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GPs and the NHS

Andrew Burnham’s latest assault on general practice would leave it denuded and dumbed down.   UKIP must fight for quality, and for the individual.

Read here.

The one skill every Labour politician has to learn is how to bury bad news, especially in health where it all too often goes hand in hand with burying patients.   Last Thursday Andy Burnham did just that with a stealthy yet vociferous attack on the future of primary care.

See here.

He suggested, after pledging to deliver GP appointments within 48 hours, and years of trashing the sustainability of general practice, to nationalise every GP in the country and replace each surgery with a nurse led unit.  He said in an interview with Pulse magazine that the independent status of GPs would be reviewed, and that we should think of people not professions.

Oh Andy, that is the point of professions!  They have an intrinsic duty to put their clients first!

They also have a duty not to put the state first and really is the rub for Labour.  The NHS once it’s natural bastion where they could do no wrong but despite 81 attempts at refusing an enquiry into Mid Staffordshire it was the state and its obsession with callous targets that was found wanting.  It was not the whistleblowing doctors and nurses who were blamed…..though many had their careers ruined….but the culture that had been driven to develop under the last Labour government.

The language that first led me into politics was there in black and white, “breaking down barriers”, “open to change” and of course obsessing over a universalist target that punishes those greatest in need.   This is where cultural Marxism and bureauphilia meet healthcare and the result is invariably a dumbing down of standards and individual patients becoming the obstacle to rather than the focus of good healthcare.

When Labour brought in the four hour target, people were seen faster in A&E than GP and costs soared, we now wonder why there isn’t enough money for primary care.  More targets will only increase expectations for those with trivial problems and further restrict supply to precious appointments.  The only way to meet this new 48 hour target is to shorten appointment times and replace some GPs with nurses.

We saw this in action during the Newark by-election where Labour planned to shut the A&E to replace it with a nurse led minor unit: the Tories obliged and deaths skyrocketed.   The Royal College of GPs have slammed Labour’s policy but we all know socialists are never wrong, and they never learn.   Rushing GP appointments or having less skilled clinicians will mean those at risk of suicide, or cancers, or other hard to spot illnesses will be missed.

I cannot think of a single person who would want their GP visit to be a rushed job.   We have to fight for quality and make more of unused capacity in the system.  At the moment GPs are not allowed to offer their NHS patients private appointments yet research shows time and again a subset of patients would be willing to pay for such a service, and leave more capacity for everyone else.   And no, this is NOT charging NHS patients to see their GP as Labour love to bark on about.

Every weekend, evening, every other Wednesday and Bank Holidays see prime medical real estate lie empty for training days or holidays.   If GPs were allowed to offer private appointments out of hours, and maybe hire a sessional GP on the weekends for minor injuries and one off issues think of how many more services could be offered?  The system would be self funding and open practices to patients beyond their original lists, creating competition to drive that fight for quality.

If we want to recruit and retain more UK trained GPs, rather than losing them to Australasia, we have to let GPs invest IN general practice.   Instead of renting from monopoly PFI schemes like LIFT they should be given a right to buy into their premises and put the assets in a private pension.   NHS dentists enjoy these rights now.

It costs £400,000 to fully train a GP.  Losing 3000 GPs and middle grade doctors a year to emigration is the equivalent to losing 1% of the entire NHS budget.  That’s a big saving to be had.  Furthermore, new enterprise investment schemes encouraging senior GPs to bud off and set up new practices with junior partners would be better value long term than them subsidizing the arty film industry.  Think about it, when was the last new general practice opened near you?

Our GP is the guardian of our patient data, of our referral system and the one doctor you know is on the side of the individual, not the state.  He or she will fight for that extra funding for a hearing device or be an advocate to listen to us on when life falls down around us.   The NHS is our nation’s citadel but only as long the gatekeepers are on our side, else it is little more than a gilded prison.

Our GPs are not “heroes in aprons” or any such nonsense.   They are serious, highly trained professionals at our beckon call and I’d rather they held the keys to the citadel than multinational corporations or charlatan politicians who can’t say sorry, politicians like Burnham.

For all its sins, and there are many, the British Medical Association is running a campaign called Your GP Cares which I hope readers get behind as it highlights many areas of concern here.    An independent Britain needs an independent primary care else we are swapping one master for another closer to home.

Mr. Jonathan Stanley MRCS

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4 Comments on GPs and the NHS

  1. If “The only way to meet this new 48 hour target is to shorten appointment times” that would suggest that GPs themselves have no further capacity. In which case, how are they able to offer private appointments? They must have capacity which they are not offering NHS patients. Of course this isn’t the only way, it is the only way he wants to give in order to support his proposal.

    There are many factors that contribute to the shortage of available GP appointments we see currently. If I am to pick one it would be the fall in use of out of hours doctors services in recent months and years which has a two pronged effect – increasing A&E visits and morning GP appointment requests.

    He is right to challenge Labour’s history with GPs and some of the weakest and worst contract negotations in recent history were evidenced by Labour allowing GPs to drop their 24/7 responsibility for a tiny reduction in pay. The result was out of hours services which are poorly funded, unable to rely on local GPs to take their turn in out of hours shifts, private providers putting profit before provision (too many examples to list here) and more.

    We should immediately return responsibility for 24/7 care to GPs who can set up co-operatives if they wish, who will have an interest in the performance of their out of hours service and a duty to take part in it. These services should have a degree of separation from 111 in order to ensure patients can speak to a GP out of hours much quicker than currently and to stop unqualified, non-clinical telephone operators making decisions on appointments and home visits on behalf of the GPs on shift. Faith could be restored in the out of hours services and the GPs who together can oversee the clinical and operational performance of their service.

    If by “replacing GPs with nurses” he means 2 nurses can be hired for the same cost of one GP what is wrong with that? For many appointments nurses offer a very good service, therefore leaving GPs more appointment slots to deal with the more complex cases he examples. He may view nurses as less skilled but suicide rates are more likely to be related to the cuts in mental health provision the current Government has overseen. No-one is at risk of cancer because they see a nurse rather than a GP, nurses should refer to their GP colleagues if they are unsure or symptoms are unclear.

    If we are going to pay so much to train a GP, we should have a call on the product of that investment, not setting up someone to set up private clinics on the back of publicly funded training.

    A brand new large practice has opened near me just last year, with a huge array of services including a pharmacy all owned by the GP partners. I wholeheartedly agree that more GPs should be encouraged to invest IN general practices and PFI arrangements should be renegotiated or rolled back. Currently PFI is a shining example of what to expect if you open up a vital core public service to private ownership: profiteering, stripping of cash from front-line services, and economy before quality becomes the norm and the reason American companies are queuing up waiting for TTIP to be implemented in the EU.

    We should also consider challenging the public mindset which sees people pitching up at GPs for very minor ailments for which a GP can only give advice and should actually be managed by the patient or parent within the home. Promotion of self-care and self-management can also help reduce hospital stays and other expensive use of health services.

    I do not wish to appear that I disagree in every way with the author, rather I wish to raise subjects and alternative ideas which some GPs tell me would address some of his concerns without the two tier GP service he proposes.

  2. The reason we are having to poaching medical staff from the third world ,is because,, past politicians have been negligent in not providing sufficient training for medical staff to power the NHS ,

    Yes it’s the politician’s fault we are in this mess,, miss management of the NHS by labour and conservatives.

    • Brian OtridgeBrian Otridge // June 15, 2014 at 9:36 am //

      The mess is a bigger one than that! We train around 6000 a year. In the 4-5 years 2008-Aug 2012 8000 of them registered for certificates to practise in Australia and New Zealand, that’s between 25 and 30% of them. (http://www.ft.com/cms/s/0/5063a2a0-b651-11e1-8ad0-00144feabdc0.html#axzz34h88Y4pa)

      Why are so many leaving our shores? Well, we can guess, and my guess is that they don’t like what they see in our cities, in the big hospitals, the climate is better there, their policies are better than ours, and probably the pay is higher too.

  3. Not sure about this article the
    gp’s are currently the fund holders for the hospitals, which needs to be reversed, because they are not actually employed by the NHS, but have contracts to work for the NHS, a very different position to every other NHS professional.

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