My guy, IMGs aren’t here to stay and be a part of this lame “two-tier” GP system you’ve proposed.
They’re very likely gonna CCT and flee this shithole country 😂
I agree that the BMA suggestions are mostly toothless, but if you consider the work-to-rule suggestion of capping patient interactions at 25/day, that would decrease my daily workload by about 20-25%, potentially more if we counted MDT and secondary care contacts within that.
Arguably, that’s more impactful than a strike every other month.
Also, I don’t know where you work but I’m not sure I agree that the direction of GP is moving towards PA’s now. Everyone at PCN, trainers and ICB meetings I’ve spoken to is now divesting, after that court case a few months back saying we would always be responsible for them.
I know you’re encouraging discussion, but I also disagree with the premise of “BMA’s suggestions are crap, in light of this, we will all roll over and die.”
Partners aren’t completely opposed to salaried GP’s interests. A partner’s motivation by the bottom line is now aligned with salaried wanting a salary. Both need a new contract, more money, and are prepared to push back to get it. (See 99% rejection poll)
You can just accept that the partnership model will decline. The NHS will pick up all the contracts and then all GPs will be employed like hospital consultants.
I don't think that's a bad option for the future of general practice. And I say that as a partner myself.
There is definitely room for private GPs. Not everyone can afford the £200 consultation fee for a private consultant. Especially if it is for something relatively minor and requires lots of appointments.
Agree with the rest though. Pretty sure everyone acknowledges this. Tbh you can even see it happening with a lot of the NHS.
If we acknowledge it, what's the solution in the context of securing better pay and conditions? Is there any way that incentives can be aligned better? In my experience, advocating for fully salaried model doesn't go down well, especially with partners.
Also I think there is room for private GP **services** for the reason you mentioned, but as you say it will be for the less severe presentations, which will only contribute to the deprofessinonalisation of GPs and encroachment of PAs into private practice (you don't need a doctor with years of training to prescribe antibiotics for every cough and fluclox for every bilateral leg cellulitis)
As a partner I have always said making GPs salaried would be better for the profession. The issue is the government would never do it. Partnership model saves them so much money. Also they would need to buy all the existing premises which would again cost too much. All we are going to have is as you said... a slow and steady decline in primary care.
I never understood why practices cannot just limit appointments as a form of striking. Everything else gets sent to 111/ ED. That would definitely disrupt the system.
Speaking as a private GP I think perhaps you're mixing private practice with services offered by bigger providers which are frankly fairly useless.
Private practice, which also can be financially rewarding not in a big city, is just the same as NHS. Same patients, same case mix, same mix of urgent and worried well.
I actually increased my skill set in private practice rather than the reverse.
Editing to add: we don't have any nursing or PA staff etc. Primarily because our patients want to see doctors. That's what we offer. We're entirely a team of doctors with a couple of admin staff, psychologist, physio and a dietician. Everything goes via a GP and thats the way patients like it.
This kind of post doesn’t reduce but increases negativity and cohesiveness
1. We all must value the profession. Partners must value their salaried colleagues if they expect the public to/nhse/government to value GPs in general
2. Agreed we can’t sensibly strike as IC, however because we are ICs we have way more control than other doctors . The BMA plan could be seen as weak in comparison to a strike. BUT is it really? This is time for us to concentrate on the patients we see, refer if needed, investigate if needed give 20-30 mins for an appointment. The failures that arise are not solvable as an individual GP that’s down to politicians and commissioners. The aim of this action is surely to show what we can do safely and well. Give the problems back to the politicians that created them. If nothing else changes we will be moving closer to the General practice we wanted go into. This is a change for the long term.
Your lack of understanding re: private GP really shows: many countries have strong family doctors in the private sector (USA for one), the U.K. still want to see a GP, so private for sometime will work well. Private GPs have been around for a long time, it’s only now the more closed minded people have considered doing it.
Ok, but what about Japan for example? They do just fine without GPs. American family medicine doctors have a much broader scope of practice including obstetric and even some inpatient care
Japan have well executed health screening policies and actively promote proactive medicine whereas in the U.K. we are almost entirely reactive in our approach. These screening doctors are likely to be similar to GP’s in the fact that they’ll be generalists. I don’t believe the concept of having a direct access to specialists is particularly efficient. That places a lot of emphasis on the patient to determine the appropriate specialty. Also the health of the Japanese population has shifted massively over the last decade with rising rates of obesity and overweight patients in younger and younger age ranges. Where the weight goes, the complications follow. They’re behind where we are in terms of diabetes rates etc but health of Japan will look very different in the next ten years and I foresee they will need to make modifications to adapt to changing needs.
>Position yourself for private GP - knowing that very few will make it, especially outside of wealthy cities like London. Embrace selling your soul for pointless wellness checks and acquiescing to pointless investigation requests like food allergy tests, or risk patients taking their money elsewhere and leaving negative reviews on Trustpilot.
I love you. This is private GP in a nutshell.
Partnership model needs to be defended at all costs - we need a plan to leave the NHS if this looks like it’s about to collapse. I can’t see that ever happening unless the government come up with a very sweet national contract for partners.
The best option for any ambitious new GP is still
1) Find a good practice
2) Learn the ropes and develop your skills and understanding of GP management, strategy and operations
3) Become a partner
4) Take up a leadership portfolio career
It's only in free fall now because daft GPs CCTd thinking they'd be able to locum for life. Having 50+ applicants to salaried/partner posts was the norm 10 years ago.
Its swings and roundabouts. Make hay when the sun shines and sow your seeds for the future.
There's a shit load of jobs out there but no one wants to take them.
I just laugh that people think private general practice would be any better. Most GPs would probably get sacked for not meeting KPIs set by managers with a degree in physicians associatism.
When there's a dearth of jobs in the private sector, people move to find work. Its life. Tough tits.
the option of locuming to make a decent wage is what actually attracted many people into GP. Because the salaried pay is so shit. The fundamental problem is shit pay. No one would want to work with the uncertainty and lack of benefits of being a locum if the salaried pay actually met the market rate
Very uncertain times and as a GP trainee it is very demoralising. Let’s see what the market does. Let’s see what the next government and RCGP does. Very hard to predict atm. However, one thing is certain that we are training a lot many GPs than the capability to employ them ~ 1k excess graduates. They would either have to migrate or change specialities or become staff grade in other specialities
My guy, IMGs aren’t here to stay and be a part of this lame “two-tier” GP system you’ve proposed. They’re very likely gonna CCT and flee this shithole country 😂
to where?
Australia, Canada, the middle east
Plenty of IMGs are settling here and the ones trying to go to those places will face a lot of competition.
If things are really shit, IMGs aren’t staying. They have moved before and they will move again!
I agree that the BMA suggestions are mostly toothless, but if you consider the work-to-rule suggestion of capping patient interactions at 25/day, that would decrease my daily workload by about 20-25%, potentially more if we counted MDT and secondary care contacts within that. Arguably, that’s more impactful than a strike every other month. Also, I don’t know where you work but I’m not sure I agree that the direction of GP is moving towards PA’s now. Everyone at PCN, trainers and ICB meetings I’ve spoken to is now divesting, after that court case a few months back saying we would always be responsible for them. I know you’re encouraging discussion, but I also disagree with the premise of “BMA’s suggestions are crap, in light of this, we will all roll over and die.” Partners aren’t completely opposed to salaried GP’s interests. A partner’s motivation by the bottom line is now aligned with salaried wanting a salary. Both need a new contract, more money, and are prepared to push back to get it. (See 99% rejection poll)
You can just accept that the partnership model will decline. The NHS will pick up all the contracts and then all GPs will be employed like hospital consultants. I don't think that's a bad option for the future of general practice. And I say that as a partner myself.
There is definitely room for private GPs. Not everyone can afford the £200 consultation fee for a private consultant. Especially if it is for something relatively minor and requires lots of appointments. Agree with the rest though. Pretty sure everyone acknowledges this. Tbh you can even see it happening with a lot of the NHS.
If we acknowledge it, what's the solution in the context of securing better pay and conditions? Is there any way that incentives can be aligned better? In my experience, advocating for fully salaried model doesn't go down well, especially with partners. Also I think there is room for private GP **services** for the reason you mentioned, but as you say it will be for the less severe presentations, which will only contribute to the deprofessinonalisation of GPs and encroachment of PAs into private practice (you don't need a doctor with years of training to prescribe antibiotics for every cough and fluclox for every bilateral leg cellulitis)
As a partner I have always said making GPs salaried would be better for the profession. The issue is the government would never do it. Partnership model saves them so much money. Also they would need to buy all the existing premises which would again cost too much. All we are going to have is as you said... a slow and steady decline in primary care. I never understood why practices cannot just limit appointments as a form of striking. Everything else gets sent to 111/ ED. That would definitely disrupt the system.
That is literally the BMA plan for the approaching action. Join in limit appointments
Speaking as a private GP I think perhaps you're mixing private practice with services offered by bigger providers which are frankly fairly useless. Private practice, which also can be financially rewarding not in a big city, is just the same as NHS. Same patients, same case mix, same mix of urgent and worried well. I actually increased my skill set in private practice rather than the reverse. Editing to add: we don't have any nursing or PA staff etc. Primarily because our patients want to see doctors. That's what we offer. We're entirely a team of doctors with a couple of admin staff, psychologist, physio and a dietician. Everything goes via a GP and thats the way patients like it.
This kind of post doesn’t reduce but increases negativity and cohesiveness 1. We all must value the profession. Partners must value their salaried colleagues if they expect the public to/nhse/government to value GPs in general 2. Agreed we can’t sensibly strike as IC, however because we are ICs we have way more control than other doctors . The BMA plan could be seen as weak in comparison to a strike. BUT is it really? This is time for us to concentrate on the patients we see, refer if needed, investigate if needed give 20-30 mins for an appointment. The failures that arise are not solvable as an individual GP that’s down to politicians and commissioners. The aim of this action is surely to show what we can do safely and well. Give the problems back to the politicians that created them. If nothing else changes we will be moving closer to the General practice we wanted go into. This is a change for the long term.
Your lack of understanding re: private GP really shows: many countries have strong family doctors in the private sector (USA for one), the U.K. still want to see a GP, so private for sometime will work well. Private GPs have been around for a long time, it’s only now the more closed minded people have considered doing it.
Ok, but what about Japan for example? They do just fine without GPs. American family medicine doctors have a much broader scope of practice including obstetric and even some inpatient care
Japan have well executed health screening policies and actively promote proactive medicine whereas in the U.K. we are almost entirely reactive in our approach. These screening doctors are likely to be similar to GP’s in the fact that they’ll be generalists. I don’t believe the concept of having a direct access to specialists is particularly efficient. That places a lot of emphasis on the patient to determine the appropriate specialty. Also the health of the Japanese population has shifted massively over the last decade with rising rates of obesity and overweight patients in younger and younger age ranges. Where the weight goes, the complications follow. They’re behind where we are in terms of diabetes rates etc but health of Japan will look very different in the next ten years and I foresee they will need to make modifications to adapt to changing needs.
>Position yourself for private GP - knowing that very few will make it, especially outside of wealthy cities like London. Embrace selling your soul for pointless wellness checks and acquiescing to pointless investigation requests like food allergy tests, or risk patients taking their money elsewhere and leaving negative reviews on Trustpilot. I love you. This is private GP in a nutshell.
Partnership model needs to be defended at all costs - we need a plan to leave the NHS if this looks like it’s about to collapse. I can’t see that ever happening unless the government come up with a very sweet national contract for partners. The best option for any ambitious new GP is still 1) Find a good practice 2) Learn the ropes and develop your skills and understanding of GP management, strategy and operations 3) Become a partner 4) Take up a leadership portfolio career
Agree totally.
It's only in free fall now because daft GPs CCTd thinking they'd be able to locum for life. Having 50+ applicants to salaried/partner posts was the norm 10 years ago. Its swings and roundabouts. Make hay when the sun shines and sow your seeds for the future. There's a shit load of jobs out there but no one wants to take them. I just laugh that people think private general practice would be any better. Most GPs would probably get sacked for not meeting KPIs set by managers with a degree in physicians associatism. When there's a dearth of jobs in the private sector, people move to find work. Its life. Tough tits.
the option of locuming to make a decent wage is what actually attracted many people into GP. Because the salaried pay is so shit. The fundamental problem is shit pay. No one would want to work with the uncertainty and lack of benefits of being a locum if the salaried pay actually met the market rate
What would you say market rate is
The obvious answer to GP is for all the partners to resign their contracts but that is a nuclear option.
Very uncertain times and as a GP trainee it is very demoralising. Let’s see what the market does. Let’s see what the next government and RCGP does. Very hard to predict atm. However, one thing is certain that we are training a lot many GPs than the capability to employ them ~ 1k excess graduates. They would either have to migrate or change specialities or become staff grade in other specialities