Wednesday, 30 April 2014

NHS GPs call to arms for strike or mass resignation from an untenable NHS GP contract

There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them” - Denis Waitley.

We are seeing a mirror image of what has happened in America with medicare/medicaid bureaucracy driving family physicians to despair and burnout. One family physician in Oregon has come up with a solution called the Ideal Medical Practice movement which has been emulated by over 500 family practices across America.

Even Australia is now buckling under the demand for free medicare.

Semi-private healthcare in the hands of GPs and consultants, not managers or private corporations

The problem is demand has been given free rein. NHS GP surgeries may not close their patient lists. NHS GPs are paid £72/patient/year for unlimited access by patients which is untenable in the context of a natioanl shortage of GPs. Medical students may now be saddled with £70k in debt from £9k/year tuition fees and £5k/year living costs. Applications to NHS GP training have dropped!

The solution must be evolution, a transition to a model of healthcare adopted by Ireland, Canada and Australia, semi-private healthcare. We must keep our GPs in the UK by bringing Australian healthcare systems to the UK. Private income may then subsidize state income. If we do nothing, then NHS GP partnerships will fold in a domino effect and patients will be left without access to primary care (except those who have access to a private GP). The knock-on effect is that secondary care, ie NHS hospitals will close next and finally the National Health Service. The cost of private healthcare in the US is escalating. The only win:win is to allow a form of semi-private healthcare so that GPs and hospital consultants are in charge of patient rates (self pay or government means-assisted insurance) and not solely health insurance giants or private companies who may choose profits over patients.

The End of NHS General Practice

The NHS has reached a point where general practice is under threat of extinction and more ominously it comes with a date of execution, May 2015, by the next general election. NHS GP surgeries have been bombarded with relentless funding cuts (MPIG cuts (minimum practice income guarantee to balance books when the outdated Carr Hill formula underpaid), QOF payment by results cuts, etc.), that many GP surgeries are now unable to afford to pay locums so GP partners are working flat out, over-time for free, to cover all appointments; are laying off practice staff and some salaried GPs, and many have now declared they will face bankruptcy in a matter of months. GPs are burning out fast.

The government's hands are tied as they have a £1.4 trillion national deficit on their hands that will continue to affect the next generation. Public funding has been cut in all sectors. NHS workers are being asked to pay more into the NHS pension and asked to cash out at a later age. We cannot deny the fact that our economy is affecting the ability to deliver safe healthcare when we see district general hospitals close, A&Es being downgraded, hospital beds being reduced, A&E staff leaving in droves for Australia. There is a huge strain on a healthcare system that is one way, patients demand and a cash-strapped system has to deliver. We have to change this archaic healthcare system that was devised in 1952 when containment was based on lack of medical technology and treatments. We are now living in a nation with a growing elderly population, limited public healthcare resources/funding, lack of manpower (15% reduction in GP training applications with 60% of GPs saying they plan to retire early due to stress) and demanding patients (UK, 27 other EU countries and global health tourists).

NHS GP Partners Call to Arms.

'The threat of mass undated resignation was what changed things in 2003/4.'

'I think the undated resignation letters a very good idea, but we should be careful to state the terms on which we would come back. No GP surgery must be disadvantaged by having submitted their resignation letter. In other words we ALL only come back when they reinstate all our contracts, making good any losses, and on more realistic payment terms. One for all, and all for one ! Bring it on.'

'I care about the NHS but not at the expense of my health and my family.'

'Let me tell you it's s**t. 12-14 hour days 40-50 consultation a day, moaning about not getting to see a GP, another reduction in drawings for more work. Staff complaining about no pay rise. My idea of a professional service is pie in the sky, it's fire fighting to get the numbers of patients seen and QoF ticked so I do not have to take another cut. The profession is gone, professionalism following soon after, I'm beginning not to give a damn anymore... Thank goodness I'll be over 50 in not so long and taking VER (voluntary early retirement) and selling my soul to whomever will let me locum or do shifts but I'm not prepared to prop up the NHS any longer on my pay cuts, back and mental health.'

'Everything you said is exactly why I relocated to Australia in 2010 - I saw it coming for UK general practice. Semi-private general practice works well over here, and co-payments are a useful income-stream to keep practice income up. So go for it - the old 20th century NHS-model doesn't fit the consumerist 21st century and broken public finances - something has to change!'

'Why not set up a website or facebook page specifically as a calls to arms for this....we are ready and waiting....thank you for your courage, i salute you! best wishes GP partner of 15 years about to have to cancel my pension to make ends meet.'

'..big battle is to beat the apathy of the rest of Gps who are watching the disintegration of GP with resignation or that they are within retirement range so cannot get exercised about it. Personally I think we are the generation of GPs who will be blamed incorrectly by history who ended family medicine.'

'you have too many people following this who support this mass resignation......please keep up the momentum.'

'must be supported in building momentum towards mass NHS resignation. If we don't, we are completely stuffed. This is a rallying call to all GPs - don't mess it up this time.'

'I can understand we are in debt and so pay has fallen at least 50% per item. It was my accountant who pointed this out. Each consultation only generates £ 3.00 take home pay now here in NI compared to over £ 6.00 9 years ago. But this extra tick box rubbish is intolerable and unjustified. Why keep increasing our workloads unnecessarily. It is pure and simple, a vindictive trashing of GPs, using the excuse of the recession. The GPC watches, wringing its hands while GPs go bankrupt. The only way is to resign and I so love the NHS, but for sure it is an unrequited love that cannot see the hours and hours of nights and days we have provided. In fact,sadly, all the papers preach a hatred that I cannot understand. That we a fabulous and wonderful and cheap resource will only be evident when it costs £50 to see a GP as it is south of this border.'

'The BMA should have started industrial action long before now.'

'I am only 49 but I am making plans to leave General Practice least I won't have the unbearable burden of trying to make things work in a thankless NHS.'

'Keep letting more and more people into the UK, don't build any more hospitals or gp surgeries and flog an ever reducing number of GP's to the point of near exhaustion.'

'Here in NI profit is £60 per patient. The Govt claws back £30 in various forms. We have slightly more than 6 consultations on average per patient per year. This is £5 per consultation. Factor in the ever burgeoning and mostly completely useless form filling and tick boxes at 40%, you are left with a profit of £3 per consultation. All the A* at GCSE and A levels and the years of training and the threat of litigation for £3.00. Do you really wish people to become GPs for this sum. No matter how much we may like the NHS and no matter how altruistic we may be, there is a point at which it becomes untenable. GPs going bankrupt seeing 40+patients a day.'

'small practice (5000 patients) loss of >£ just how can we be expected to survive, let alone take on the massive shift of workload from secondary (hospitals) to primary care (GPs)?'

'get the ball rolling for en masse resignation....come on GPC.'

'in 1965 they (BMA) collected undated resignation letters. Remember that farce when the govt imposed additional hours for no money and we were balloted "Are you just angry or are you REALLY angry".

'There will be an article on our practice in the Guardian Wednesday (April) we will be forced to close within the year because of govt and NHS England policy.'

'I am 30 and I love GP. I simply cannot believe what is happening to our profession. How is this being allowed to happen I have friends who have emigrated and are doing great, very happy. I know those who are taking early retirement.'

'You can ballot your members on mass resignation from the GP contract. This is the only card you have left and the threat must be real with a plan B for the profession. Firstly, the government may listen and acknowledge the problem. Secondly, they don't care and we resign. No NHS primary care in 4-6 months time. No private contractors are capable of stepping in at such short notice for a large number of practices...a contract which can be unilaterally altered is no contract at all.'

'You have clearly expressed what myself and many of our colleagues feel. Mass resignation is a powerful way forward. We have tried so hard to work in an NHS system to the detriment of ourselves mostly. There comes a time when enough is enough.'

'General Practice is being slowly destroyed by a government feeding expectations to a ravenous thankless public. I retired at 55, not a moment too soon. I would counsel young Doctors to stay away from the least for the foreseeable future.'

'I'm in my early 40s..I can't retire...currently a locum..a locum used to be a GP looking for a partnership, now it's more likely a GP looking for an exit from the NHS.'

'A complicated funding stream, over inspection, and a demoralised workforce with no control is turning Primary Care into an Orwellian nightmare. If we did mass resign (as my dentist sister who lives a lifestyle I will never afford in this sorry state of affairs did), the whole NHS will collapse. However with the way I and most of my peers feel at the moment we are being pushed into saying 's*d it!'

'when you do ballot for a strike,..please ban all over 50s from voting at all because they are already well on their path to retirement anyway,' younger GP partner at the mercy of her coasting towards retirement senior partners.

'I have finally had enough...and will be retiring later this year. I think doctors with skill will survive, very possibly as private GPs but there's going to be some very sticky months between now and then.'

'I am over 50...and took strike action last year. I think you will find that a lot of people simply resign and walk away rather than fight.'

'The elephant in the room is the gulf between workforce and demand.'

'I think GPs will vote for mass resignation IF there is a specific proposal on the table...if current workload continues and worsens and there is no increase in the pay per capitation to a realistic amount then GPs should be allowed to negotiate either a 1) pay per consultation fee, 2) charge for DNA's, visits or appointments above a certain number a year directly to patients or the government.'

'The workload is unsustainable and we have less than 1500 patients/FT GP in a inner city practice. It is likely to be worse in many practices. I would STRONGLY support any decision to quit the NHS. Right now we can't see patients privately either that is allowed or we quit NHS en masse. Everyone is aware there is less money to spend in times of austerity and hence the win-win for both the Governmebt and us...lots to gain by allowing us to see patients privately outside each GP's working hours just like consultants are allowed to. The alternative is to consider changing our surgery to a charity and let the patient participation group decide on our remuneration if any!'

'Safe - what is safe? I have done over 700 weekends starting at fri 9 am to mon 5 pm - 80 hours with little or no sleep. This NHS has never ever been safe - it has always run on doctors working to the bone. Who will define safety in patient numbers seen and consultation times. If not us, Why NOT?'

'Three years ago when I was made enough to join my local CCG Board I suggested that A and E departments should be paid for seeing minor injuries at the same rate as GPs were paid and that I did not understand why a review of a sprain was paid at a higher rate in A and E compared to GPs. I immediately got told off for daring to suggest such a thing. 2 other GPs on my board then immediately disciplined me and I was told that I could not be trusted to work closely with the local DGH managers as they were "upset" by my remarks. This year our CCG board is making us code all minor injuries to see if we deserve any payment at all for seeing minor injuries. So instead of questioning the payments hospitals receive, it's our payments that are in doubt which are tiny compared to the hospitals. This scheme like many others are successful because GPs are able to get things done cheaper and unfortunately many of our CCG colleagues (may) be in cahoots with hospital managers in order to save money by exploiting GPs goodwill and dumping more and more stuff on our doorstep. This project is yet another example of GPs being used by the system. It's time to say no. I feel really sorry for Manchester GPs. We cannot wait for the motion and to be able to say to our CCG "leaders", the public and the government, that we have had enough and wish to resign from the NHS.'

'I retired much earlier than I had planned (to live a less materialistic but greatly more satisfying life) mainly because of the rise of telephone triage. The only way we could manage demand for appointments was to triage all appointment requests. My all time record was 130 calls (plus scripts, results, the odd home visits and walk-in). I used to lie awake at night worrying about all the wrong decisions I might have made. It seems inevitable that as demand grows, more practices will be forced into this way of working. Prescribing over the phone without face to face assessment is asking for trouble. I sleep much better now, going to bed knowing I'm not going to be gambling with someone's life.'