October 1st 2011 Letter from Alex Barber in The Times: Pay us per patient if you want ‘Martini’ GPs (don’t say you were not warned). How Australia “makes it work”, and sustainable,. 6 years alter and GPs are leaving for Australia, NZ and Canada, and the voting citizen needs to know why… The straightjacket of the shape of a GPs job is the main reason. Gabrilla Swerling puts it concisely in Jan 2016: Trainee doctors put off ‘dead-end’ jobs as GPs. It is not about money, but about the pace of work, and the treadmill of unlimited demand, limited resources and no disincentive to make a claim.
Sir, I believe that the current crisis over the lack of availability of GP appointments is easily remedied: pay GPs a proportion of their income on a per-consultation basis, at least at weekends “Cameron tells GPs to work at weekends”, Sept 30). The more work undertaken, the greater the practice income. Should remuneration be adequate, demand and supply may match, just like any other business.
This is how Australia makes it work. Efficient and productive GPs earn more, and many British GPs and specialists are emigrating for precisely this reason. We, meanwhile, plug the gaps with doctors trained in second and third-world countries, who would be in Australia if they met the entry requirements. Britain’s problem is compounded as there may be a reluctance for GPs to work much harder or longer because at above £100,000 a year our tax rates are punitive; and with the ever-rising costs of medical indemnity it is not worth undertaking what is effectively overtime for perhaps £15 per hour net. Most of us would rather have the time off. Show me the money and I’ll work anytime, anyplace, anywhere.
Dr Alexander Barber
On the same day, some 5 years ago, the other letters remark on the proposed 7 day week, and the possibility of enticing retired GPs back. Nothing will entice me back to work unless and until the politicians are seen and heard to be out of denial. Kate Gibbons on March 28th 2016: Failure to recruit more GPs raises safety fears but Mr Hunt is still promising 6000 extra or clones, or imports from other countries!
Sir, The Conservatives’ plan is intended to enable patients to find it easier to see a GP. Doctors, however, will instead interpret it to mean an occasional longer day on a rota basis, offering the same number of appointments as now. Patients will be no better off, and may just find themselves as frustrated as they do today. What is needed is a contractual appointment rate — perhaps the number of standardised (ten-minute) GP appointments per 1,000 registered patients per week, together with publication of each individual surgery’s performance.
Dr Stephen Humphreys
Sir, The funding for seven-days-a-week GPs will be paid from existing budgets. At my surgery we have started to politely refuse requests to take on new unfunded projects such as this initiative. We are ensuring that we do not burn out and can continue to cope with the ever-increasing workload. It would be much better for David Cameron to sort out the duplication of out-of-hours care, the 111 phone number, and minor injuries units to create a streamlined weekend service.
Dr Stephen Brown
Sir, Mr Cameron’s proposal would require more than a doubling of GPs’ workload. It implies an increase in annual GP salary costs of £3 billion a year — excluding additional support staff costs. I believe that many doctors will simply press the early retirement button. Is it really necessary to be able to take someone’s blood pressure on a Sunday?
Sir, Yet again GPs are being used as a political football. One issue to be considered is the incompatibility of increased opening and the viability of small practices. Are patients prepared to see the end of their “local” practice as the price for increased GP access? As a recently retired rural GP, I believe that most patients here would find larger (but more distant) providers of GP services too high a price to pay.
Dr John Harris-Hall
Sir, I should imagine that those GPs working evening shifts will be the single, older and childless. Some GPs have families too, and might not be keen to sacrifice seeing their own family in order to facilitate others seeing theirs.
Dr Larry Amure
Sir, The proposal to provide 24-hour care by GPs is not new. My contract 20 years ago demanded that I provide care for my patients 24 hours a day, seven days a week. Time off was organised with colleagues to cover each others’ practices. In my case I was on call one in four nights and one in every four weekends. One never felt overworked unless there might be an epidemic. I even had time to play golf and with loci assistance take holidays. However I do not know how Mr Cameron’s plans will
work given the great shortage of doctors. Will he ask we retired GPs back?
Dr Michael Bott
Kirkella, E Riding
As the Health Services collapse, some doctors may be enticed to those regions with the best contract. All except England have kept the old junior doctor’s hospital contract, and for GPs Scotland is abandoning QOF. Wales is scaling it down. All these are attempts to reverse the trend in the diagram above. Unfortunately they are too little and too late for most of us. A short report from Kate Gibbon in the Times (not on line) reads: GPs working in A&E are “no solution”. It says that GPs do not reduce the pressure on front line staff or ease patient waiting times. But this shows exactly how misunderstandings occur. Shami Ramlakhan’s report (Nov 2015) is titled “The safety of emergency medicine”, but what it omits is how often the experienced GP can say “go away” or “see your GP tomorrow” rather than have the patients block casualty. Experienced GPs in A&E do make for more efficiency, but then you are taking them away from their other work.