Category Archives: Interviews or replies

GP partnership model dead within 10 years, says NHS England GP

Colin Cooper reports on an interview with Mike Bewick in GPonline 10th September 2014: GP partnership model dead within 10 years, says NHS England GP

The GP partnership model will disappear in a decade and primary care will be provided by organisations the size of CCGs, according to the deputy medical director of NHS England.

I would agree with Mike, and furthermore, I would say that in future the “real doctor” in the community will be one who maintains his emergency skills, is able to manage Out of Hours, and at the same time is involved in teaching and end-of-life care. Such individuals will be really valuable, especially now that successive government administrations have rationed the number of doctors in training so that we need to import for the next decade..

Dr Mike Bewick, a former GP in West Cumbria, said the combination of a growing shortage of GPs and the changing needs of patients and local populations, would require a major restructuring of primary care.

The advent of co-commissioning by CCGs, and the need to provide services ‘at scale’, meant it was now ‘squeaky bum time’, he told a Westminster Health Forum conference in London.

‘This is the time when we actually have to say what we are going to do. And I am going to say just two things that I think are going to be true.

‘One is that in 10 years’ time the term independent contractor will be anachronistic and probably it will be gone.

‘And the second is that we will not talk about primary care, we will talk about out-of-hospital provision and out-of-hospital providers.’

GP shortage damaging partnerships

He said the lack of new GPs being trained meant that ‘we are going to lose doctors from the frontline very, very quickly’, and this would impact on the partnership model of general practice.

‘If you look at primary care, more than 50% of the doctors are salaried. There will be a force majeure to move away from a partnership type organisation because it will not serve them. And equally if you cannot recruit to partnerships you will need to think of something different.’

Dr Bewick said that ‘organisational nihilism’ in the NHS was preventing the system developing to meet changing priorities.

Primary care unsustainable

‘I do not believe that the current organisational structure of primary care is sustainable or, increasingly, desirable.

‘I do believe that in the end, the whole of the out-of-hospital service needs to come together to form a more integrated service.’

He expected new provider organisations to develop, each covering populations of about 300,000 – the average size of a CCG. ‘The provider at scale is in the six figures. It is not in four or five figures.’

Pharmacists and other healthcare professionals would be better utilised to fill the gaps left by GP recruitment problems.

But the move to large-scale primary care provider organisations would not mean the loss of local, personal healthcare services, said Dr Bewick.

‘I do not think we should be confusing that with not delivering healthcare by people you know in your locality. Localism is in my blood.

‘We should be forming organisational mergers with either community trusts or secondary care, or with other providers from other sectors. Providing they have the values of the NHS at their heart, I am not too worried about who delivers but more how it’s delivered and the outcomes for patients.’

Mr Cameron has to instruct CEOs, Board members and Chairman to give exit interviews

Mr Simon Stevens is going to meet Raj Mattu … but “fear leaves us frozen” (Hannah Devlin in The Times April 23rd)

I am afraid that very little will change the “alarming culture of fear” unless the politicians listen to the evidence and change their instructions to the Chairman and CEOs. They need to instruct them to give exit interviews, and to say they will not get a gong if they don’t…… Nothing short of this will reverse the current situation, and the cynicism in which the NHS is viewed by it’s staff. Once this process of honest feedback has begun, only then can we correct the damage done by the toxic mix of performance management and covert post-code rationing, political dishonesty and cowardice, and short-termism.

Whistleblowing and the NHS culture of fear. letters in The Times

 A new philosophy- What I believe


The New Year’s Honours (RHS) List 2014

NHSreality has awarded the following three levels of New Year’s Honours. Don’t be afraid to apply for a gong….. But remember you wont get a royal award if you speak out.. In an age when whistleblowing is renamed non-disclosure, and is covered in CEO and Chairman’s contracts, I do not expect many volunteers from those in post, but I believe we have a duty to aspire and speak out…

The three NHSreality RHS (Regional Health Service) awards are:

1. The Nye Bevan RHS award for honesty. This is given to those who have agreed to Exit Audio Interviews on their working lives, usually starting in the NHS, and then in the different health services. Nye Bevan had a clear view of what he wanted to achieve. NHSreality respects his intention, but also feels that technology and society have moved on so that we can no longer afford “Everything for Everyone, for Ever“.

Interview with Paul Davies, Welsh Assembly Member (Conservative Party)

Interview with Kim O’Doherty, retired GP from Saundersfoot, Pembrokeshire.

Interview with Roger Burns, former GP Educator and site author

Interview with Glan Phillips, Orthopaedic Surgeon Pembrokeshire

Interview with Julie Milewski, retired Nursing Sister

Interview with Peter Milewski retired General Surgeon

An Interview with Bill Clow, retired Consultant Obstetrician & Gynaecologist, and now Locum in NZ

Interview with Jon Skone, retired chief of the combined Social Services and Health budget in Pembrokeshire

2. The Emperor Nero RHS award for “fiddling while Rome burns”. This is given to those who agree(d) to an interview, but have not delivered, or who are considering whether to do so. In Pembrokeshire this includes representatives of the Community Health Council.

I don’t intend to publish names …. guilt may change their minds..

3. The Charles De Gaulle RHS award. This is awarded to important people who say “Non” to requests for interviews on the health service to be posted on NHSreality. In 2014 It is awarded to Stephen Crabbe  MP and The Welsh Labour Party who have not responded to several requests for interviews on NHSreality.


Pre retirement and retirement interviews: the opportunity lost

CQC recommended to conduct exit interviews?

The Telegraph’s Fraser Nelson reports 12th December 2013:

Telling harsh truths about the NHS is a bitter but necessary pill

Health Secretary Jeremy Hunt has begun a hard but vital journey to transfer   power to patients

Sometimes it’s right to tell voters they’re wrong

David Aaronovitchin The Times 6th June reports:

“Everyone knows some hospitals must close to improve healthcare. Politicians on all sides must make the case

What should politicians in a democratic society do when they believe the public is wrong about something? Such as, say, hospital closures.

Expert professional and medical opinion, from the think-tank the King’s Fund though the royal colleges to the patients’ group National Voices all points in one direction: as a country we spend too much money and effort running too many hospitals and we should close a number of them and put the resources elsewhere. If we fail to do this, they warn, healthcare, already sub-optimal, will suffer.

But people don’t want “their” hospitals closed. Faced with the choice between the abstract proposition of a better future and the (literally) concrete one of an existing and visible set of buildings, they vociferously choose the latter. In other words — from the policymaker’s point of view — they’d rather die than change.

Unfortunately they aren’t the only ones who’ll die. If they successfully frighten politicians away from making the right decisions, then most of us are affected by the resulting bad decisions…..”

Its hard to find a Doctor who does not want the highest standards of specialist care for himself or his family, but I did find one in my own practice who felt choice was unimportant – I expect until the reality of what is available in the particular situation hits him. Finding employees to speak out on NHSreality has not been easy: many say they will but then “fade away”. Even with the new theoretical spirit of openness people are afraid and effectively gagged.  Post code rationing is happening today all over England,  Covert rationing by restriction of choice is happening here and now in Wales.

I am happy to receive digital audio interviews from any NHS staff, of any level, but reserve the right to reject if they are unprofessional or libellous.



Public services ombudsman for Wales wants more privacy power … Gag the press as well as the professionals

BBC News reports 5th May 2013:

“Wales could become the first UK nation to have an independent watchdog with the power to stop the publication of some of its reports and to prosecute those who go against its wishes.

Public Servicers Ombudsman Peter Tyndall wants more confidentially powers to protect vulnerable people.

It would mean complainants could face contempt of court charges if they go to the media.

But some warn it would mean less transparency.

Mr Tyndall has legal powers to review complaints about public services such as hospitals or councils in Wales…..”

So once this is law, the people of Wales won’t necessarily know what is going wrong! It will affect us all. The differences will have to be explained to them from outside Wales, in the same way broadcasting uses propaganda to undermine Middle Eastern despotic regimes, and inform its people of the truth! Not much chance of public confidence in stopping gagging, reducing post-code rationing, encourage commissioning for quality, and provides an immediate perverse incentive not to correct problems.

Interview with Paul Davies, Welsh Assembly Member (Conservative Party)

Interview with Paul Davies, Welsh Assembly Member (Conservative Party)

This takes about 20 minutes and is focussed on National Issues relating to health

This takes about 15 minutes and is related to Local issues on health – relating to Pembrokeshire and West Wales.

The first interview template for anyone wishing to interview their own political representatives is here.Politicians interviews

Paul’s interview contains a detailed analysis of the national and local situation regarding the debate on health. He does not accept the need for rationing, and prefers the term prioritisation. He would like choice, and does not commit on free prescriptions.

Most of the nursing and medical professions will stay disengaged with management and philosophy of the NHS unless the words and the language used are mutual.

The Kings fund and the Nuffield Trust support the need for pragmatic rationing, but it will take a further series of crises before the politicians, and then the public, accept this. 

Paul is clear that his party would like “choice”, and for general interest and historical accuracy I am attaching correspondence (Choice in Wales 2010 3) and  articles from the Western Mail (Choice in Wales 2010 2) and Choice in Wales 1 2010_rotated)  in 2010. I have rarely met a Doctor who would argue against choice.


Interview with Peter Milewski retired General Surgeon

Mr Peter Milewski is a retired General Surgeon with a particular interest in Gut Surgery at Withybush Hospital

10th April 2013.

See also – Interview with Paul Davies (WAM) for Pembrokeshire. Don’t be afraid to interview your MP or WAM or SAM or other professionally elected member – and send the Audio file to this site.