Time to start a campaign?

(With thanks to Prit Buttar and colleagues on the BMA Communications team)

This one is mostly for my GP readers, but here is a transcript of an email I've just sent to my LMC mailing list.

I listened to Darzi on Radio 4 this morning. If anyone missed it, use
the BBC website 'listen again' thingie, it was at about 0712.

He was explicitly asked whether PCTs would be able to choose NOT to
have a polyclinic if that was what the locality decided. He said that
they would be allowed to make such a decision.

Annual budget for one of these places is going to be somewhere in the
region of £800k-1m per year.

Using PBR tariffs and the BNF, I estimate that this could be used to buy:

1,139 cataract operations
154 hip replacements
113 courses of Herceptin
or 36 full-time district nurses

Perhaps we should therefore be undertaking a survey of our patients to
find out if they want a centre of some of the above. We should then
pressurise the PCT boards to accept our findings. especially as Darzi
specifically said that PCTs should take into account local
preferences.

This could be run along side the BMA campaign (see Laurence's email of
yesterday or press release on BMA website).

Window of opportunity here I think.

Any other GPs reading this: Get up and start making noise. Now is not the time to knuckle down and get on with it, or the rug will be pulled from under you. Talk to your patients. Read the bumph from the BMA which will arrive next week.

If not us, then who? If not now, then when?

I don't believe it

Last year I posted this.

She's back.

I have just had the SELF-SAME CONVERSATION with her!

Thank goodness its Friday.

Hendrick's, Fever-tree tonic and cucumber await...

George Monbiot tells it as it is.

An excellent article has been written by Mr Monbiot, a Guardian journo who is unhappy with the political direction the NHS is taking.

His article is well written and contains much insight into the current threats to YOUR health service.

Required reading, especially with local elections coming up.

http://www.guardian.co.uk/commentisfree/2008/apr/29/nhs.health

Compliments

I have just been described as "a lovely bit of stuff" by a female patient*. To my face.

So how should one deal with this sort of thing? Complaints are dealt with in a structured way, utilising our Practice's complaints procedure as a first step. The huge majority are dealt with in this way, insofar as no further action is taken by the complainant. Presumably most are satisfied by the resolution of the problem. Sometimes the complaints are trivial, other times more serious. Some are patently vexatious, though they are few and far between thank goodness. All complaints are dealt with as significant events in our practice, which effectively means we try and learn from them. That sounds rather "cardy" (by which I mean "cardy-wearing, leather elbow patches, touchy-feely") but generally there is something which we could change. At the very least we discuss it (partners, practice manager and if appropriate other staff). All the details are recorded and kept.

I sometimes think, though, that we don't deal with compliments as robustly as we might. I receive compliments fairly often in the form of thanks (for doing my job!). Sometimes, especially around Christmas I receive small gifts, often of the imbibing variety. Soemtimes, I receive letters or cards. I keep the cards. A few years ago I put them in my appraisal folder as I thought they might help show that my relationships with patients contributed to the evidence that the GMC should continue to register me. I no longer do that. I now keep them in a different folder, for my own benefit. I don't look at them often but I know they are there. Perhaps we should be logging all of these episodes as we do with complaints. That seems a little excessive but I suppose it would allow a veriafiable balance against the complaints.

But there is a part of me that feels that doing so might cheapen the intentions behind the gestures.

As for the ribald comment I have just been both the subject and recipient of, well, I take it as its intended and wink.










*Ok, she's 74 and partially sighted...

Tax cuts

Losing the 10p tax band has hurt my staff. not badly, but all of them.

They have each lost about £15-25 a month (they are all part-time). Those paying pension contributions have seen those drop by about £10 a month as well. None of them will be able to recoup this money as their husbands/partners are all in work as well, so no tax credits.

Thanks Gordon.

Extended hours - some random thoughts

Still no sign of the specification of the DES to provide this apparently vital service. There has been some interim guidance published (here)by the Department of Health to allow the development of LES's by PCTs and LMCs. I noticed that our illustrious Health Secretary, Postman Pat, is now talking about "Family Doctor Services" rather than "General Practice" and that Laurence Buckman is being described as an Arthur Scargill figure (good for you Laurence). I was also disgusted to hear AJ say that he was pleased that 92% of GPs accepted their proposals, but not surprised. Firstly, 92% didn't, it was 92% of those that voted. I bloody well didn't. And the 92% had little choice, did they Alan? What was the alternative?

Anyway, back to extended hours. I can't see why anyone would want to commit to a system which has yet to be agreed, or at least published, which will result in more work for less money, for minimal benefit for a minimal number of patients.

Some GPs will it seems do anything for money. I fear a lot of GPs will just keep their heads down and get on with it anyway, even if it ends up costing them money. Some I'm sure would argue they can't take the financial hit of not doing it. Although quite how you get your practice finances in to such a state that the loss of £6000 per partner (approximately, maximally and gross) can be so catastrophic is something I struggle with.

But it isn't about the money as far as I'm concerned. Its about the hours. I have a contract. Well, I call it a contract, it can be changed at will by the Government at 3 months notice.

Some extra background about me. I'm a full timer. I work 4 and a half days a week. My half day not infrequently ends up being a "finishing a couple of hours early" day instead. I recently worked out my hours of work for my appraisal. 47 hours a week, in 4.5 days. More than most I suspect. I don't mind my hours. I'm a GP, its what I do. I'm also a married, family man.

The government reckons that 6.5 million people want us to open longer hours, an analysis of a survey which even the most ignorant of people must realise is a bogus extrapolation. For my practice of just under 6000 patients, only 42 people who were surveyed (out of 330, so 13% of those surveyed but only 0.72% (that is, not quite three quarters of one percent) of our entire list) were unhappy with our current hours. 3 felt we didn't open early enough in the mornings. 2 were unhappy that we weren't open long enough at lunchtime, although we don't actually close during the day, unlike many other surgeries. 9 felt we needed to open longer in the evenings. 15 wanted us to open on Saturdays. 4 had what is described as "other reasons", undelineated.

If we were to open for 1.5 hours in an evening and 1.5 hours on a Saturday, that would provide 12 extra appointments in the week. Bear in mind that this would be for routine, pre-booked appointments. Home visits would not be on offer. Emergency care would not be on offer (although quite how we could morally turn away someone who turns up acutely unwell is unclear to me, apparently it is not a major problem from the politicians' point of view). I would be very surprised if that service was utilised fully for some time. Indeed, the people who would eventually make use of the service on the whole are very likely to be the very people who come during the day at the moment. So the people who might "need" (for which read "want") the appointments in the extended hours would be unlikely to be able to access them because they would get filled by other people.

And we are back to square one.

And I don't wish to repeat my divorce experience, thank you very much.

Of more concern to us, in actual fact, was the perception by those surveyed that patients could not prebook appointments. Only 29% of those surveyed thought they could. In actual fact people have been able to prebook for several years. We did have a period of time where we adopted so-called Advanced Access, in other words, day only booking, to reach a target. When it became clear (within a few months) that it wasn't suiting some of our patients we started to allow a limited amount of prebooking. We are trying very hard to advertise the fact that people can. Part of that work is that we have set up our practice website. Registered patients can make appointments and request repeat prescriptions through the website.

We are actually quite pleased. The system has only been up and running for about 4-5 weeks. We already have 71 patients registered to use it. 10 patients have made appointments. We are starting to get repeat script requests through.

So things are improving. I think.

But we have no wish to open longer hours. We don't think that there is actually any demand for it.

Teachers

The NUT has my support, for what it is worth.

Think about it: a 3 year pay deal which is below inflation (as per RPI, rather than the completely useless CPI) and depends on Government plans for the economy coming to fruition.

The BBC annoyed me this morning (for a change) by comparing the "average teacher's salary" of about £34k with nurses' and police constables' starting salaries, figures which they acquired form that font of all accuracy, the Government. So of course the figures are not comparable. Idiots (and Voltaire had a thing or two to say about idiots...).

The fact that the NUT and its members felt that a strike was needed speaks volumes to me. The first national strike for over 20 years by a teaching union.

(Apologies for the lack of links. Lazy perhaps, but I'm in the middle of surgery. This post is what Neighbour would describe as "housekeeping", to aid in the maintenance of my (in)sanity.)

Bad news

Sometimes a patient comes along who reminds me why I'm here.

Ettie is a lady of 82 years. She's been widowed for almost a quarter of a century. Apart from high blood pressure and quiescent ischaemic heart disease she is relatively fit and healthy. I've been her GP since I joined the practice in 1999. She only sees other GPs rarely, usually if I am on leave.

But Ettie wasn't well recently. She had what appeared to be a chest infection with some pleurisy. I treated her with antibiotics. She felt better in herself, but the pleurisy didn't settle so she came back to see me a month later. Although her chest was clear I arranged a chest x-ray.

The x-ray showed a shadow in the top of her right lung. It also showed some destruction of two of her ribs, just where she was still getting discomfort. Ettie probably has lung cancer, almost certainly in fact. It would also seem to have spread beyond her chest to her ribs. This is bad news.

I have seen Ettie this morning. I have spoken to her at length about what is going on, what the likely problem is, what will happen next. I have referred her to our excellent local lung cancer rapid assessment clinic.

Ettie is devastated. She is scared. She is sure that this means the end for her. It may well do. But I will be there whatever happens. I will treat whatever symptoms she develops to the best of my ability and will enlist the help of our local palliative care team if I need to (or if Ettie needs me to).

I would prefer not to have to, but I will coordinate her care, to what will hopefully not be the bitter end, but a dignified, peaceful death.

Who better than me, who has known her for so long, who she has a relationship with, who she trusts?

I am her GP.

Enough said.

New practice website

Apologies for the lack of posts.

I've been rather busy trying to make some headway against the destruction of General Practice.

Sadly I think that we (the public) will lose our Primary Care service. Even more sadly, many people won't realise that the replacement is less good than the current system until it is too late to go back.

I suspect that within 5 years the current model of partnerships providing continuity of care for patients will be largely defunct, replaced most likely by Polyclinics with some shift-working salaried doctors but mostly with non-medically trained staff such as nurse practitioners and nurses.

On the up-side, we have spangly new practice website at www.manorparksurgery.com

Have a look if you like.

And to the 50-60 or so people (according to site monitor) who view this website a week despite the lack of posts, thanks for keeping an eye out for so long.

Letter to MP

Peter Holden, GPC negotiator and jobbing GP, recently wrote to his MP regarding the current attack on GPs.

I was so impressed by his letter that I wrote my own MP (David Lepper(lab) in Brighton) and the MP (Norman Baker (lib.dem) in Lewes) in whose constituency my practice lies, using some of his information.

Below is a transcript of my letter.

Perhaps Peter and I can persuade more of you to do the same.

Norman Baker MP

23 East Street

Lewes

East Sussex

BN7 2LJ

Dear Mr Baker

I am a GP and am not one of your constituents, although my practice lies in Polegate. However, I am responsible for the health of approximately 2000 of your constituents. I am however sending a similar letter to David Lepper, the MP in whose constituency I live. I am also a member of the East Sussex Local Medical Committee, representing GPs.

I am heartily fed up with the current vogue in Government to blame GPs for the ills of the NHS. The recent media circus promulgated by the Prime Minister (among others) does nothing to actually alleviate the problems faced in Primary Care today. It serves only to cause a significant increase in the stresses of the job and consequently is directly responsible for the dramatic reduction in morale I see in my colleagues.

There has been a concerted government and probably No. 10 inspired campaign for several months about access to GPs, extended hours opening, and out of hours services. They are 3 different things but the government is trying to coalesce them. Part of the campaign has been to smear GPs by constant reference to their performance related pay earnings which are referred to as net earnings. Such net earnings are not take-home pay but net of practice expenses before tax, national insurance, sick pay insurance and surgery mortgage capital repayments.

At no stage during the current media onslaught against GPs has the government in the shape of No.10, the DoH or ministers contacted the General Practitioners Committee of the BMA - the body with whom the deal was done- about extended hours of service. They have received not one phone call, no letter, no email, no communication about extended hours. None of the negotiating team, nor the chairman of the GPC, Dr Laurence Buckman, has even had any informal approaches concerning extended hours from senior civil servants or ministers in their day to day business, including when paths have crossed. I have that on good authority from Dr Peter Holden of the GPC, one of the original negotiators (one of only 2 of the original team, including Dr Buckman; in contrast the NHSE/DoH team has none of the original team who engaged in negotiations).

Out of hours services (services outside of Mon-Fri 0800-1830)

The continuous and erroneous intimations that somehow GPs are responsible for the level of service provision in the out-of-hours period are nothing short of risible. It is widely ignored by Government spokesmen that responsibility for out-of-hours care has lain squarely with the PCTs since 2004, and not, as is so often stated, with the GPs. The NHSE, Treasury and DoH underestimated the cost and complexity of a service which GPs had provided at an uneconomic cost and a massive personal price since the inception of the NHS in 1948. For years the DoH officials had been denying the GPs assertions about the burden and the costs. For them to subsequently blame us for the inadequacies of a service which they are responsible for commissioning and managing is nonsense. In addition, there are frequent assertions that over 90% of GPs have opted out of providing out-of-hours cover. While in itself, that statement is true, the actuality of the situation is that many GPs still do work out-of-hours, but we have ceased to be the body responsible for the commissioning and running of the services, and so any inadequacies must be laid at the feet of the PCTs and the Department of Health. Their attempts to save money are what has led to the out-of-hours horror stories which occur from time to time, not the lack of GP involvement.

Extended hours is about the provision of NORMAL General Practice into the evenings and weekends. As I am sure you are fully aware modern General Practice requires receptionists, phlebotomists, Health Care assistants, practice nurses, district nurses, pathology services (such as blood testing), access to social services , X-ray facilities and the ability to discuss findings with a consultant. With the new contract we took on 52.5 hours of opening based on 37.5 hours of staffing and funded the difference from our "over-performance". PCTs have always been free to commission extended hours and some GPs may be prepared to provide it if commissioned at a commercially acceptable price. We are not prepared to simply be a "GP with a prescription pad" working alone, with patients having to return to complete the consultation, just so that the government can have a soundbite. I have asked my staff if they would (for pay obviously) be prepared to work extended hours and to a woman they said not at any price. In any event, in order not to breach the EWTD, some of us would have to take on and train yet more staff, something which would take considerable time and resource.

GPs are tired of the "banks and supermarkets opening argument". The longer banks and supermarkets open, the greater their profits. What is more, it takes at least 5 years to train any of my professional staff to work independently and up to a year for my non-professional staff. Shelf stackers and checkout operatives take a matter of weeks to train and the operation of the store does not require the continuous shop floor presence of the board of directors. The only people banks employ are sales people and money counters, who again take little real training. Indeed medicine, dentistry and veterinary medicine are the only professions where nothing can happen without the actual presence of the most highly skilled and trained individual member of the team working on the shop floor or immediately available to do so.

Access

This is about the ease with which patients can make and obtain an appointment. A national survey costing £11 million has been undertaken recently and there is a satisfaction rate of 84% of patients with the current access arrangements. Analysis of this survey results in politically difficult messages. Most of the 16% of patients expressing dissatisfaction are registered with practices of a particular type, in particular geographical locations, serving a particular type of population, with services delivered by a doctor qualified from particular parts of the world. I know of many leading edge practices where they refuse to try to meet the 48 hour target (and forgo the resources) where the urgent and emergent are dealt with today but a routine appointment is 15-17 working days away.

Doctors have always struggled with their appointments systems. We are now on the 5th version since I joined the practice in 1999 and much of the problem concerns workforce resources and increasingly surgery space! The de facto moratorium on practice premises funding (unless you are in a Labour area LIFT scheme) means that we cannot increase our staffing as we are hot-desking already! We have always seen anyone with a clinical priority the same day and a clinical emergency on an immediate basis. Mr Blair's interference over the 48 hour access target (which we by and large meet) has meant that we cannot forward book significant chunks of the appointment book. I DO recognise the problems which working people, especially those who commute have in gaining access, but they are the very same people who do not want taxes to rise! Of course I could operate (and actually would take pride in) an 0700-2200 ROUTINE service 6 days per week (provided nobody was required to work compulsorily more than a 40 hour working week) but that is neither affordable nor cost effective. Even if we have the resources the staffing is impossible on current workforce Levels (GPs, never mind other staff).

The most recent straw contributing to the creaking in the spine of British General Practice has been the appointment of Ara Darzi to review General Practice. What does a tertiary world class surgeon know about general practice or primary care?

This crude attempt to blacken GPs for the political prize of 16 hours per day of routine general practice, even if does mean a return to paid slavery for GPs personally, is despicable. Irrespective of the financial facts, the government have conveniently forgotten the long term health gains already accruing from that performance related practice resource deal - the Quality and Outcomes framework. Doing this by means of fomenting public envy and disapproval of our earnings is beneath contempt and is hypocritical. Ministers in addition conveniently omit the facts that GPs still have to provide a service for a 40% longer working week than the norm. GPs still exceed the EWTD. 40% of GP income is performance related pay. GPs are stunning value for money. It is fascinating to note that the new accession states in the Baltic have adopted the British primary care system because of its cost effectiveness.

The new GP contract was negotiated and agreed with the knowledge, influence and intervention of No.10, HM Treasury as well as all 4 Departments of Health. It was further endorsed by the independent Doctors and Dentists Pay Review Body whose recommendation was not amended by the Prime Minister or the Chancellor at the time and they did not see fit to interfere with its findings! Gordon Brown and Tony Blair therefore had at least two opportunities to veto this deal if they felt that it had been too generous. The GP pay rise was deliberately substantial in return for substantial extra work and to correct the massive workforce crisis in General Practice. It was designed to correct 15 years of pay drift from repeated interference with DDRB reports. Remember that GPs were only required by Ken Clarke's contract to do 26 hours over 42 weeks per annum. You now get 52.5 hours of responsibility a week, with an actual average of 44. The fact that out of hours was priced by the independent DDRB as late as 1997 at only a few thousand pounds meant that the loss of it could only cost us a few thousand pounds.

You need to know that the massive relentless adverse and unfair media onslaught of the past few months against GPs has demoralised them hugely. Causing this much ill-feeling in GPs will damage the NHS because of the corrosive effect it has on morale. We have a massive GP retirement bulge looming in the next few years and the UK needs as many GPs as it can find. The government assertions border on lies and they are distorting the truth in such a manner that if I indulged in a likewise fashion in my practice I would be struck off.

I hope that this information helps to inform debate and I am happy to elaborate further, or direct you to other colleagues representing GPs if you wish. I do not wish to receive a reply from the Minister, as it will answer none of my points or concerns.

Yours sincerely

Russell Brown MB ChB

Go on. You know you want to.

Circituitous conversations

"Doctor, I've got this very itchy rash on my arms, look! It appeared over night!"

"Oh yes, those are bites of some sort."

"No they're not, I haven't been bitten."

"Yes, they are. I'll give you some antihistamines to try."

"They're not bites you know..."

"Ok, what do you think they might be?"

"You're the doctor, how should I know?"

"Fair enough. I think they're bites."

"No they're not."

"Try the tablets and see how you go."



That was 3 days ago.

This morning:

"Doctor, that rash on my arms is better, look!"

"Oh yes. Good, glad the tablets helped. Anything else?"

"What do you think it was?"

(Sighs) "Insect bites."

"No they're not..."

Thank you Andrew O'Hagan

I tend not to read newspapers. I don't have time.

But I do browse their websites from time to time, especially when health stories are prominent in the news.

An article in today's Telegraph (or rather on its website) has for once made me something other than angry.

I don't know who Andrew O'Hagan is, or what his usual political "colour" might be. But his comments about the NHS were an eloquent testimony to what I suspect is the view of most health professionals, whether medics or not.

So thank you Mr O'Hagan. Your concerns about political interference are recognised and shared, and your good wishes are appreciated.

Been a while...

Morning all.

Not blogged for a month or so. Been rather busy, what with the end of the financial year and a new baby (who is coming along nicely thank you).

So this is just to say I'm still alive (if anyone was wondering) as sitemeter tells me I have about 140 visits a week, even if I don't post (which is nice, thank you!)

Once I'm getting abit more sleep, I'll probably start getting cross again, so keep an eye out...

Kind of puts it in perspective...

So, GPs are overpaid according to Patsy, right?

Loads of stuff in the news over the last six months about it.

Look at this.

Says it all really.

Bastards...

GP OOH

Well, the newish system of providing out-of-hours (OOH) care hasn't benefited anyone except doctors.

Could have told you that...

The BBC this morning reported on the Parliamentary Select Committee's report on the rehash of OOH care. Apparently it is "shambolic".

What a surprise.

Well, we did tell them that it would be expensive. We did point out that market forces would take over.

But I was cross when I heard some MP from the Committee (and I'm afraid I'm not sure who he was) say on air that GP's were "Laughing all the way to the bank".

WHAT?! We give up 6% of our budget to opt out of OOH care provision, and we're laughing all the way to the bank? How do work that out, idiot?

Despite the fact that the BBC were quite clear that the responsibility now rests with PCTs, that one comment at the end of the report on the Today program once again tried to make it seem as though we are money grabbing unscrupulous shysters.

Well, shame on you in Westminster. Get your own house in order before casting aspersions. And put the blame where it lies: on the Department of Health and its Secretary of State.

And in further news...

Patients will be able to boycott opt out of the uploading of their medical records.

Report in the Register here.

Well, that is a result.

The Information Commissioner's report can be found here. Astonishingly for a governmental report, it is only 4 pages long.

I especially like the following excerpt, with my own highlighting:

NHS Connecting for Health has confirmed that people living in areas
introducing Summary Care Records will be contacted before any of their
medical records are uploaded on to the NHS Care Record Service. They will be given information about their options to limit the future scope of the
information on the Summary Care Record or the option not to have one at all and they will also be given the opportunity to make arrangements to view their information before it is uploaded. They will have a specified period before
their information is uploaded to consider their options.

The initial upload will take place without explicit consent on the specified date unless you choose to utilise one of the options mentioned above. Explicit consent is only one of the conditions for processing sensitive personal data referred to in schedule three of the Data Protection Act 1998 and NHS
Connecting for Health are confident they are able to meet the requirements of
one of the other conditions.

Once the basic health information referred to above is uploaded on to the
NHS Summary Care Record:
• you will be able to choose to remove some or even all of the
information initially uploaded
• you will be able to keep the uploaded information but make the
Summary Care Record invisible.

Any further information will not be added to your Summary Care Record
unless you have agreed to it in discussion with your GP. The
Commissioner understands that these types of discussions will take place
at the next consultation you have with your GP following the initial upload.

Later on, you will have another choice. Instead of the whole record, you
will be able to choose to prevent specific information from being visible
without your consent by utilising what will be called a ‘sealed envelope’

Please note the highlighted bits. If you are in one of the pilot areas and you share my concerns about what might be termed information governance I suggest you make use of these options. As far as I am aware, I will not be in an area of "early adoption". But they can't have my info if I am.

Thank you to the BMA who were lobbying hard behind the scenes to get this sorted. Your efforts are, as always, appreciated.

More Spinal Privacy problems

As if we haven't got enough to worry about with our own national scheme, now someone in Brussels wants us to share all pour medical problems with most of Europe as well! According to the report, there are 5 million health workers across the EU, so if there is anyone who won't be able to access medical records at the drop of a hat, could they raise their hand now please?

No? Oh.

I've already posted about this twice (and on a related matter here, here and here).

Its bad enough that billions are being wasted on the UK scheme which, after £12 billion (at least) and several years, is still charitably describable as an insecure waste of money with a long term usefullness rating that most health professionals aren't convinced about.

How much will a pan-European scheme cost us and who is going to make the most money from it?

Oh, yes.

Who will benefit from the scheme?

Sorry. Forgot that one.

"The data that will be shared will include some kind of emergency care records and patients' medication histories. The aim of the scheme is that if, for example, a UK citizen falls ill while in Spain, doctors there will know what medication the patient cannot take or what existing conditions they already have."

Right. So instead of asking the patient, they can Google the patient. Great.

Still, what do I know?

Sack Patsy

There is a petition here to urge the Prime Minister to get rid of Patsy.

I urge you to read and consider whether to sign (I have).

My only slight concern is who would replace her...



(With thanks to Dr Ben Taylor for starting the petition, and Dr John Crippen for bringing it to my attention.)

Its all our fault (again)

Patsy is at it again.

Apparently, my pay should have been capped. I earn too much.

Given how the GP contract was negotiated, that of course implies that the quality of care which I am providing is of an excessively high quality. I will not however desist from providing good care. Its what I was doing before, and I see no reason why I should stop.

Ms Hewitt said: "I think if we anticipated this business of GPs taking a higher share of income in profits we would have wanted to do something to try to ensure that the ratio of profits to the total income stayed the same and therefore more money was invested in even better services for patients."

Right. So, as a self-employed, independent contractor, I may not take as much profit as I wish from my business. I have to reinvest the money into services which are otherwise inadequately funded, I have to effectively bung the DoH a sub.

"Now it is quite true that neither the government or BMA anticipated how much GPs would do in response to performance-related pay."

Well, not quite, Patsy. If you check the memo's from your negotiating team, you'll see that Dr Fradd et al did warn you that we would strive to maximise profits and do as well as we could. We are business people you see. Our business is health and illness management. That's what we do.


And then there's someone called Joyce Robbins, from Patient Concern:

However, Joyce Robins, from the health watchdog Patient Concern, told BBC News that the new contract did not represent "value for money".

"I do think that the doctors' unions took the government to the cleaners with that contract because, I mean, nobody's mentioned that in fact they do a great deal less work," she said.

"They no longer do evenings, no night work, weekend work - this has all got to be paid for somewhere else.

"And yet their money has gone up quite enormously.

"In fact, I understand that far more GPs are actually retiring early because their pensions have gone up so much that they can afford to do that."

Well, she's obviously speaking from a position of knowledge about these issues then, isn't she?

Ms Robbins, we still work about 50 hours a week, we are doing more and more during the day, and we didn't get paid for doing out of hours work before the new contract, indeed we used to pay for the privilege of working, and since the advent of nGMS, the government take 6% of our core budget off us if we opt OUT of providing out of hours services.

(Quite who Patient Concern are, I'm not sure. According to their site, they've been going for 6-7 years, but I've not heard of them before now. I'm also not sure that their agenda is as transparent as they would wish. Certainly to my mind some of their "Campaigns" are a little naive, though I agree with the principals behind some of them.)

Anyway.

If the Government aren't happy, they should try to renegotiate the contract with our representatives. All this spin is not helpful. Patients (and voters, lest we forget) don't believe it anyway, from the comments I've been getting from my patients.

In the mean time, I will continue to maximise my income to the best of my ability by caring for my patients to the best of my ability.

If its all the same to you, Patsy...

Safe Arrival

I am delighted to announce the safe arival of our new daughter Willow Rose on December 28th, at 0742, born at home (about which more in a future post), weighing in at 7lb 10oz.

My wife is doing well, so is Willow and we're smitten.