One of the greatest source of disquiets about the NHS is not that there are long hospital waiting lists - although no-one is overly chuffed by that - but that people cannot get to see their GP.
The idea being put around by politicians is that there is a shortage of GPs in the UK.
The claim is being made that this requires that we train assistant practitioners - who are not, by a very long way, comprehensively medically trained - to take the place of the GPs we cannot get.
But this is not true. As the GP Online news service from the British Medical Association reported last month:
The BMA has warned that thousands of GPs are currently 'underemployed' because practices can't afford to hire them - and GPonline has reported in recent weeks on locum GPs turning to foodbanks and one GP working as an Uber driver because they were unable to find a job in general practice.
This report is not made in isolation. This letter in the GP newspaper - Pulse - provides personal evidence of the fact that this significant level of unemployment amongst GPs is now happening.
So what is going on? Three things are, I think.
First of all, the government is deliberately making the NHS crisis worse. The goal, presumably, is to encourage private medicine as an alternative.
Secondly, it is also doing that to promote the 'cheap' option of assistant practitioners - even though horror stories resulting from their lack of broadly based knowledge because they are only trained in specific fields (at best) when medicine is necessarily a holistic subject, are now becoming commonplace. The aim is to break the role of the doctor.
Third, the Treasury has said we can no longer afford to provide people with the medical care that we need, even though we know that the trained people who could provide it are available and the multiplier effect of that spending is considerable, all because they want to do nothing more than balance their spreadsheets, whatever the cost to real people might be.
And what is Labour saying about this? Nothing at all, as far as I can see.
So why isn't Labour saying they will find a job for all trained GPs who want to work? That's all down to Rachel Reeves' iron-clad fiscal rules, I am sure. She would much rather people die than spend what is needed to help them.
And that might be one of the tests for a new Labour government. Will they end GP unemployment, or would they rather people suffer?
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Could you kindly set out Reeves’ fiscal rules as bullet points as a reminder? Googling them doesn’t work. Thanks.
Will do
Not now
Its really chilling – NHS being run down in plain sight. They are confident they can do it and get away with it – and both parties have been bought by private healthcare money.
I think they are called ‘Physician Associates’ – hadn’t realised there were GP’s out of work, although I had heard GP’s saying they couldnt afford to run their practices under the present regime..
There is a very good source – I think its Dr Grace Patterson – cant get link just now – monitoring the mini privatisations going on right across the country.
I doing a podacast with Julia Patterson later today…
Here is the link. Julia is doing sterling work highlighting the ongoing assault on our NHS.
https://jujuliagrace.substack.com/
I did a livecast with her last night.
“The aim is to break the role of the doctor.”
This aim will be accelerated if Sunak implements his plan to overhaul fit note system:
“In a speech on how to reduce people being signed off sick from work, the prime minister will say the government is planning to trial getting “work and health professionals” to issue fit notes, shifting away from GPs carrying out this role.”
https://www.theguardian.com/politics/2024/apr/19/sunak-to-cite-britains-sicknote-culture-in-bid-to-overhaul-fit-note-system
UK birth rate: 2020: 1.55, 2022 1.49. (data source: gov stats) .Trajectory for e.g. 2030 1.4 ish. UK population is not replacing itself & has not been for a very long time (decades).
UK gov & LINO are willing to see more people die (accelerate pop decline) rather than to e.g. employ GPs to reduce this. At the same time, immigration is the only thing holding off population collapse, but the current “gov” wants to send “illegals” to Rwanda.
A. Is the reduction in population intentional?
B. Does the gov/LINO want to reduce the native pop to some low level with a more easily managed group of immigrants doing stuff UK serfs don’t want to do? (fewer GPs would help in this)
C. Why does the gov/LINO want an unhealthy population? (note the resistance by gov & LINO to doing something about sugar).
The Tories (& LINO) are far too stupid to have done this deliberately. But one can see how the population decline will accelerate as the Uk becomes an increasingly shit place in which to live (unless you are rich) & thus by extension – to have chidlren. Women voting with their wombs. The situation is no better in Italy & other places. Neo-lib chickens coming home to roost.
I hadn’t realised there was a significant pool of GPs under-employed and unable to find work. This should have been much more widely publicised, and it made clear that the issue is government funding not availability of doctors.
But having said that, I was aware that there has always been a subset of qualified GPs who are not in substantive jobs for reasons of personal choice. A number of my colleagues were in that position. Some took locum jobs while they waited for a permanent position that suited them (e.g. geographically), some were in career breaks but maintaining their clinical skills, many had “portfolio careers” in which GP work was just one component and they appreciated the flexibility of locum work. Locum work is (or was) well paid and didn’t involve the practice administration side of being a substantive GP.
There were always around 25% of GPs who worked in this way
But there is no money to pay them now
Essentially prcatices have been ordered to pay assistant practitioners instead – which will end in a disaster
On physician practitioners. Educating people to understand what they are doing is always better than training them to respond to facts/cues relating to the current situation. The first gives you adaptability and resilience. The second doesn’t; also, it gets boring to act like a robot.
I think it worth distinguishing between England, Wales and Scotland in terms of access to GPs, and then hospital based services too.
We don’t have the disconnected English system, but there are still many problems here.
There really is a shortage in Scotland of GPs in terms of recruitment – between 10% and 20% depending on area. The islands have special problems in recruiting GPs.
There is also a marked reduction in the number of practices, especially in the highlands and islands, so access for us patients is more difficult, but there are also more patients per GP, and increasing demands for GP services, mostly down to our ageing demographics.
There are also serious problems in doctor recruitment for hospital based services – 75% of advertised posts in Greater Glasgow had no applicants on the first trawl in 2022.
Orthopaedics is particularly under served.
My own GP told me that hospital based consultant teams are smaller these days, often two or more junior doctors less per team, and that alters the rate at which waiting lists can be reduced in general surgery, as the work output of the consultant is cut.
BTW I’m unusually lucky in that I can always either see or speak with my GP within 48hrs, and we have a daily drop in community nurse service here too, and I’d hope that everyone should have access to the same high level and quality of provision that we do in my part of Scotland.
Forty five years of evidence should have taught politicians two things about the relationship between Public Services and Businesses.
Point 1
Attempting to run a Public service as a Business is a disaster.
The NHS is a perfect example.
Turning them into pseudo-businesses operating via pseudo-markets, or charities, or Quangos is a recipe for increasing non-productive costs, increasing disorganisation and continually declining services.
Point 2
Businesses running Public Services is a recipe for disfunction, chaos and corruption.
Thames Water and the state of the Railways being fine examples, but there are so many others.
The evidence is in and has been for decades but politicians still cling to this nonsense. Why?
Partly, I think it is ignorance. On all sides in Parliament, few politicians have any idea of how businesses or Public Services really operate.
Mostly for the Tories it is about greed, power and the desperate attempt to hang on to the idea that they know best.
For all the opposition parties it is mostly about a failure of nerve.
Having worked with or for private, public and third sector organisations I strongly agree. I get very irritated with business people and politicians who argue that everything should be run ‘like a business’. They self-evidently have not a clue. The public sector is way more complex, and also much larger than all but the very largest businesses. It also has to meet a complex variety of goals and objectives – not just ‘make a profit’. Third sector organisations are different again, often trying to meet very challenging goals with a fraction of the resources needed. Yes there are skills and tools that transfer from the business world – getting a large NGO to recognise that project management might have some relevance to their development projects, or that financial management might be useful for instance. Private sector organisations might be surprised to find that they can learn from other sectors too.
Kinda makes sense. Put in my repeat prescription on 19/4 as I’m diabetic. Still waiting.
Not the first time either – by the way.
The generation remembering the bad old days in health have almost died out (80 years plus). The generation remembering WW2 have largely died out. The rest have been slowly fed decline and restriction, and along with many other manifestations of rip-off UK (like sewage in the water), mass culture is managed to produce passivity, compliance and obedience. I include identikit political parties in this, as well as the education system and the MSM.
I’ve just been revising Culture with my Yr 13 Sociology students, showing them how many disparate topics can be grouped under ‘Social Control’ and used in answers. I suddenly felt like some nutty conspiracy theorist, but really it is largely traceable to neoliberalism and the minimisation of politics in the face of the great god ‘Mammon’ (as the late David Marquand had it). Are people of our generation, largely over 60s and critical thinkers, a relic of the past?
It’s easy to feel like a conspiract theorist
Sometimes I feel there might be a conspiracy
Hello Richard.
Would it be a conspiracy to say that the situation is running perfectly well as far as the government/many MP’s/the 1%/neoliberal corporations are concerned?
Brexit is perfect for them as it allows the erasure of democracy through Special Economic Zones and Freeport’s, with all laws being corporate laws.
@europeanpowell has much to say on Twitter about this.
That is the conspiracy
Very good points, ref conspiracies.
Could it be that a system, such as neo-liberalism, tends to be self-sustaining? It has people in positions that want to keep the show on the road, they benefit (often personally). Not to keep it going would make them worse off. They will tell themselves: “Yes, the system has failures, but I can live with them & if I stick my head above the parapect bad things will happen”. There is always a personal aspect.
Couple this to assorted clubs of true believers (e.g. WEF) and the whole thing becomes a self-sustaining organism. Neo-lib ideology is a cancer in the body of society, which needs to be excised asap. What about its adherents, publicists and “little helpers”? How to deal with them?
Point: more likely dealing with a system, rather than a conspiracy. Perhaps this is worthy of more discussion: – what, exactly, are we looking at?
Hard questions to answer…
In essence, what are the provocations for change, and from what, to where are we going?
Is Streeting aware of this? If not why not. Is his plan for the private health sector to reduce NHS waiting lists by employing these GPs? So why not invest in the NHS to take them on? Far better value for money surely.
But is value for money his aim?
Might it be unkind of me to imagine that Wes Streeting IS providing value for money to those who own “have contributed to…” him?
No, it isn’t
An excellent question. I doubt it very much.
It may surprise people to know that there were 11,000 applications from doctors wishing to become GPs last year. The Government is promising ‘another 3000 GPs by 24/25’ but is refusing to train the ones who want to work in this primary care sector.
It is definitely a determined plan to take the NHS out of its post-war ethos and into the US ‘accountable care’ system.
This will show you how it all got a foothold as the Lib Dems conjoined with the Tories to allow it to begin
https://www.opendemocracy.net/en/ournhs/former-health-secretary-andrew-lansley-s-diaries-finally-released-in-nearly-full/
The latest General Practice budget settlement specifies that any increase in clinical staff costs cannot be used to employ more doctors but must be used to hire staff such as physician assistants or other professions allied to medicine.
This is the latest in a long list of ideologically driven policies designed to undermine the basis tenets of an effective, well funded, caring and patient orientated health service. Chronic underfunding since its inception; repeated top-down re-disorganisations; the disastrous internal market that served to disrupt effective coordinated care; the 2012 Health and Social Care Act; austerity; the refusal to accept that health outcomes are intimately linked to social and economic factors. I could go on.
The absurdity of investing huge sums of money into training doctors while landing them with massive personal debts and then facing the possibility of unemployment is beyond belief. Will Labour and Wes Streeting do anything to change this? His only idea seems to be that investment in technical fixes while keeping day to day expenditure fixed (read don’t employ expensive people – GPs) will do the trick. The man is joke.
I spent 30 years as a GP and 10 years as a hospital doctor. Since I retired in 2009 I have watched the deliberate destruction of a Primary Care System that, despite its many faults, was fundamentally effective in promoting a clinically and personally valuable relationship between GPs, clinical teams and patients. You talked about seeing “your doctor”, Richard. You were wrong, such a beast doesn’t exist any more.
Shame on all those politicians, economists, private sector lobbyists who have deliberately mislead the population that the country can’t afford a well functioning health service
Martin Hime FRCP MRCGP
Retired GP
North Somerset
Thanks Martin
I agree there is no “your doctor” anymore
As I also agree with much else you say
Martin your description of what has been happening is spot on.
I did a story recently on the Integrated Care Boards’ ‘consultation’ on further changes to the GP service which intends to split primary care into GP service for those with complex needs and the rest will get a ‘hub’ based on a 111-style request service where you would go to a large clinic to be seen by one of many non-GP staff. These staff members would be supervised by a single GP.
Our GP and GP trainer, Dr Salisbury, said our ICB would not ‘force’ this but it feels as though the ICBs are being told what the new, US-style NHS blueprint wants and it is to bring in the accountable care system bearing the blue and white NHS logo.
https://www.banburyguardian.co.uk/health/goodbye-to-the-family-doctor-banbury-campaigners-support-oxford-demo-4591209
The problem is that the mainstream media – being so wedded to the neo-liberal beast described by Mike Parr above – refuses to cover this kind of appalling, wholescale dismantling of what was once a single, national health service and is now 42 ACOs (by any other name), bent on rationing, refusal of service, medical insurance and privatisation.
As I keep being reminded, as a result of living with a retired GP, who decides what are the complex cases? Most people are very bad at doing so. The whole point of being a GP is to appraise risk – which they can do better tha. Anyone else, but only if they get the chance to do so by appraising all relevant patients.
The picture we were given was that the ‘complex’ cases were likely to be (in the main) elderly people with co-morbidities and several different issues related to their age.
Dr Salisbury (an experienced GP in Oxford) is concerned about the ‘family’ knowledge that doctors have, and that they develop an instinct for seeing if there is something else that is causing problems – anything from family issues to psychological problems.
It is frustrating that it is very clear that patients want GPs who know them, their families and their medical issues, GPs want that, doctors want to be GPs but it is being stalled and prevented as a political choice.
People need to know this. But we are back to the reality that the mainstream media will not touch these issues and don’t until there is a huge scandal – and even then they are likely to blame the NHS (as an institution) for the trouble.
To be clear that model of GP practice is not possible. It creates massive workloads for female GPs and much less for men and that is not sustainable.
“It creates massive workloads for female GPs and much less for men and that is not sustainable.”
I missed something in the translation from British English to American English.
Why are larger workloads created for the female GPs????
Because vastly more women go to see GPs than men do and they almost always prefer seeing a woman. They also usually prefer that a woman sees their children.
Richard,
Thanks for the clarification.
I don’t think the Integrated Care Boards, who are tasked with pushing this through for NHS England, understand anything about it Richard, and certainly not the balance of male/female GPs. They are just doing what they are told.
They appear to have dragged into the ICBs people who were admin staff, who have been promoted beyond their understanding of the issues.
Agreed