Why I fear GPs are part of the NHS's problem, not the solution, by surgeon J. MEIRION
19 November 2014, 07:14 AM
#1
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
Why I fear GPs are part of the NHS's problem, not the solution, by surgeon J. MEIRION
19 November 2014, 09:01 AM
#3
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
He's being somewhat of an iconoclast here and it's refreshing. He's right that the BMA is basically a special interest group and as such resistant to change.
19 November 2014, 09:14 AM
#4
Scooby Regular
Join Date: Dec 2006
Location: Mars
Posts: 11,470
Likes: 0
Received 0 Likes
on
0 Posts
The shortage of doctors a while back meant salaries went slightly mad; so we're "stuck" with (some) overpaid and sometimes complacent GPs still calling the shots.
19 November 2014, 09:19 AM
#5
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
As for the 2004 pay deal everyone knows it was excessive.
19 November 2014, 10:17 AM
#6
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
Meanwhile in the real world:
I took home £27k last year, albeit for a 34 hour week. Not bad, but as my accountant says, unlikely to set the heather alight. Much of my net worth has been made through investments and vehicle engineering work.
My drawings are suspended until next year whilst two of my three colleagues are absent due to maternity leave and critical illness, the remaining one is part time.
I have been cited to go to court at five days notice and cannot get someone on the phone to work out how I can close my practice as I am the last man standing.
Somehow an independent survey of my patients revealed saturated satisfaction ratings.
What is described in the article is not representative of what I see working in General Practice, which I suspect this Professor of sarcoma surgery hasn't. Clever he may be with sarcomas, his comments are laughable not only amongst GPs but specialist colleagues I know. The Royal College of Surgeons have distanced themselves from his previous Daily Mail article.
GP forums have a meme of RLE, "retire, locum, emigrate" and many that can are, which has created a workforce crisis worse than 2004.
The primary care model in the UK was world renowned and many elements of it have been copied and presently are being in the US.
Over 90% of patient contacts are dealt with in GP for 8% of NHS budget, a dwindling share.
My patients, and I would do better with no NHS, regardless of what happens to General Practice. The problem is increased uptake of services rather than the NHS being a safety net. I do think the NHS is on a path to destruction, and I won't miss it.
I took home £27k last year, albeit for a 34 hour week. Not bad, but as my accountant says, unlikely to set the heather alight. Much of my net worth has been made through investments and vehicle engineering work.
My drawings are suspended until next year whilst two of my three colleagues are absent due to maternity leave and critical illness, the remaining one is part time.
I have been cited to go to court at five days notice and cannot get someone on the phone to work out how I can close my practice as I am the last man standing.
Somehow an independent survey of my patients revealed saturated satisfaction ratings.
What is described in the article is not representative of what I see working in General Practice, which I suspect this Professor of sarcoma surgery hasn't. Clever he may be with sarcomas, his comments are laughable not only amongst GPs but specialist colleagues I know. The Royal College of Surgeons have distanced themselves from his previous Daily Mail article.
GP forums have a meme of RLE, "retire, locum, emigrate" and many that can are, which has created a workforce crisis worse than 2004.
The primary care model in the UK was world renowned and many elements of it have been copied and presently are being in the US.
Over 90% of patient contacts are dealt with in GP for 8% of NHS budget, a dwindling share.
My patients, and I would do better with no NHS, regardless of what happens to General Practice. The problem is increased uptake of services rather than the NHS being a safety net. I do think the NHS is on a path to destruction, and I won't miss it.
Last edited by john banks; 19 November 2014 at 10:21 AM.
19 November 2014, 10:46 AM
#7
Hi John
I am not saying he is completely right, just that I hold his opinion as one of note. of course, GPs like yourself who are at the coal face see the real world experience and have very valid opinions.
Slightly off-topic here: What I have certainly noticed in my time is that city GP's have certainly moved from a 'caring for the person approach' to a 'treat the condition' approach. So, yes, less personal caring but with the numbers they need to see then it is not suprising as they would not have the time to see everyone if they took a personal interest in that persons wellbeing.
I am not saying he is completely right, just that I hold his opinion as one of note. of course, GPs like yourself who are at the coal face see the real world experience and have very valid opinions.
Slightly off-topic here: What I have certainly noticed in my time is that city GP's have certainly moved from a 'caring for the person approach' to a 'treat the condition' approach. So, yes, less personal caring but with the numbers they need to see then it is not suprising as they would not have the time to see everyone if they took a personal interest in that persons wellbeing.
Trending Topics
19 November 2014, 11:12 AM
#8
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
Meanwhile in the real world:
I took home £27k last year, albeit for a 34 hour week. Not bad, but as my accountant says, unlikely to set the heather alight. Much of my net worth has been made through investments and vehicle engineering work.
My drawings are suspended until next year whilst two of my three colleagues are absent due to maternity leave and critical illness, the remaining one is part time.
I took home £27k last year, albeit for a 34 hour week. Not bad, but as my accountant says, unlikely to set the heather alight. Much of my net worth has been made through investments and vehicle engineering work.
My drawings are suspended until next year whilst two of my three colleagues are absent due to maternity leave and critical illness, the remaining one is part time.
GP forums have a meme of RLE, "retire, locum, emigrate" and many that can are, which has created a workforce crisis worse than 2004.
Last edited by tony de wonderful; 19 November 2014 at 11:19 AM.
19 November 2014, 11:12 AM
#9
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
I suspect you are right, I never wanted to be an urban GP because I could see years ago that it would be constant fire fighting, never meeting the demand to get time to think ahead. For every one 'entitled demander' I might have, I suspect they have more and that they rapidly grow a thick skin to protect themselves and their staff against what can feel like an onslaught of abuse and medicalisation of everything possible for gain. How do you switch from being like this to being open, exploratory, caring and sensitive when someone has just abused you because you have said no to their illegal, non medical or manipulative requests?
The actual medicine is a lot more interesting in a rural practice where you do have a bit more time to think as it isn't so drowned out by all the other stuff. I think many would be surprised by how much we get done before the patient gets to see the specialist and how much specialists now work it seems to us more like technicians only looking at their own narrow field and excluding some diagnoses rather than making a diagnosis. Nurse specialists need caution too, they do not save time or money and there are some calamities when their even narrower remit misses things that someone with a medical training spots. I have sometimes had to rerefer to get the cancer diagnosed because whilst I knew and spelled out what I thought was wrong in my referral letter, they were only seen by a nurse specialist working to a protocol. Not their fault, but the fault of their supervision and protocols.
The actual medicine is a lot more interesting in a rural practice where you do have a bit more time to think as it isn't so drowned out by all the other stuff. I think many would be surprised by how much we get done before the patient gets to see the specialist and how much specialists now work it seems to us more like technicians only looking at their own narrow field and excluding some diagnoses rather than making a diagnosis. Nurse specialists need caution too, they do not save time or money and there are some calamities when their even narrower remit misses things that someone with a medical training spots. I have sometimes had to rerefer to get the cancer diagnosed because whilst I knew and spelled out what I thought was wrong in my referral letter, they were only seen by a nurse specialist working to a protocol. Not their fault, but the fault of their supervision and protocols.
19 November 2014, 11:17 AM
#10
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
Rather selective and loaded a question. From where I'm sitting, the GP NHS system has many of the disadvantages of public and private. For example, many of my patients want me to treat them privately, but I cannot. If I could I would have more direct, prompt access to investigations and more time. 10 mins isn't enough for multiple complex problems.
I don't own a piece of the NHS. It is illegal to sell goodwill. If I leave by closure due to failure, I have a building that is worth less than the debts on it if not used as a GP surgery and I have staff to make redundant. It would result in my personal bankruptcy.
19 November 2014, 11:22 AM
#11
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
I appreciate that you are taking a financial risk John but its nothing like the risks any ordinary business faces, where 8/10 start-ups will fail.
19 November 2014, 11:58 AM
#13
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
John, I read talk about how all UK doctors are going to emigrate and I've heard this for years. We live in a globalised world though with easy movement of labor, so what are the barriers preventing the NHS hiring thousands of foreign doctors? Other industries are easily able to avoid skills shortages in this way and statistically the UK offers some of the best pay in the world for doctors.
There are an increasing number of failing or failed GP surgeries who are reliant on foreign locums. When looking for locums in the past few weeks it struck me how many were not UK trained and how poor their communication skills were.
19 November 2014, 12:33 PM
#14
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
As for communication skills I sort of understand that, but to an extent its relative and one also needs to adapt to other people/cultures.
19 November 2014, 01:03 PM
#15
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
The comment about how few were UK trained was in response to you asking where all the foreigners were. I don't know of any barriers to EU registered doctors working in the UK.
Communication skills are important in medicine when you are dealing with ill people who often have a degree of sensory deprivation. My patients claim not to be able to understand many foreign doctors. Some of them are closet or not so closet racists, but not the majority. From my personal experience, which is not prejudice, I have had trouble with the clinical abilities, work ethic and communication skills with a small minority of colleagues, but there was a disproportionate representation of non UK training where there have been problems. Lack of language skills dealing with white elderly Scottish patients results in them having no confidence they were understood. Often they weren't and serious errors can result. I would not attempt to practise overseas unless my language skills were equivalent to native.
Communication skills are important in medicine when you are dealing with ill people who often have a degree of sensory deprivation. My patients claim not to be able to understand many foreign doctors. Some of them are closet or not so closet racists, but not the majority. From my personal experience, which is not prejudice, I have had trouble with the clinical abilities, work ethic and communication skills with a small minority of colleagues, but there was a disproportionate representation of non UK training where there have been problems. Lack of language skills dealing with white elderly Scottish patients results in them having no confidence they were understood. Often they weren't and serious errors can result. I would not attempt to practise overseas unless my language skills were equivalent to native.
Last edited by john banks; 19 November 2014 at 01:06 PM. Reason: Correcting autocorrect so my language skills are not hypocritical
19 November 2014, 01:14 PM
#16
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
BTW, the UK does rather well for the quality of its medical education. Methodologies vary, but consider the locations of the top 50 medical universities and then where the available doctors come from and how the list varies.
19 November 2014, 01:25 PM
#17
Scooby Regular
iTrader: (17)
Join Date: Nov 2011
Location: London
Posts: 1,425
Likes: 0
Received 0 Likes
on
0 Posts
I used to work in the BMI building for the BMJ. Within the BMA everyone received the same pay rise as the GP's in 2004, was very nice!
Within the BMA most agree that the NHS is an outdated system that has just grown so large that's in inefficient for government to run it. Privatisation is the only way forward.
In the meantime, the whole system is just a half arsed attempt at providing free care.
GP surgeries receive incentives for not referring people and prescribing certain drugs (normally cheaper versions of more effective drugs).
Its all a joke. Now i have a 4 month old son, just today i have called round to get private healthcare costs. Hopefully i can afford it, because the care we get from our GP is CRAP.
Within the BMA most agree that the NHS is an outdated system that has just grown so large that's in inefficient for government to run it. Privatisation is the only way forward.
In the meantime, the whole system is just a half arsed attempt at providing free care.
GP surgeries receive incentives for not referring people and prescribing certain drugs (normally cheaper versions of more effective drugs).
Its all a joke. Now i have a 4 month old son, just today i have called round to get private healthcare costs. Hopefully i can afford it, because the care we get from our GP is CRAP.
19 November 2014, 01:45 PM
#18
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
The comment about how few were UK trained was in response to you asking where all the foreigners were. I don't know of any barriers to EU registered doctors working in the UK.
Communication skills are important in medicine when you are dealing with ill people who often have a degree of sensory deprivation. My patients claim not to be able to understand many foreign doctors. Some of them are closet or not so closet racists, but not the majority. From my personal experience, which is not prejudice, I have had trouble with the clinical abilities, work ethic and communication skills with a small minority of colleagues, but there was a disproportionate representation of non UK training where there have been problems. Lack of language skills dealing with white elderly Scottish patients results in them having no confidence they were understood. Often they weren't and serious errors can result. I would not attempt to practise overseas unless my language skills were equivalent to native.
Communication skills are important in medicine when you are dealing with ill people who often have a degree of sensory deprivation. My patients claim not to be able to understand many foreign doctors. Some of them are closet or not so closet racists, but not the majority. From my personal experience, which is not prejudice, I have had trouble with the clinical abilities, work ethic and communication skills with a small minority of colleagues, but there was a disproportionate representation of non UK training where there have been problems. Lack of language skills dealing with white elderly Scottish patients results in them having no confidence they were understood. Often they weren't and serious errors can result. I would not attempt to practise overseas unless my language skills were equivalent to native.
Fair point about communication but english is the worlds most widely spoken language, not that formal language ability is all that communication revolves around, but the UK has far more opportunity to source foreign doctors than other places which don't speak english primarily. One wonders how many other countries in Europe manage to recruit enough doctors.
19 November 2014, 02:06 PM
#19
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
You are expressing an opinion about restrictiveness without knowing all the information. An English language test is new for EU doctors. The GMC has no interest in running a closed shop. I am not a BMA member.
19 November 2014, 02:11 PM
#20
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
All professions restrict entry and close off competition, but you are right, I don't have all the details to hand.
19 November 2014, 02:22 PM
#21
Scooby Regular
TDW, your hatred for doctors and GPs in particular makes it impossible for you to have rational debate on the matter.
What you've written so far is full of so much misinformation I'm struggling to know where to start, actually I can't really be bothered.
You talk about the BMA being all powerful, it's actually an impotent organanisation, believe me, I'm a member.
You imply the GMC is some kind of 'union' preventing some kind of free labour. We are talking about doctors here not dock workers. They are there to make sure only appropriately qualified doctors care for you when you are sick.
As for 'foreign' doctors, you'd be the first to complain if you were treated by a doctor with poor language skills. Hell, you refuse to even use a taxi driven by a Pakistani!
https://www.scoobynet.com/non-scooby...rcharging.html
What you've written so far is full of so much misinformation I'm struggling to know where to start, actually I can't really be bothered.
You talk about the BMA being all powerful, it's actually an impotent organanisation, believe me, I'm a member.
You imply the GMC is some kind of 'union' preventing some kind of free labour. We are talking about doctors here not dock workers. They are there to make sure only appropriately qualified doctors care for you when you are sick.
As for 'foreign' doctors, you'd be the first to complain if you were treated by a doctor with poor language skills. Hell, you refuse to even use a taxi driven by a Pakistani!
https://www.scoobynet.com/non-scooby...rcharging.html
19 November 2014, 02:31 PM
#22
Scooby Regular
Thread Starter
Join Date: Mar 2010
Posts: 10,329
Likes: 0
Received 0 Likes
on
0 Posts
TDW, your hatred for doctors and GPs in particular makes it impossible for you to have rational debate on the matter.
What you've written so far is full of so much misinformation I'm struggling to know where to start, actually I can't really be bothered.
You talk about the BMA being all powerful, it's actually an impotent organanisation, believe me, I'm a member.
You imply the GMC is some kind of 'union' preventing some kind of free labour. We are talking about doctors here not dock workers. They are there to make sure only appropriately qualified doctors care for you when you are sick.
As for 'foreign' doctors, you'd be the first to complain if you were treated by a doctor with poor language skills. Hell, you refuse to even use a taxi driven by a Pakistani!
https://www.scoobynet.com/non-scooby...rcharging.html
What you've written so far is full of so much misinformation I'm struggling to know where to start, actually I can't really be bothered.
You talk about the BMA being all powerful, it's actually an impotent organanisation, believe me, I'm a member.
You imply the GMC is some kind of 'union' preventing some kind of free labour. We are talking about doctors here not dock workers. They are there to make sure only appropriately qualified doctors care for you when you are sick.
As for 'foreign' doctors, you'd be the first to complain if you were treated by a doctor with poor language skills. Hell, you refuse to even use a taxi driven by a Pakistani!
https://www.scoobynet.com/non-scooby...rcharging.html
19 November 2014, 02:36 PM
#23
Scooby Regular
Join Date: Dec 2006
Location: Mars
Posts: 11,470
Likes: 0
Received 0 Likes
on
0 Posts
Not sure I'd call it hatred.
Doctors are bright, well educated and clearly empathic.
What I have a beef with is any public sector job that's overpaid and despite the ethical responsibility, a qualified doctor doesn't need to look for work. Many pretend they are business people by doing private work but it's nothing like the real World. So there's a lot of moaning while being paid more than most successful business people who have taken huge risks; people that would give their right arm for a guaranteed supply of work.
I know loads of doctors; all good people but they don't half moan about who tough their jobs are while sending kids to the best schools, living in the biggest houses, etc.
It's all since the shortage; suddenly GPs had all the power and ten years later, the tax payer is suffering IMO.
We just can't afford the NHS as it is and have to make cuts and allowances.
Doctors are bright, well educated and clearly empathic.
What I have a beef with is any public sector job that's overpaid and despite the ethical responsibility, a qualified doctor doesn't need to look for work. Many pretend they are business people by doing private work but it's nothing like the real World. So there's a lot of moaning while being paid more than most successful business people who have taken huge risks; people that would give their right arm for a guaranteed supply of work.
I know loads of doctors; all good people but they don't half moan about who tough their jobs are while sending kids to the best schools, living in the biggest houses, etc.
It's all since the shortage; suddenly GPs had all the power and ten years later, the tax payer is suffering IMO.
We just can't afford the NHS as it is and have to make cuts and allowances.
19 November 2014, 02:37 PM
#24
Scooby Regular
Not derailing, it is appropriate.
You are implying (with no factual basis) that UK doctors are acting as a vested interest group to not allow foreign doctors into the country.
Yet you aren't even prepared to get into a taxi driven by a 'paki'
You are trolling and have been called out
19 November 2014, 03:01 PM
#27
Scooby Regular
Not sure I'd call it hatred.
Doctors are bright, well educated and clearly empathic.
What I have a beef with is any public sector job that's overpaid and despite the ethical responsibility, a qualified doctor doesn't need to look for work. Many pretend they are business people by doing private work but it's nothing like the real World. So there's a lot of moaning while being paid more than most successful business people who have taken huge risks; people that would give their right arm for a guaranteed supply of work.
I know loads of doctors; all good people but they don't half moan about who tough their jobs are while sending kids to the best schools, living in the biggest houses, etc.
It's all since the shortage; suddenly GPs had all the power and ten years later, the tax payer is suffering IMO.
We just can't afford the NHS as it is and have to make cuts and allowances.
Doctors are bright, well educated and clearly empathic.
What I have a beef with is any public sector job that's overpaid and despite the ethical responsibility, a qualified doctor doesn't need to look for work. Many pretend they are business people by doing private work but it's nothing like the real World. So there's a lot of moaning while being paid more than most successful business people who have taken huge risks; people that would give their right arm for a guaranteed supply of work.
I know loads of doctors; all good people but they don't half moan about who tough their jobs are while sending kids to the best schools, living in the biggest houses, etc.
It's all since the shortage; suddenly GPs had all the power and ten years later, the tax payer is suffering IMO.
We just can't afford the NHS as it is and have to make cuts and allowances.
Mattee, you are trying to compare apples and oranges. I probably wouldn't make a very good businessman (because I'm not selfish enough) but many of the succesful businessmen you talk of more than likely could not do what I do.
Many times you've accused people like me of having no idea of what it's like 'living in the real world'.
I'll tell you again what I've told you before. Spend 48hrs with me on call in a busy hospital with death, disease, vomit, faeces, child abuse, rape victims, gunshot/knifings, drug addicts, alcoholics, genital mutilation, stillbirths etc and I'll show YOU what the real world is.
19 November 2014, 03:05 PM
#28
Mattee, you are trying to compare apples and oranges. I probably wouldn't make a very good businessman (because I'm not selfish enough) but many of the succesful businessmen you talk of more than likely could not do what I do.
Many times you've accused people like me of having no idea of what it's like 'living in the real world'.
I'll tell you again what I've told you before. Spend 48hrs with me on call in a busy hospital with death, disease, vomit, faeces, child abuse, rape victims, gunshot/knifings, drug addicts, alcoholics, genital mutilation, stillbirths etc and I'll show YOU what the real world is.
Many times you've accused people like me of having no idea of what it's like 'living in the real world'.
I'll tell you again what I've told you before. Spend 48hrs with me on call in a busy hospital with death, disease, vomit, faeces, child abuse, rape victims, gunshot/knifings, drug addicts, alcoholics, genital mutilation, stillbirths etc and I'll show YOU what the real world is.
Sorry Mattee, but you do not have it bad.
19 November 2014, 04:05 PM
#29
Scooby Regular
Join Date: Dec 2006
Location: Mars
Posts: 11,470
Likes: 0
Received 0 Likes
on
0 Posts
Mattee, you are trying to compare apples and oranges. I probably wouldn't make a very good businessman (because I'm not selfish enough) but many of the succesful businessmen you talk of more than likely could not do what I do.
Many times you've accused people like me of having no idea of what it's like 'living in the real world'.
I'll tell you again what I've told you before. Spend 48hrs with me on call in a busy hospital with death, disease, vomit, faeces, child abuse, rape victims, gunshot/knifings, drug addicts, alcoholics, genital mutilation, stillbirths etc and I'll show YOU what the real world is.
Many times you've accused people like me of having no idea of what it's like 'living in the real world'.
I'll tell you again what I've told you before. Spend 48hrs with me on call in a busy hospital with death, disease, vomit, faeces, child abuse, rape victims, gunshot/knifings, drug addicts, alcoholics, genital mutilation, stillbirths etc and I'll show YOU what the real world is.
Now you try 48 hours running a business whose major client had just pulled the plug for no reason, who has to do everything humanly possible to be better than the competition, who risks large amounts of his own money on a daily basis, who has no idea what he'll be earning next year, who has to adapt constantly to stay ahead, who is responsible for the livelihoods of many others. Who may work bloody hard then not get paid. Then see how you get on.
Mr Edge; I'd call that mild stalking...
Last edited by Matteeboy; 19 November 2014 at 04:07 PM.
19 November 2014, 04:41 PM
#30
Scooby Regular
Join Date: Nov 2000
Location: 32 cylinders and many cats
Posts: 18,658
Likes: 0
Received 1 Like
on
1 Post
Matteeboy, I know you think I'm insulated and in a faux business environment and don't like doctors moaning, but I'm not paying myself so I can pay my staff at the moment. It is a risk I take. You are not alone in that.