Category Archives: General Practitioners

2,000 foreign GPs needed to tackle growing shortage. How about an apology to 20 years of rejected applicants to medical school?

When the Times reports (Kat Lay) that there is such a vast shortage of GPs that we are going to repeat the recruitment drive of the 1950s, then you know there has been a dereliction of manpower planning. The duty of government is to protect it’s citizens. It has failed. Short termism, and not listening to the profession has led to this demise. Rationing of medical school places, avoiding more graduate entry, and preferential selection of female candidates at age 18 when they perform better than men, are to blame. Somebody needs to recognise that it takes 10 years to train a GP, and longer if they have children. Part-time GPs are unable to deliver as much continuity of care. The shape of the job is partly to blame as well. It’s too late. It’s going to get worse, especially for those living in deprived areas. And the overseas doctors recruited will block places for our own in 10 years time! Perhaps they could all be over 60 and on short term visas? And how about an apology to those aspiring med students who were rejected?

Kat Lay in the Times, 8 th July reports: 2,000 foreign GPs needed to tackle growing shortage

The NHS is set to recruit 2,000 foreign GPs — quadruple the previous target — in a drive to combat a shortage of family doctors.

Simon Stevens, chief executive of NHS England, said it would target other EU countries as well as Australia and New Zealand.

Last year health service bosses set a target of recruiting 500 overseas GPs at an expected cost of £30 million. The new target comes after figures showed that the number of GPs was in decline, despite a government pledge of 5,000 more by 2020.

In an interview with the Health Service Journal, Mr Stevens said: “Although there are some good signs of progress on increases in the GP training scheme, nevertheless there are real pressures around retirements.

“And so the conclusion we’ve come to is that in order to increase the likelihood of being able to have 5,000 more doctors in general practice, we are going to need a significantly expanded industrial-scale international recruitment programme. We intend to launch that in the autumn.”

He added: “Rather than the current 500 or so GPs that are being targeted for international recruitment . . . it probably needs to be four times more than that, from international sources — [from the] rest of the EU and possibly New Zealand and Australia.”
The total number of full time-equivalent GPs dropped from 34,914 in March 2016 to 34,372 in March this year, according to figures from NHS Digital.
Doctors’ representatives raised concerns about the long-term viability of overseas recruitment, given uncertainty over the status of EU nationals in the UK after Brexit.
The British Medical Association called the measure “a sticking plaster”.
Dr Richard Vautrey, acting chairman of the BMA GP committee, said: “Overseas doctors have for decades provided a valuable contribution to the NHS, especially in general practice where they have a strong track record of providing first-class patient care.
“However, this announcement is yet another clear admission of failure from the government, which is effectively conceding it cannot meet its own target of recruiting 5,000 extra GPs without an emergency draft of doctors from abroad.”
He called for a long-term solution to address workload pressures on GPs, which he said were putting students off choosing general practice as a career.
Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “Workload in general practice is escalating — it has risen 16 per cent over the last seven years — yet investment in our service has declined and we are desperately short of GPs and nurses.
“It is imperative that we do everything possible to address this, including recruiting more GPs, retaining existing ones, and making it easier for trained GPs to return to practice after a career break.”
She welcomed the extension of overseas recruitment, and called for “the position of EU GPs already working in UK general practice to be safeguarded beyond doubt as part of Brexit negotiations”.

Letters…

Also, there is the unintended consequence of limiting pension amounts which many full-time (mostly male) doctors are endanger of breaching.  This is resulting in them (and many higher paid public service workers, e.g. head teachers) taking early retirement.

Additionally, no real account has been taken of the large number of female GPs who (like my daughter) chose to jobshare so they can accommodate family life.  It will not be long before GPs (like primary school teaching), will be an overwhelmingly female profession.  There is a lot to be celebrated in rise in the number of female doctors over the last 25 – 30 years, but the nation needs to account for the different life work patterns when planning the workforce.

The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations

Gender bias. The one sex change on the NHS that nobody has been talking about

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Hands up – who want’s to be a GP today? Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

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David Millett for GPonline 17th July: Emergency draft of 2,000 overseas GPs is ‘clear admission of failure’, says GPC

Scottish GPs accuse government of ‘long-standing underfunding’

The same is true of the other regions. Deliberate rationing by undercapacity…

BBC Scotland reports 14th July : GPs accuse government of ‘long-standing underfunding’

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The Royal College of GPs has accused the Scottish government of “long-standing underfunding” of GP practices.

It has also criticised the “confusion” surrounding £500m of future spending commitments.

The comments come in a written submission to Holyrood’s Health and Sport Committee.

The Scottish government said it had already committed to investing “a further £500m in primary care by the end of this parliament”.

The Royal College of GPs (RSCP) called on the Scottish government to say exactly how much it would spend on general practice in the next four years.

It follows a statement by Health Secretary Shona Robison after the government announced that its share of health spending would be increased to 11% of the overall health budget by 2021.

Ms Robison said: “This forms the first stage of the Scottish government’s commitment to provide an extra £250m in direct support of general practice per year by 2021 – increasing the overall investment in primary care by £500m.”

The RCGP said Scotland “does not yet have understanding of what ‘in direct support’ may mean and the point has been raised with Scottish government that the term is too broad and lacks sufficient clarity”.

It added: “General practice is in severe need of a clear, positive future, illustrated by adequate governmental investment, if it is to attract sufficient numbers of medical graduates to general practice specialty training.

“If the long-standing underfunding and confusion that we are currently experiencing is to continue, we will keep witnessing a considerable number of general practices closing and transferring the running of their practices to Health Boards due to insufficient resource through which to remain solvent.

“Patients will continue to be found queuing outside practices for the uncertain opportunity merely to register with a GP. It is a major deficit to bear such long-standing underfunding and confusion.”

Increased staffing

Responding to the RCGP’s submission, a Scottish government spokesman said: “As the First Minister announced last year, a further £500m will be invested in primary care by the end of this parliament.

“This spending increase in primary care, to 11% of the frontline NHS budget, will support the development of a multi-disciplinary approach, with increased staffing as well as investment in GP services and health centres.

“Health Secretary Shona Robison recently set out that £250m of this new investment will be in direct support of general practice, helping to transform the way services are delivered in the community – an approach that was agreed with the British Medical Association.

“In this financial year, over £71m of that funding is to support general practice by improving recruitment and retention, reducing workload, developing new ways of delivering services and covering pay and expenses.”

‘Reneging on promise’

Scottish Labour said the RCGP’s comments were “absolutely damning”.

The party’s health spokesman Anas Sarwar said: “Nicola Sturgeon has promised to boost the proportion of spending on GPs and it now appears she is going to renege on that promise.

“The importance of GP surgeries cannot be stressed enough. Particularly as we face an ageing population, with people living longer, primary care will only become more and more important.

“The reality is that under the SNP our health service is not prepared for this.

“We would do things differently. Labour’s government-in-waiting in Westminster would hugely increase the money available to our NHS as part of our plan to create a society that works for the many, not the few.”

‘Doctors are furious’

Scottish Conservative health spokesman Miles Briggs branded the government’s spending plans “a funding con”.

He said: “Nicola Sturgeon happily stood with GPs and backed their campaign for an extra £500m to be directly invested in general practice.

“Now this has been cut in half, and the SNP is offering some waffle about the money being spent more generally.

“It’s no wonder doctors are furious about this deception.

“The nationalists were happy to lap up the support of GPs when this commitment was made, but now seem to have completely u-turned on that promise.”

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An endangered species? You may be lucky to find a GP soon…

An endangered species? You may be lucky to find a GP soon… It will be better in the cities as they have the best schools, and most of the part time, and predominantly female, GPs come from suburban schools. The current situation cannot be solved quickly, and any sensible professional would never have got to this situation. Therefore they should not be expected to find a short term way forward.  Meanwhile the Guardian reports: Record number of GP closures force 265,000 to find new doctors … It’s going to get worse.. and part of the problem is the belittling of GPs in Hospitals, and the lack of exposure medical students get to GP. Access and waiting times are both threatened, even for GPs

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15th July and the Times reports: Hundreds of GP practices forced to close or merge

More than 200 GP practices across England have closed or merged in the last year.
Data from NHS Digital reveals that while just eight practices opened, 202 closed or merged. Practices were affected in all regions, but the north of England experienced the most change, with more than 60 closing or merging, while more than 50 closed or merged in the South East. The Midlands and the east of England had the most new surgeries.
Last year, NHS England announced a £500 million “turnaround package’“ to help struggling surgeries. NHS England data shows that between last summer and this, the same time period covered by the 202 closures and mergers, more patients became registered with GPs across the entire country. Taking into account that some patients may register with more than one GP, 58,492,541 patients were registered with a GP on July 1 this year, up from 57,744,814 the year before.
Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “When practices are being forced to close because GPs and their teams can no longer cope with ever-growing patient demand without the necessary funding and resources, it’s a huge problem.” Dr Richard Vautrey, acting chairman of the British Medical Association’s GPs committee, said: “With over 200 practices closed or merged in the last year and many more struggling to manage their workload pressures, it is time for government and NHS England to step up their efforts to resolve this crisis before even more patients lose their much loved local GP service.”

The Yorkshire Post: ‘Hundreds of GP practices closed or merged in a year’

In Wales the BMA – Welsh General Practitioners Committee (GPCW) has not been listened to for years. BMA in Wales wants faster action on GP ‘crisis’ – BBC News and Hywel Dda is one of the worst (and most rural) areas in Wales.

BMA heatmap reveals scores of struggling GP practices across Wales …

Half of North Wales GP surgeries on ‘verge of closure’ claims doctors …

GP practice closures ‘at record levels’, GPC chair tells BMA annual …

In Scotland on 4th December 2016 the Herald reported: Scotland’s GP crisis deepens as vacancies soar

SCOTLAND’S GP crisis has deepened with one-in-three practices reporting a vacancy, the British Medical Association claims.
Last year the BMA found that almost a fifth of practices surveyed had at least one vacancy for a GP but the figure has since risen from 17 to 28 per cent.
The shock figures follow the closure of a rural GP clinic. Glencairn Medical Practice shut the doors of its Fenwick premises in East Ayrshire on Friday….

BMA – List closures in Scotland

In N Ireland: 20 GP surgeries face closure in Northern Ireland affecting 120,000 …

Patients ‘forced to change surgeries as record number of GP practices …

and in GP magasine in May Nick Bostock reports: General practice in parts of Northern Ireland ‘one closure from collapse’

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Its the “philosophy” sillies – and I am talking to you politicians.

Ron Lilley on NHSmanagers.net and in his e-mail blog to 5000 people rightly points out some of the problems with regard to the disintegrating, formerly National, health services. He points out that a lack of leadership (read “honesty”) leaves us with no idea about how the health service will run next year, let alone in 25 years’ time. Reading his blog he alludes to, but does not mention rationing, making him equally culpable for dishonesty… The workforce is not enough, and is too female biased. Even the spin on Wales recruiting more GP trainees (By bribery) is not reality. We need twice as many in Wales alone to cover the next generation. This can never seem to be said…. and many doctors are working a 3-4 day week but doing well over 40 hours. The reporting is shallow..  How many MPs have Private Medical Insurance (PMI) and why? Its the “philosophy” sillies – and I am talking to you politicians. 

Reasonable rationing is derided, and when reversed because of politics this is celebrated. Laura Donelly in the Telegraph: ‘Monumental’ NHS U-turn

Deserts based rationing is unofficial and facilitated by “privatisation”, especially for the obese.

Despite a “primary care led” Health service, the staffing needs of A&E, so badly planned, trump this as we are in meltdown. In such a situation prevention should rightly be abandoned, and emergency treatment becomes essential. So GPs all need A&E training, (as well as Paeds, Psych, O&G etc….. this is not the case as Deaneries’ decisions are not taken by GPs but Consultants.

Roy Lilley opines: (http://www.nhsmanagers.net/)

The call is for a national debate about the future of healthcare.  The debate, if there is to be one, is as much philosophical as it is practical.

Thus far we have struggled to survive by cutting, patching and repairing.  It is inconceivable we can survive another year of the same.

The way forward is beset with difficult choices as much about how we behave as it is about how the institutions that provide our care, behave.

Setting aside issues of the ‘money’, there are four questions; let’s call them the ‘retains’, that spring to mind.

1.  Will we retain our present willingness to share our risks?

The potential is for middle-class families, presented with options to clunky access to primary care, to elect to pay subscriptions for Apps such as Babylon or Go-Doc and start to undermine the solidarity of the NHS.

The NHS only works because it is ‘our’ NHS, we agree to syndicate the costs and risks of our illnesses, disease, accidents and maternity.

We may be lucky, pay our dues and only have rare occasions to call-in a dividend of care.  On the other hand, disaster may strike and put us on a long and painful road to recovery.

We may not share your pain but we do agree to share the cost.

Employers, frustrated at the thought of losing the skills of key staff to prolonged absence through illness, are already sparking a rejuvenation in the private insured care market, in the hope of circumventing waiting lists, now north of 300,000.

If support is fragmented the NHS fails.

2.  Will we retain power and influence at the centre or are we prepared to give it away in devolution and independence?

How the NHS is organised is important.  We have seen what happens when the NHS is broken up.  The disastrous Lansley reforms gave us a disaggregated, fragmented leadership model and a confusing array of over 200 commissioners; most of them inexperienced, too small to be effective and too costly to run, to be viable.

Devolution may be a seductive alternative to government from Westminister but sharing budgets means sharing risks.  However, we have also seen, from the better CCGs, fragmentation can bring decisions closer to populations.  In the worst, macho CCG management is already set on giving away the NHS, to third parties, to run for ten or even fifteen years.

Do we want to give the NHS away?  How much do we want to break it up?

3.   Will we retain the tendency to ‘accumulate’ healthcare data or will we make a determined effort to ‘use’ personal information for the wider public health.

Do we overcome the reservations we have about sharing data?  The Caldecott conclusions do not bring us closer to solutions for front-line staff trying to work across boundaries.

The extent to which we agree to our data being pooled is the extent to which public health bodies will be able to forecast and plan for a healthier nation.  Thus far, overriding concerns about privacy have slowed progress.

4.  Will we retain our resistance to interference in our lifestyles or will we surrender some choices in the interests of good health and wider societal gains, seeing it as a civic duty.

Perhaps governments have done all the easy stuff with public health; adult literacy, childhood immunisation and clean water.  The future lies in the extent to which governments are prepared to interfere in the lives of ordinary people.

Are we prepared to accept the law interfering in our lifestyle choices?  Banning foods, penalising anti-social life-styles that lead to costs for the NHS.  Refuse treatments to the obese and smokers is one thing but in the interests of equity, do we refuse treatment to a person with a self-inflicted injury sustained in a recreational game of squash.

The four ‘retains’… Public health, data, holding-on or letting-go, sharing our risks.  Perhaps the cornerstones of modern healthcare upon which we either agree and build for the future, or we run the risk of being spectators as, through lack of clarity, vision and determination, we watch it fall apart.

I judge there is an appetite for change if only we knew what it looked like?

How can you paint me a picture of the NHS in 2025 when you can’t sketch what it will look like next year.

Have a good weekend.

 

 Chris Smyth in the Times 16th June 2017: Young doctors go part-time to avoid long hours

A shortage of family doctors has been exacerbated by millennials’ reluctance to work long hours, the NHS training chief says.
More part-time young doctors means that the NHS now has the equivalent of 10 per cent fewer doctors, said Ian Cumming, chief executive of Health Education England, which supports the delivery of healthcare in England. Ministers have had to downgrade their estimate of the number of full-time equivalent doctors, he said……

Also on the same day: NHS secures deal with pharma for breast cancer drug Kadcyla

Kat Lay reports: GPs reluctant to refer fat men to clubs such as Slimming World

Laura Donelly: ‘Monumental’ NHS U-turn on breast cancer drug…

Neil Roberts for GPonline reports 14th June: Exclusive: Hospitals could need more than 200 GPs to staff NHS A&E plans

Owain Clarke for BBC news 13th June 2017 reports: GP recruitment: More junior doctors choosing Wales

Gender bias. The one sex change on the NHS that nobody has been talking about

 

 

The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply

Normally there would be a budgetary report on the English Welsh and Scottish Trusts before the election. Home office staff are arguing that such data is so politically sensitive that it should be kept secret until after the election. What nonsense. Hiding the truth is not a good precedent for something which should be routine. Darlington Hospital is one of many who may not be able to pay their staff. The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply to something routine and pre-planned. BBC News reports 19th May: Reality Check: Why is NHS budget data delayed by purdah? and Will NHS stats spark polling day debate? 

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All the Trusts are bust.

Ben Glaze in the Mirror reports 20th May 2017: Tories accused of ‘blocking damning figures on state of NHS finances’ – Key statistics were due to be released at the end of May but ministers are citing “purdah” rules to hold the information back until after the election

on 19th May in the Northern Echo, Graeme Hetherington reports: Darlington Memorial Hospital trust could run out of money to pay some wages unless plan to solve cash crisis is found

A HOSPITAL trust could run out of money to pay some staff wages unless it comes up with a plan to solve its dire financial predicament by next month.

Concerns over the future of Darlington Memorial Hospital have been raised after details of its financial situation were leaked to The Northern Echo.

Senior management and consultants are being told to tighten their belts as money-saving initiatives are missing their targets and an email sent to some staff has highlighted that the trust could run out of money if drastic action is not imposed.

The County Durham and Darlington NHS Foundation Trust ( CDDFT) introduced cost reduction targets (CRT) in an attempt to balance its books – but is missing its £6.9m savings target by about £1.7m.

The detailed email raises the prospect of the length of operation and appointment waiting times being extended beyond the Government target of 18 weeks, the Trust’s inability to cover staff wages and a reduction in nursing levels.

However, the CDDFT’s consultant surgeon and surgical care group director is reassuring people that patient safety is central to all discussions in the hospital and that there are no plans to reduce staffing levels.

The internal email was sent out to senior staff following a meeting of the Trust’s Financial Stability Programme, which was described as a “maul” after the stark warning was driven home by finance chiefs.

And the news comes just days after it was revealed that maternity services at the hospital could be lost as plans are being investigated to centralise care in Darlington, Durham and North Tees – albeit on a temporary basis.

Today, the full extent of the financial pressures on the hospital’s surgical departments can be revealed.

The email reads: “The three of us have to go back in four working days time with a full plan, costed and developed for a further £1.5m pounds of guaranteed CRT in addition to the already identified as an interim to meeting the full amount. So far in month one we are forecasting to be £350k (April) overspent due to not achieving CRT.

“I do not intend to just pass on this message in the same way. You all work hard and I know you are all very hard pushed for time. However, I need urgent and focused work form every one of you to help the senior triumvirate as yesterday’s is an experience I have not had before and never want to have again.

“I have been asked to ensure that all staff are fully briefed that if by June we do not have a full plan for CRT and are not completely in control of expenditure that we, CDDFT, will run out of cash to pay wages.

“Whist this has been briefed before I chose not to put it in these terms. I have been asked not to sanitise the message.”

But Mr Steve Scott, consultant surgeon and surgical care group director at County Durham & Darlington NHS Foundation Trust, has reassured people that patients’ health will not be put at risk, as the document is not a formal trust plan.

He said: “NHS organisations are working under financial pressure and we regularly review the best way to provide safe efficient patient care. It is worth noting that County Durham & Darlington NHS Foundation Trust ended 2016/17 with a surplus and ahead of our financial plan.

.

What and when is “purdah”?

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The Hacking reveals a collusion of anonymity for responsibility for rationing…

Update 13th May 2017: Mark Bridge May 13th in the Times: Outdated technology offers easy pickings

As readers know NHSreality says there is no NHS, but a regional system. The rationing of services, and this includes IT, is the responsibility of the Trust Boards, and commissioning groups in England. An inability to provide the requisite upgrades to computer systems is a decision made at a higher level. IT managers, paid much less than those in the private world, are rewarded by job security (never get sacked), but they have failed to use their leverage and knowledge to force the changes needed. The debate would have been puerile, if it ever happened at all. On December 8th NHSreality posted: Hackers get easy route to patient data – still on Windows XP but we have no sense of sangfroid, only sadness. The Hacking reveals a collusion of anonymity for responsibility for rationing…

“The first duty of government is to keep the nation safe”. (Amber Rudd on Radio 4 this am) The Health Services are part of this safety, but the net has been holed in so many places, and the responsibility for errors leading to potential disasters such as this is missing. NHSreality predicts that no heads will roll, and the media will fail to find a scapegoat.

The good that may arise is that computer systems may be updated. GPs in Wales were in charge of their own systems and backup until 5 years ago. The Welsh Government took over the computers, put all the data in one central server, and connected to the periphery by BT lines . ( Virtual Private Networks ) I recommended to my own practice that we had our own independent back up system which would ensure that, if the government server failed, or the lines were sabotaged, that we could perform our daily work. My recommendation was rejected but the idea needs re-visiting, even though Wales was unaffected on this occasion.

There is so much evidence for rationing, not prioritisation when it is “all or none” as in IT. Here are some articles/news from the last 24 hours:

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Laura Donelly in the Telegraph: Thousands of children and teenagers with anorexia forced to wait months for help

Chris Smyth in the Times: Hospital backlog is worst for decade – A&E units had their worst year since 2003, with one in ten patients not being seen within four hours and Patients wait longer as GP jobs lie vacant and, initially reported in the Shropshire Star: Nurses ‘forced to buy pillows for patients’

and because of the rising anger even a cancer sufferer is standing against the Minister for Health: The Deathbed Candidate. Getting nearer and nearer to “posthumous voting” isn’t it?

Paul Gallagher opines in the Independent: General election 2017: what role will the NHS play among voters? and implies Theresa May is more trusted than the others…. but this was written before the latest Hacking.

NHSreality trusts none of the parties. They are all lying. It is only going to get worse. Patients are going to wait longer. (Personnel Today) More and more, those who can afford it, will go privately.

Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”.

The debate is puerile. There is no addressing the real issues..

NHSreality on IT systems

Hackers get easy route to patient data – still on Windows XP December 8th 2016

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Hands up – who want’s to be a GP today? Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

We all know that the one on one confidential consultation is the bedrock of primary care. We have been taught that confidentiality is paramount, and as a profession we have honoured this. However, being a GP (or any type of Dr) means complaints and possibly litigation at some time in your career. These problems are much less if the Dr is a) female and b) British trained.

False claims against doctors are not yet commonplace, but to keep the confidentiality and the confessional nature of the GOP consultation will need audio-visual recordings in every room. The patient can undress behind a screen, but the acoustics should remain even when the video is missing.

An alternative, accepted in many hospitals and most dental practices, is to have a “chaperone” or another person (assistant) present at all times with patients. GPs could move in this direction, as could teachers. Male teachers in particular know about “false claims” against them. More and more teachers and doctors are female ….. the adverse selection processes, the timing of recruitment, and the behaviour of  students/patients/clients is excluding men.

The Yorkshire Post 11th May 2017 reported: Growing GP recruitment problem ‘staggering’ as vacancies hit new … ITV News reported 12th May 2017: ‘Staggering’ GP recruitment problem hits new high – ITV News – ITV.com and the Standard followed it up with a report by Eleanor Rose: GP recruitment problem “staggering” as vacancies hit new high, research shows.   for Pulse reports 12th May: One in five practices abandon recruitment due to ‘staggering’ shortage of GPs

Almost one in five practices has had to abandon searching for a new GP as vacancy rates have hit their highest ever, a shocking Pulse survey has revealed.

Pulse’s annual practice vacanies survey was answered by 860 GPs and reveals that 12.2% of all positions are currently vacant – an increase from the 11.7% reported at the same time last year.

More worryingly, 158 said they had to give up recruiting a GP in the past 12 months after unsuccessful attempts.

The survey – the only longitudinal data available on this subject – also reveals that the average time taken to recruit a GP partner has lengthened by almost a month over the past year….

Dr Richard Vautrey, deputy chair of the BMA’s GP Committee, said: ‘The high number of positions vacant and one in five practices abandoning their search) is another sign of the recruitment crisis with many practices struggling to find GPs.

‘This is adding to the pressure of the remaining staff. Some practices are looking to recruit therapists, pharmacists and other health professionals but of course they are not a replacement for a GP. There needs to be a real step-change in recruitment initiatives to ease the pressure on GPs.’

Professor Helen Stokes-Lampard, chair of the RCGP, said: ’We know that practices across the country are finding it really difficult to recruit GPs to fill vacant posts, and the degree to which this problem has increased over the last six years is staggering. In the most severe cases, not being able to recruit has forced practices to close, and this can be a devastating experience for the patients and staff affected, and the wider NHS.’

Abi Rimmer in GP careers warns: Workload pressure would not be a defence against clinical negligence, barrister warns

Rosemary Bennett The Times May 11th 2017: False claims ‘have made teaching a lottery for men’ and False claims ‘have made teaching a lottery for men’ : ukpolitics – Reddit

What kind of person makes false rape accusations?