As this week’s BMA poll demonstrates, 90% of GPs are feeling under pressure as resources shrink, workload increases and another reorganisation washes over the NHS. So nothing new then.
As the English NHS heads for the buffers, we must fight to preserve a resilient, free and independent service that treats patients on the basis of their need and not on the size of their wallet.
Over the course of the last year the NHS has had to cope with another unnecessary pressure: the complex challenges facing our health service have been boiled down by government into cheap sound-bites and vacuous political point scoring.
The on-going issues with emergency care are a good case in point. The roots of this problem include reductions in bed numbers, staff shortages in key departments and the botched introduction of NHS 111.
An aging population requires increasingly intensive and expensive healthcare that rightly consumes time and resources. The NHS now has 18 million patients of all age groups that have chronic conditions; many managed primarily by GPs, but some requiring emergency admission. RB, acutely sick people going to A&E are not committing a crime.
Problems with urgent care need a sensible, rational and joined up solution involving NHS staff and patients. Guess who hasn’t bothered to ask or listen? Instead, the causes of this complex problem have been simplistically blamed on GPs or out-of-hours care. Without a scrap of evidence to back them up, hey presto, another set of ill defined reforms to out of hours. A magic wand to solve all the challenges besetting the NHS. What incoherence that the government forced the NHS to defund the GP co-ops that delivered out-of-hours care so well, and shunt the money into the NHS111 fiasco?
GPs working hard
The facts are clear: GPs are working harder and more effectively than ever before.
We are undertaking more consultations per patient and getting through a million appointments a day across the UK. The QOF has helped boost diagnosis and treatment rates for conditions like diabetes. More than nine out of ten patients trust their GP and the work they do.
A government survey recently showed that seven out of ten patients were satisfied with their out-of-hours care they receive. Out-of-hours care is not perfect. It has been starved of investment for decades. It will not improve with a war of words and insults in the media.
In England, the imposition of changes to the GP contract this year will pile more pressure on already overstretched services. Practice funding will fall once more and there will be a new wave of oppressive box-ticking and micromanagement. Some of the changes have no basis in clinical evidence or, in some cases, reality.
Lack of evidence
What benefit is there from conducting a yearly survey of diabetic patients asking them if they have erectile dysfunction? Why am I now asking large numbers of patients if they do the gardening, or old people with Zimmer frames if they go cycling? And why are we testing healthy people in their thirties for blood pressure problems when there is little evidence this group is suffering from this condition?
The QOF that the BMA help to bring into being in 2004 was designed to support high quality practice work and should be used for exactly that. They managed it in Scotland, Wales and Northern Ireland, so why not in England? GPs have to have time to treat patients holistically, to treat patients as people not diseases, and offer the continuity of care that we and they want and need.
For the moment the four country contract stands as we are much more effective together than separately and negotiations in each nation feed off each other.
Since the English contract imposition, we have spent a lot of time producing a survival guide for practices, and held road-shows all over the country so that all GPs could hear from us how bad it might be. We have also issued support material aimed at patients to help GPs explain service changes and pressures to them.
Since April we have endured the latest top-down, NHS reorganisation in England. The vision initially presented by government sounded OK to many GPs – it promised more power to local clinicians and less political interference. But I’m really worried that an alternative vision is taking hold, where competition rules the roost and tenders are won by the lowest bidder.
This is not conjecture. It’s happening. How else can one explain the bizarre turn of events when all the GPs in Hackney tried to deliver out-of-hours Care and were stopped by their PCT?
Clinical commissioning groups still have a chance to protect what is best about our NHS. But they must do this by working with all GPs in their area and with colleagues in their local hospitals, public health services, and with patients. They are the only hope of a safety net – to ensure patients continue to have access to high-quality, local NHS services.
However much we dislike the changed NHS, GPC has to help English GPs cope with it, and we have issued plenty of material to help them avoid the worst of this new system. We must not see the rise of conflicts of interest or competitive tendering that ends in repeated court battles. The BMA’s new patient resources will help explain the changes to a wider audience.
We will continue to be vocal to the public and straight with our patients about what the results of the English government’s approach to their NHS will be. General practice is stretched beyond capacity, saddled with box-ticking administration, unrealistic workload and declining resources. Ministers must stop announcing things without thinking and work for real solutions with those who know how to deliver healthcare.
One of my biggest fears is for the next generation of GPs. With a shortfall in GPs applying for partnerships, we desperately need more young doctors to choose this path. Yet the trainees’ supplement that enables trainees to afford to train in general practice has just been cut. We’re lobbying hard to protect this supplement, as well as to try to secure funding for the fourth year of training.
Locums are a vital part of the GP workforce and we need them more than ever. Yet, in just the last few months we have had a disastrous change in how locum superannuation is paid – reducing funding to those practices that use locums the most. Guess who did not listen?
With revalidation and the CQC registration of general practice – both introduced in the past year – we have liaised closely with the respective organisations involved to make them work, for patients and doctors. Revalidation systems might even work for principals but how locums can get feedback from patients when they are never in the same place for more than a day I do not know. The GMC says that locum appraisers can agree to look at things other than multi-source feedback. Locum GPs will now have to pay for their own appraisal, with no warning this was coming. Guess who did not listen? This is unacceptable and something we will continue to fight.
We need a real debate within the profession as well as an engagement with patients and government about what they really want the NHS to look like.
With government that is something that lies in minister’s hands. It is time for them to stop using GPs as a political football – the politics must be taken out of the NHS. Don’t give us all the 'jewel in the crown' stuff while briefing against us in the press. GPs won’t hang around forever while competing politicians try to climb the greasy pole on doctors’ backs.
I have many people to thank including the UK Negotiating Team of Richard, Peter, Chaand, and Dean, the three Celtic chairmen Alan, David and Tom; our assistant secretary Fleur Nielsen, Chris Finlan and Gail Norcliffe our heads of division, all the senior policy executives, executive officers and admin staff of GPC, and our wonderful PA Jenny Jamieson.
I also want to thank BMA staff including the communications directorate, the health policy unit, the pensions department and our lawyers. I must end with a word of gratitude to the GPC who elected me and who have supported this team of Negotiators through some rotten and many good times.
On July 18th I step down after 16 years on the Neg Team and return to my practice almost full-time. Some of you will be pleased I am going, though not as much as my wife. I have been privileged to be elected to the task, and to have received the support of most of the 46,000 GPs and well as the RB.
RB, Mr Chairman, I move my report to the ARM. An artist knows when to stop. So this is it.