey.

    There is a basic conflict between 2 things – ability to see a GP at all times convenient to the patient and ability to have continuity of care with the same GP.

    I would posit it is of high importance to see the same GP – developing a relationship, feeling confident, picking up on small changes, following the course of an illness etc.
    If you want a surgery to be open 6 days a week 7 am to 9pm, there is no way you will see the same doctor each time. The govt doesn’t seem to appreciate the choice to be made between longer opening hours and continuity of care. I find their argument to be propagandist and disingenuous.

    I am also dissappointed by the whispering campaign against GPs (lazy and greedy is a summary of the govt position). my wife is a gp. some days she is in work at 8am and doesn’t come home until after 9pm. its hard work which deserves to be well paid.

  • lamh dearg

    COI first of all, I am a GP here in NI

    “GPs are paid an average of around £120K”

    No they aren’t, it reached a peak of £100K when the full benefits of our new contract kicked in (2005) and we were very grateful for it after years of underpayment.

    Since then the income has stayed the same while our expenses have increased (we have to pay our staff who got their usual annual uplifts, phone, electricity etc.) so in 2006 I (a typical full time NI GP) earned £90K. a fair return for my average 50 hour week, a lot of training and experience and a hell of a lot of clinical responsibility (insurance in regard of this responsibility takes away another £5K of the above figure).

    So this is not about money, we are not the greedy sods The Daily Mail would have you believe and we believe we are fairly paid.

    It is about 2 issues

    as Turgon says New Labour is chipping away at traditional NHS including GP, contracting it out to mainly American private health care companies who make money by offering a nurse led servive with transient doctors supervising the nurses and, yes, offering this service at all hours.
    In Camden last week three local practices were awarded to United Health Care Europe rather than to local GPs whose plans were assessed as better quality, why? simply because UHE were cheaper
    (http://www.healthcarerepublic.com/news/GP/LatestNews/780212/GPs-lose-APMS-bid-despite-outscoring-firm/)

    These companies will not offer continuity of care, it will be different nurses and doctors (on short term contracts to avoid employment rights) seeing patients at each visit. This is not what we want because we believe that it is not in our patients longterm interests as well as not in our interests.

    Second issue; we believe a contract should be a contract, we have a written contract with the Govt freely negotiated, they now say “tough, we are imposing a new one, end of story” If they do it to us they could do it to anyone.

    btw re access, the largest survey of patient opinion on this issue (done by English DoH at a cost of £20 million) showed that 84% of patients did not want extended opening, 5 % didn’t care and 11% wanted it, most of this 11% resided in the commuting belt of the South East of England.

    Apologies for length of post

  • runciter

    my wife is a gp. some days she is in work at 8am and doesn’t come home until after 9pm.

    So what?

    Lots of people work long hours for a fraction of what GPs earn.

    £120K is outrageous.

  • Runciter did you read the post above yours before you dove in feet first?

    GP’s at most earned £100k a year, while this is almost 10X what I earn considering the time and expense that goes in to training to be a doctor I don’t consider it an “outrageous” amount.

  • Comrade Stalin

    No they aren’t, it reached a peak of £100K when the full benefits of our new contract kicked in (2005) and we were very grateful for it after years of underpayment.

    I appreciate the correction.

    But you can’t expect to be taken seriously if you think GPs are or were underpaid. You are earning approximately four times the UK median wage. You can afford to buy an average house with less than 2x your annual salary, when most people are having to borrow 5x. Please, don’t take the piss.

    I think that GPs should be well paid, and I don’t mind the fact that you get £100K. But you have to accept that a vast salary like that pretty much removes your right to whine and bitch. There are people out there earning less than one tenth of what you are, and who have to claim benefits so that they can support their families.

    Since then the income has stayed the same while our expenses have increased (we have to pay our staff who got their usual annual uplifts, phone, electricity etc.)

    Yup, that’s the same right across the economy. Do you think you guys live in a vacuum ?

    a fair return for my average 50 hour week, a lot of training and experience and a hell of a lot of clinical responsibility

    Granted. Although that training and experience is all paid for by the NHS, isn’t it ?

    (insurance in regard of this responsibility takes away another £5K of the above figure).

    Your insurance and expenses aren’t taxable, are they ?

    So this is not about money, we are not the greedy sods The Daily Mail would have you believe and we believe we are fairly paid.

    The Daily Mail are wankers. Yes, you are fairly paid. No, you are not underpaid and historically you never have been.

  • Comrade Stalin

    Granted. Although that training and experience is all paid for by the NHS, isn’t it ?

    Duh. I did, of course, mean just the training.

  • runciter

    GP’s at most earned £100k a year

    Not according to the BBC, who say that the average was over £100k.

    Anyone who thinks this is a ‘fair return’ for 50 hours a week is living on a different planet to the rest of us.

    No wonder GPs are developing a reputation for greed.

  • Are you serriously suggesting that you judge a job by hours worked rather than also taking into account the time, effort and dedication that also goes with those 50 hours a day? Think on what you’ve said if, FSM forbid, you actually end up with a life threatening illness. I’ve been in a position where a local GP was able to spot the symptoms of cancer in a family member of mine and she was able to get them Chemo.

    Medical workers, not just GP’s, are in my opinion worth every single penny they get and in the case of nurses etc not paid enough.

  • Star of the County Down

    Pounder,

    ‘Are you serriously suggesting that you judge a job by hours worked rather than also taking into account the time, effort and dedication that also goes with those 50 hours a day?’

    I presume you mean 50 hours a week – I don’t think anyone would be quibbling over GP pay if they did 50 hours a day!

    Seriously though, I think the argument is best framed by the comparison with hospital doctors below consultant, who have to work shifts & nights, be on call, probably work more than 50 hours a week (no matter what the official ‘statistics’ say), all for a lot less than £100,000 a year. Add on the additional work required to progress towards hospital consultant, such as working towards MDs, clinical research, etc. and the deal looks even worse.

    I’m not a doctor myself, but judging from the anecdotal evidence of my medical acquaintances, this imbalance in work burden and rewards (combined with the MTAS balls up) is driving a increasing number of vocational hospital doctors towards GP training. Now, I don’t know about you, but I’d rather our brightest doctors aspired to the sharper ends of medicine, rather dishing out happy pills and referring anything serious-looking onwards, but maybe that’s just me…

    Oh, and GP pay can be a lot more than £100,000 – up to £250,000, even 3 years ago, in England/Scotland/Wales at least. Check the link:

    http://www.guardian.co.uk/society/2005/may/11/primarycare.nhsstaff

  • runciter

    Medical workers, not just GP’s, are in my opinion worth every single penny they get and in the case of nurses etc not paid enough.

    Unfortunately resources are limited – which means that if one group if rewarded disproportionately well, then the rest of us – including nurses, cleaners, etc – pay a price.

    The doctors’ greed and the government’s weakness on this issue is bad for all of us.