Sunday, 13 April 2014

My plea to our Prime Minister David Cameron and SoS Jeremy Hunt

January 6, 2014 Sky News - The Burden being placed on family GPs

April 13, 2014 Sky News  - Dr Una Coales objects to government plans on 8-8, 7-day GP openings.

 April 14, 2014 Channel 5 Live News Dr Una Coales explains lack of GP manpower to deliver 7/7 GP openings to Emma Crosby.
Dear Prime Minister David Cameron and Health Secretary Jeremy Hunt,
I just did a Sky news interview today on your proposal that NHS GPs open surgeries 8-8, 7 days a week. The public were interviewed before I came on and said they don't trust politicians. This is the message I am trying to get across to you to keep the Tories in power through the next election. Honesty is the best policy!

You have got to stop blatant electioneering using NHS GPs as scapegoats and appearing to give the public what they want, ie 24/7 access to their family GP, skype and email consultations, named GP for the elderly when there is a severe shortage of GPs running on a skeleton staff struggling to provide care even during weekdays. One GP in Essex is covering 8,000 patients on his own, as the other partners have quit! Another newly qualified GP has joined a practice as a GP partner and the other partners have either emigrated or retired so now he is suddenly the senior GP partner running the practice just barely months after qualifying. Patient safety is at risk when one GP covers more than 1,700 patients himself. Not only does it look bad for Tories to bash workers but it will also bring about the collapse of healthcare in the UK before you have an alternative model in operation. GP surgeries are closing left, right and centre as the domino effect takes over.

Please allow NHS GPs to buy their buildings and charge NHS pts for NHS and/or private services so they can sustain themselves and transition into semi-private practice like NHS dentists and GPs in Australia and Canada. We must try to keep our homegrown doctors in the UK and try to stem the national brain drain of GPs and A&E doctors. At the moment, there is not one single reason to keep them working for the NHS as state GPs or A&E consultants.

There aren't enough private GPs to cover 60 million patients. Only 200 private GPs in London when I chaired as IDF GP chair.

Earl Howe saying that 50% of medical students will become GPs is another untruth. Medical students with a £60k debt from 5 years at university reading medicine and a £1,563 GP licencing exam per sitting, are unlikely to choose general practice (salaried pay is ~£56k and partner ~£78k) and if you cap hospital specialty training posts, then they are more likely to get that GP degree and run with it to Australia where they can earn 2.5 x for fewer hours of work or $200,000-$300,000 for a life without NHS bureaucracy, red tape or GMC revalidation.

Tories are at risk of being massacred by your current strategy. Please be honest with the public who can see through electioneering. Many of my colleagues are of the opinion that Tories may be more interested in power and wealth, as common sense seems to have left the building.

No, Cameron's £50 million challenge for 1,000 surgeries will not ensure 7/7 patient access to GPs, as roughly £50,000 per surgery to find and hire an extra GP to work late evenings Monday to Friday and all day weekends is IMPOSSIBLE! No GP will work unsociable hours for less pay than day shift work or for pay comparable to a London underground tube train driver.

Doctors were Tories strongest ally, hard workers and most trusted among the public. Now doctors are turning to undecided or Labour. Why help Ed Milliband to win when he seems to have nothing better to offer? Even the public are now undecided as there doesn't seem to be a party leader with an ounce of common sense?

Strategy 1. Clamp down on benefits. No work, no pay. Workers feel sick that it seems like half this country appear to be living on benefits and single mothers have no shame having children with multiple partners. Why should worker's hard earned wages pay to keep the work-shy at home?

2. Jails are for punishment and not a luxury hotel with restaurant menu selection. Work in jail for no money but your room and board. No tv in cells but 1 tv to be shared by 100 inmates. Remember we are conservatives! Jail should be a deterrent to crime. Why pay compensation to prisoners who get assaulted in prison by inmates, when families of victims cannot bring back their dead ones.

3. Applaud all workers, including NHS GPs! If you keep bashing the public's lifelong family GP, they will not thank you. One GP surgery has already written to their 1000s of patients to tell them what this government has done and how they have driven him and his wife GP to retire and close their surgery. If patients cannot get an appointment to see their GP for 3 weeks, it is because there aren't enough GPs!!! NHS GPs are leaving left, right and centre.

4. Revalidation is making many doctors turn in their GMC licences. At this rate, I predict the healthcare in the UK will become like Greece. We are going to see a domino effect in which patients will not be able to access care as there aren't enough trained doctors. EU doctors are unlikely to stay as they may find appraisals and revalidation nigh impossible to do or pass (imagine trying to complete a tax form without the aid of an accountant) and IMG (international medical graduates) doctors are facing 15 times more chance of failing the actor CSA GP licensing exam taken in their final year of GP training, so fewer may work and help out the GP workforce.

I want to help the Tories but at this rate you are handing the next election over to Labour!

Please heed my advice ASAP. I am a Tory loyalist but you are making my job hard to help keep the Tories in their seats.'

yours honestly and sincerely,
a NHS GP, the most trusted profession in Great Britain.

Comments from NHS GP partners:

'On the ground, primary care is on its knees. There is relentless amount of extra work being moved to primary care, with no, or very little funding. There is a big recruitment crisis unfolding with older GPs retiring in droves and a huge fall in number of applicants into General Practice, We are seeing practices struggle and expect some to go out of business, if the trend continues.
In short, there is no funding for doing any extra hours at the moment. Worse still, there are no extra GPs to cover the rota gaps if GPs had to do more hours.
What we need is for the politicians to address the real issues of increasing patient needs and expectations. We need to look at how the NHS, and its various parts, are being funded. Unfortunately I have no hope that the politicians will do the right thing as their calendars only go as far as the next election.'
A UK NHS GP Partner writes me, 'Thank you. The partners are the rocks general practices are built on.'

A private GP writes me on Hunt's proposal for skype consultations, 'From a medico-legal standpoint, phone and Skype consultations are fraught with danger. Using new technology will just delay and use up more resources better used in face to face consultations. No one ever discusses reducing inappropriate demand on the NHS as a way of solving capacity issues. The Skyped patients will just end up going to A+E anway, and as the £ follow the patients, A+E don't mind patients turning up, it increases their funding.'

A NHS doctor writes of the £50m challenge, 'Classic bait and switch move.'

A female NHS GP writes 'The question regarding a GP taking time off was irrelevant. Anyone whether a GP or not should be able to take time off work to attend a doctor's appointment. We as GPs tend not to do that because of the inconvenience it may cause to the patients and surgery. I myself tend to see my GP on my days off, including appointments for antenatal care when I was pregnant but that again is out of goodwill - which by the way, is running out fast!'

A male NHS GP 'Government doesn't realize that they are destroying the morale of GPs. No wonder they are leaving the country and nobody wants to take up partnerships.'

A young female NHS GP, 'It's the lack of manpower but some may argue secondary to the poor finances, low morale, poor public perception of doctors, regular and constant denigration in the public eye! It needs to be a multi-model approach. I am starting to hate my job and why? Demanding patients, multiple problems, not enough resources and not enough time. I'd love to be a private GP right now.'

A male NHS GP partner, 'Please highlight the fact that to run this service, it needs to be adequately funded. They really are trying to get blood out of a stone! The new proposals will do nothing to address the problems which are not enough GPs to provide adequate services, patients blocking appointments with minor self-limiting problems and patients not using existing services correctly, e.g. going to casualty instead of their own GP, walk-in centre or OOH provider.'

A female GP partner, 'I love my job, but it is almost impossible to do it well these days. A full day is 12 hours, so a full-time partner often does 60 hours a week! It is the sheer quantity and complexity of work and the feeling that we are not valued that really saps the will. I do not know the answer, but more GPs would be a start and emphasis that you cannot have access all hours and continuity. Who is going to work at this intensity for 100 hours a week or more?!'