Category Archives: General Practitioners

90% of GP care is good quality. Are you lucky enough to be in a post code with good GP care and good choice?

I am still asked “how should I choose my GP practice”, and I usually give a guarded reply which amounts to “It depends what functions/services you value most”. Continuity of care is a rarity these days, and with more and more part time GPs the problem will get worse. Patients are not “ill” on days that suit a Dr working 2-3 days a week. Children are ill suddenly, and so practices where partners offer a daily surgery, albeit with a different doctor, are valued. One thing to consider is whether there is an “individual list” system, or a “shared list” system. In the former it can be harder to see your doctor, but it may be worth waiting especially for older patients with chronic conditions. In the latter system patients are often fitted in quickly but usually see a different Dr each time if it is an emergency (as defined by the patient)! Mothers of young children usually prefer this type of system, but not always. Does the practice have an active Patient Participation Group?Other things to consider are whether the practice is a teaching practice, what the turnover of staff is, and whether they have a QPA (Quality Practice Award) which is in date. If you know a family who have had a death recently, the quality of any palliative or terminal care is pertinent, but remember “dead patients don’t vote“. Despite all this, and the Care Quality Commission report, most patients will still ask their neighbours…

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It’s a pity that we don’t know the quality of care for comparison in the other 3 UK health regions, thus emphasising that there is no NHS. Rather than reporting the bad news, the Times could report that 90% of GP care is good quality, and ask “Are you lucky enough to be in a post code with good GP care and good choice?” as many areas have reduced choices, even in cancer care.

Chris Smyth in The Times reports 21st September 2017: 7m patients are urged to leave unsafe GP surgeries

Seven million patients are treated at GP surgeries with serious safety problems, according to the first comprehensive review.
Inspectors urged patients to switch to better performing surgeries after finding that one in seven had issues with safety and one in ten was not good enough overall.
They uncovered “pockets of persistent poor care” including out-of-date medicines, a failure to follow up on test results, delayed cancer diagnoses and a lack of checks on the medical qualifications of staff.
Smaller surgeries were more likely to do badly, the review showed, with the worst half the size of the best. They have been ordered to end “professional isolation” by linking with neighbouring surgeries to share resources and expertise.
The Care Quality Commission (CQC) has finished inspecting all 7,365 GP practices that existed when it started its revamped regime three years ago. Nine in ten were good or outstanding, significantly better than hospitals or care homes. It initially found that one in three was not safe enough, forcing inspectors to take action including shutting dozens of surgeries. One in seven still had safety problems, however, covering seven million patients, with 13 per cent “requiring improvement” and 2 per cent, with almost a million patients, “inadequate” for safe care.

“Safety is the one clinical area that we worry about,” Steve Field, chief inspector of GPs, said. “You find surgeries where they have lots of [test] results that haven’t been acted on, they might have out-of-date medication, their fridges might be at the wrong temperature so the vaccines might not work. It’s really poor leadership.”

Professor Field recently had to intervene to replace out-of-date emergency adrenalin that could have led to the death of a patient, he revealed. He urged patients to use ratings on the CQC website to switch to a better surgery. “I was in a surgery two weeks ago where they said they’d had 300 patients move to them because they were rated outstanding,” he said.

The average “inadequate” practice has 5,770 patients compared with 10,126 for the average “outstanding” one. Professor Field said that smaller places often found it harder to stay up to date, manage services well and employ nurses to help patients with long-term conditions. He said that most should be linked to other family doctors and social services. “I suspect that if you’re a weak leader but a good clinician and you’re part of a larger group, the quality of care will be better,” he said.

Ministers have promised GPs £2.4 billion as they struggle with rising patient numbers and Professor Field said that this had to get through before a “winter crisis”. Richard Vautrey, chairman of the British Medical Association GP committee, said: “These positive results are undoubtedly down to the hard work of GPs and practice staff, but many are in an environment where they are increasingly struggling to deliver effective care.”

The union has clashed with Professor Field, insisting that his inspections were not fit for purpose. Dr Vautrey insisted that the process “remains overly bureaucratic and continues to result in GPs spending time filling in paperwork when they should be treating patients”.

Jeremy Hunt, the health secretary, said: “Nearly 90 per cent of GP surgeries in England have been rated as ‘good’ or ‘outstanding’ — and that is a huge achievement for GPs given the pressures on the front line.”

What do we know?

  • Every GP practice has an overall rating shown on the CQC website
  • Each practice is also given sub-ratings assessing whether it is safe, clinically effective, caring, responsive and well-led
  • The NHS GP patient survey assesses whether people would recommend their surgery, whether GPs give them enough time and whether they see the same doctor
  • There is little other official data on GPs
  • Patients can post ratings on websites such NHS Choices

Dead people don’t vote… End-of-life care ‘deeply concerning’

The NHS and reckless election promises. How about posthumous voting?

NHSreality postings related to choosing a practice

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Deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying, (de-)commissioning: it’s all “rationing”

It is deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying: it’s all rationing and it needs to be discussed openly and honestly as such. Until it is the professions will remain disengaged. Since there is no honesty in our politicians, the response of the professionals in the UK’s 4 health services is entirely predictable. Meanwhile the disparity in services for the rich (private) and the poor (state) will become greater.

Paul Frances for Kentonline 14th September 2017 reports: West Kent Clinical Commissioning Group forced to cut services

An on-going cash squeeze on NHS budgets could see further restrictions on non-urgent operations and other treatments for patients in west Kent, it has emerged.

The West Kent Clinical Commissioning Group (WKCCG) says “significant cost savings” are needed to balance the books and rationing additional services will have to be considered.

Earlier this year, the CCG – which serves 463,000 people – delayed non-urgent operations for four months to save £3.2m, affecting 1,700 patients….

Dennis Campbell in the Guardian 12th September reports: NHS waiting times ‘driving people to turn to private treatment’Report says private providers have seen 15 to 25% annual rise in ‘self-payers’ as patients resort to using savings or loans

Chris Smyth in the Times 14th September reports: Elderly patients with broken hips wait too long for treatment

Four in ten elderly patients who break their hips suffer delays in vital treatment that increase their risk of ending up in a care home, a report says.
Seven patients a day also break their hips while in a hospital bed and the number appears to be rising, with some hospitals failing to do enough to keep patients safe, the study found.
Broken hips are a common injury among frail elderly patients and dealing with the aftermath is estimated to cost the health service £2 billion a year.
While death rates from the condition are falling, analysis of records of 65,000 patients, almost all those admitted to NHS hospitals over a year, found thousands not getting the care they should.
Almost one in ten patients were still immobile four months after an injury with “enormous variation” in rehabilitation rates at hospitals, the National Hip Fracture Database reported.

Patients are meant to get standardised care, most importantly surgery within 36 hours and a prompt review by a geriatrician. However, the review found 40 per cent of patients were not getting the treatments they should. “It’s truly terrible not to have early surgery. If you have to get on a bedpan with a broken hip there’s no dignified way of doing that and people just unravel,” Antony Johansen, clinical lead for the project, said.
“If 40 per cent of patients are not receiving this care — usually because they miss out on just one or two elements — this could compromise their rehabilitation and recovery.”
He said that while some hospitals had 80 per cent of patients back in their own homes a few months after injury, elsewhere it was “a tiny little number”. Hospitals are paid extra for good care and Dr Johansen said that there was no good reason for poor treatment.
“With care of frail older people, doing it well is cheaper than doing it badly. I know if I fail to rehabilitate someone and they go into a care home that’s a bill of £70,000 for them or the taxpayer.”
The audit also found that 4.1 per cent of all fractures happen while older people are in hospital, up from 3.9 per cent last year. Accidents peak during staff changeover times, it said.
“Seven people every day are breaking their hip in hospital and the slight trend for that to go up is concerning,” Dr Johansen said. “It’s something we need to challenge. It’s very easy not to have enough staff on the ward or have staff doing paperwork rather than being with patients.”
While saying that hospitals should not be overcautious and confine patients to bed, he said that some hospitals had only one fracture for each 700 beds each year, while others have as many as one for every 16 beds.
Patients in England are also spending a day longer in hospital than last year, at an average of 21 days.
Caroline Abrahams, of Age UK, said: “We are dismayed that 40 per cent of those who go under the knife don’t benefit from the best practice available. She added: “The numbers of hip fractures in hospitals are unacceptably high.”
• Elderly patients face becoming sicker if they are rushed out of hospital in an NHS drive to empty beds, say local councils. Simon Stevens, chief executive of NHS England, has given hospitals six weeks to free up thousands of places after saying flu was likely to hit the UK harder than usual. The Local Government Association said the plan would backfire as patients were taken back to hospital at the busiest times.

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Let us charge patients for extra services, GPs urge – is this “decommissioning”?

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

We need to be talking de-commissioning and not commissioning….. Fewer doctors and higher occupancy mean more deaths – in Hospitals..

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

 

£500 each citizen, man, woman and child, paid for “negligence” annually by 2010. Why no “no fault” compensation?

Kat Lay reports in the Times September 7th 2017: Negligence payout bill for NHS to hit £3.2bn in 2020

There is a built in inflation in medical negligence claims. GP insurance is rising rapidly, and some years ago the removal of unlimited cover occurred. Some GPs are paying well over £1500 per month, and the average is £1000 per month. This comes back over the years in the pay review package, but there is built in delay. £3.2 billion (£3,200,000) represents a bill for £500 for each citizen, man, woman and child, paid for “negligence” annually by 2010. If we exclude the people who pay no tax, the burden will fall on a small number – say 25% of the population, which means £2000 each. Why are the politicians ignoring the idea of “no fault” compensation? The escalating scale is reported in the Mirror in July, and that’s just for this year..

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Clinical negligence claims are likely to cost the NHS £3.2 billion a year by 2020, and could worsen patient care, the National Audit Office has warned.
Action to control costs will require co-operation across government departments, it has said in a report but the government has no coherent strategy.
Amyas Morse, head of the NAO, said: “The cost of clinical negligence in trusts is significant and rising fast, placing increasing financial pressure on an already stretched system. NHS Resolution and the Department [of Health] propose measures to tackle this, but the expected savings are small compared with the predicted rise in overall costs.”
Spending on the clinical negligence scheme for health service trusts has quadrupled, from £400 million in 2006-07 to £1.6 billion in 2016-17. In the same ten years the number of successful clinical negligence claims where damages were awarded rose from 2,800 to 7,300. Last year 590 claims were settled with an award of more than £250,000, while NHS Resolution, which handles claims for the health service, spent £602 million on legal costs. In 61 per cent of successful claims last year the claimant’s legal costs exceeded the damages awarded.
The report said that trusts spending a higher proportion of their income on clinical negligence were significantly more likely to be in deficit. In 2015-16, all 14 trusts that spent 4 per cent or more on clinical negligence had deficits.“There are indications that financial stress faced by trusts has an impact on patients’ access to services and quality of care,” the report said.
A rising number of claims accounted for 45 per cent of the overall increase in costs but rising payments for damages and claimant legal costs accounted for 33 per cent and 21 per cent respectively.
The Department of Health and NHS Resolution have put forward measures aimed at reducing costs, including fixed recoverable legal costs for low-value cases and a voluntary alternative compensation scheme for birth injury cases.
But the NAO report said that some of the biggest factors were outside their control, including changes in the way courts calculated lump sum payments.
A government spokesman said that clinical negligence costs were too high and that it was taking action.

Keir Mudie in the Mirror 23rd July 2017: NHS sets aside £56 BILLION for compensation claims as payouts for medical blunders soar

Experts say the NHS is sitting on a ‘timebomb’ of future claims and legal reform is needed to tackle the problem

Cancer sufferer urges patients to stop suing NHS – No fault compensation is the answer.

Patient complaints hit a ‘wall of silence’ from NHS – No fault compensation would help change the culture…

Litigation – The rising tsunami is swamping us all.. NHSreality lists all the posts on litigation in the two years of existence. NFC (No fault compensation) is essential.

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The facts, What doctors earn – except that GPs are self employed and you wont know their overhead/expenses/debts which will vary by GP and by practice.

BMJ has helpfully published the latest data on GPs (BMJ Aug 30th article by Tom Moberly

Data chart: what doctors earn

Authors: Tom Moberly

Publication date:  30 Aug 2017


In 2016, the mean annual pay for all doctors working full time in the UK was £78 386, according to figures published by the Office for National Statistics (ONS).

The ONS data show that 78% of doctors work full time. For the remaining 22% who work part time, the mean annual pay was £46 277. Across all doctors, working full time or part time, the mean pay was £71 455.

Separate figures on doctors’ earnings are published by NHS Digital, and these figures provide data on the earnings of different sections of the workforce.

These figures show that, in 2014-15 (the latest period for which these data are available), the mean earnings for GPs was £101 500. This figure is for income before tax, but after expenses, for salaried GPs and partners working under either general medical services or personal medical services contracts.

For consultants and other hospital doctors, NHS Digital has published data on earnings in the year up to March 2017. These show that the mean earnings for consultants were £111 563. For specialty and associate specialist doctors they were £69 336, and for all doctors in training, mean earnings were £49 318 (£55 629 for those in higher specialty training, £47 420 for those in core training, and £36 122 for those on the foundation programme).

The ONS data show that, between 1997 and 2016, mean pay across all doctors increased from £36 849 to £71 455.This equates to an average annual increase of 3.5% over that period.

What doctors earn

Consultants £111 563
GPs £101 500
Specialty and associate specialist doctors £69 336
Trainees (higher specialty training) £55 629
Trainees (core training) £47 420
Trainees (foundation programme) £36 122

Source: NHS Digital. Note: GP data are for 2014/15; other data are for 2016/7.

Tom Moberly UK editor BMJ

West Wales Health has to have a future – somewhere in the “middle” ground… Back to 2006 and reversing the wrong decision taken then not to build a new Hospital.

Pembrokeshire and the Welsh health services are degenerating rapidly. In the Pembrokeshire Herald on September 1st 2017 Jon Coles writes  “Minister’s answer raises more Withybush questions. But it is the staffing crisis across the nation (see Times letters; page down) which is the issue, due to political denial and short termism. This is a template for the debates going on all around the country.

The article rightly points out the problems of recruitment and retention, but gives the impression that this problem could be solved locally. It is of course a National problem, of rationing of medical student capacity over decades, and of a gender bias towards female doctors, who work fewer life hours.  The gender bias is a result of undergraduate recruitment, and could be addresses by graduate recruitment. The problem of few applicants from rural schools and deprived areas needs to be addressed by adverse selection. State supported places at Medical School are a majority in the UK, but this is not the case abroad. So more and more determined applicants who are rejected may choose to train in Prague or in Malta. This is a National Problem and the “rules of the game” mean Hywel Dda is going to fail. To attract medical staff for the next decade areas such as Pembrokeshire need to combine resources with surrounding areas, and have high tech cold surgical units in their centre. 

The “middle” ground is around Whitland or St Clears. Funny than was mentioned some time ago…

Katy Woodhouse in the Western Telegraph writes: Last chance to have a say on health services changes 

As if the Trust are going to take any notice. Utilitarian decisions taken for the people of West Wales mean that each District General Hospital will lose a little, but the overall result could be better eventually, provided there is adequate funding and the longer term rationing of medical student and nursing places is corrected. Do attend the last meeting in Pembroke Dock on Friday 15th September, and then reflect in a decades’ time… Kate implies that the Trust are reconsidering the plans of 10 years ago!

IT may feel like deja vu but the idea of a new hospital between Haverfordwest and Carmarthen has been raised again, over ten years since it was suggested by the then health board.

As Hywel Dda Health Board prepares to make more changes to services in the area – stating that changes need to be made – residents are being urged to have their say.

The current consultation on ‘transforming services’ and mental health provision are drawing to a close and Hywel Dda state there have been a number of surprising suggestions made by those who have already taken part.

“I’d like to thank everyone so far who has taken the time to attend an event, write us a letter or fill in our survey. We understand that this may not be a new message to most, that you may have heard us say many times in the past that the NHS needs to change. But what is different this time is that we have our doctors and services telling us that if things don’t change, our money and the time and expertise of our staff will be spent on simply maintaining the same services and plugging gaps.
“In the field of medicine we should be investing in new ways of working, modern buildings and giving our staff the time to change the way they work for the benefit of their patients. It is time to move forward and no longer stand still.
“So I’d like to formally invite any Pembrokeshire residents who haven’t yet shared their thoughts to come to Pater Hall and make their voices heard. Now is the time for people to speak up and share their ideas and experiences to help make the NHS in mid and west Wales the best it can be.”


NHS ‘FACES STAFFING CRISIS POST-BREXIT’

Sir, Most people realise that there is a looming crisis in the NHS because of the growing shortage of capable and qualified people available to work in it at all levels. It is perhaps less well understood that this manpower shortage will be greatly exacerbated by the impact of Brexit. If solid reassurances are not forthcoming in the near future, there is a real risk that the quality of the service people expect from the NHS will deteriorate. We are already seeing staff who are EU citizens leaving the NHS or seriously considering their options for the future. This should concern us all.

While I acknowledge the complexities of negotiating with EU officials representing the interests of 27 other member states, and the need to seek guarantees for UK citizens in living and working in Europe, surely the prime minister and her ministerial team could do more now to assuage the fears of our EU colleagues.

If nothing is done now, then we face the very real threat of highly qualified and valued members of staff leaving in ever greater numbers in a relatively short period of time. Nobody should underestimate the dire consequences if and when this scenario becomes a reality over the coming months.
Tim Melville-Ross

Chairman, Homerton University Hospital NHS Trust, and former director-general, Institute of Directors

Breaks Ranks 24052006

A series of intellectually and ideologically bancrupt administrations has led us to a GP recruitment crisis.

Not to have enough staff to diagnose patients means nurses waste more resources, and refer more patients for more investigations. The efficient GP of yesteryear, “living with uncertainty” for a period of time, saving resources by allowing the natural course of disease to take place (in 80%) seems to be dying. The result has to be more and more rationing…. Most of us are irate at the rationing of medical school places over many years. Almost all rejected applicants could have done the job. Being a Dr is about determination and staying power as much as intellectual ability. Good Communication and Cultural awareness are also important, and the imported doctors will lack this. They will then block places for our own in the future, not to mention the immoral act of taking much needed doctors from poorer countries. In addition, after 40 years of building up an exam (MRCGP) to be proud of, the college of GPs is threatened with undermining by the pragmatic need for emergency recruitment. 

A series of intellectually and ideologically bankrupt administrations has led us to a GP recruitment crisis. The government are even planning to restrict (ration) referrals!

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Gill Plimmer for The Financial Times 31st August 2017 reports in headline: Search for doctors set to cost NHS £100m in agency fees- Recruiters to be paid £20,000 for each GP in drive to fulfil Hunt’s 7-day service pledge

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The National Health Service is planning to pay recruitment agencies up to £100m to find 5,000 doctors — about half of them from overseas — to plug mounting staffing gaps.The recruitment drive over the next three and a half years is intended to tackle a growing shortage of general practitioners in England, as well as fulfil a pledge by Jeremy Hunt, the health secretary, to make GPs available to the public seven days a week by 2020.The hiring is expected to start in the autumn and will enable recruitment agencies to secure about £20,000 in fees per GP, according to a contract notice published by NHS England this month.Up to eight agencies, which could include Hays, Reed, and Healthcare Locums, are due to be awarded the contracts to hire recruits collectively, with 2,000 to 3,000 of the 5,000 expected to come from overseas. The shortage of GPs in England has been caused by multiple factors, including doctors leaving the profession early because of an increasing workload linked to a rising population.The shortage predates Britain’s vote last year to leave the EU, but the Royal College of GPs said before the June general election that Brexit might exacerbate the shortfall.Gus Tugendhat, head of Tussell, a company that compiles data on public procurement, said the new recruitment contracts were the biggest tender for international hiring by the NHS since October 2014 and an example of the challenge facing the government’s post-Brexit policies.

“There is an inherent conflict between the need to hire international staff in order to maintain public services and the Brexit-related agenda of reducing immigration,” he added.“In future, if the government really is to improve its public services without relying on international recruitment, the NHS will have to invest more either in training UK nationals or in productivity-enhancing automation.”Arvind Madan, NHS England director of primary care, said most new GPs would continue to be trained in the UK but argued overseas doctors were essential to maintaining services. “The NHS has a proud history of ethically employing international medical professionals, with one in five GPs currently coming from overseas,” Dr Madan said. “This scheme will deliver new recruits to help improve services for patients and reduce some of the pressure on hard-working GPs across the country.”The hiring initiative follows a move by the government last year to increase GP funding in England by £2.4bn, to enable the recruitment of 5,000 doctors.The Royal College has warned some of the GPs working in England but born elsewhere in the EU could have to leave if their immigration status were not protected during the Brexit negotiations between the UK and Brussels.

 

It estimated about 2,000 of the 34,000 GPs in England are from other EU countries, and its chair, Helen Stokes-Lampard, said in May: “EU workers in general practice — and the NHS as a whole — play a vital role . . . Losing this skill and experience would be disastrous for the sustainability of our health service, and our ability to deliver the care our patients need.”A report by the National Audit Office, parliament’s spending watchdog, this year found that Health Education England, which is responsible for NHS staff training, filled 3,019 GP places out of a target of 3,250 in 2016-17. That was an increase from 2,769 in 2015-16.The NAO also warned that poor access to GPs during the working day could be fuelling pressure on hospitals’ accident and emergency units.Michelle Tempest, a partner at Candesic, a heathcare consultancy, said hiring GPs from overseas was an “expensive way of building a workforce”. “Training and retraining your own doctors is much cheaper and more efficient,” she added. The decision to pay up to £100m to recruitment agencies is likely to fuel concerns over the planned sale of NHS Professionals, a state-owned agency that oversees recruitment for a significant part of the NHS.The agency is estimated to save the NHS up to £70m a year by supplying staff more cheaply than private sector recruitment agencies.

Pulse opines 22nd August: An overseas GP recruitment drive is not enough

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Chris Smyth in the Times: £100m on table to hire enough doctors for the seven-day NHS

Recruiters will be paid up to £100 million to find enough doctors to plug staffing gaps in the NHS as the seven-day…

Kat Lay in the Times 31st August 2017: Plan to cut GP referrals ‘a safety risk’

The GP recruitment farce – Mr Hunt never said the 5000 would come from the UK!

NHS chief brands GP recruitment strategy ‘crazy’. Now that government has abandoned it, is General Practice is a key election issue

Choice is not all it is made out to be – without overcapacity including GP recruitment

Fresh concerns raised about GP recruitment after figures showed more than 40% rise in number of GPs over age of 55 in past decade

The government shows its misunderstanding of GPs – scapegoating the resentful and disengaged may lead to unintended consequences.

Health boards take over 42 doctor’s surgeries as GP shortage crisis deepens. It’s happening now. Implosion of your health services due to prolonged rationing by undercapacity, underprovision and denial.

A first city GP service implodes. Being a GP is too stressful to do full time, say trainees

When I started work as a GP I did 9 sessions working Monday to Friday in routine surgeries with one half day exchanged with my partner. We also covered our own patients in the evenings and at weekends. and we delivered 50-60 babies per annum. After a few years the doctors combined in an Out of Hours rota (OOH) as a co-operative which was run from the local hospital. This was the high point of my on call career, with cooperation and teamwork three doctors could cover 120,000 people when formerly there had been 30 doing personal on call. The OOH system was demobbed, and the new “Blair” contract allowed us to opt out of OOH. By now many of the newer GPs had young families, and the benefits of no OOH were obvious. The cost of running OOH with locums became too much and salaried posts were created. Nowadays we have too few doctors and paramedics covering vast numbers of patients and in the rural locations vast areas. 

Meanwhile, since Mr Blair’s new contract, the working day has become more intense. GPs often don’t stop for lunch, or coffee breaks, and engineering time for their own health or families is hard. A 12 hour working day is commonplace. More than this, the shape of the job has changed. Where I had flexibility in 1979 and could do other things at times during the day, there is now no time flexibility, and 10 hours fixed to a computer screen is unhealthy, and leads to sarcastic patients who expect and complain more….

Rationing places in Medical School means 9 out of 11 have been disappointed for years. Now Portsmouth is the first city to implode, and its going to get worse.. It takes 10 years to train a GP…

 

Chris Smyth reports in the Times 3rd July 2017: Being a GP is too stressful to do full time, say trainees

Only one in ten trainee GPs wants to work full time, according to a survey that raises fresh fears of a shortage of doctors. The average family doctor-in-training wants to work three days a week, saying the job is too intense to do a full five days.

Waiting times are already lengthening and health chiefs fear that a national GP shortage will be worsened as younger adults shun the long-hours culture of previous generations.

One in five junior doctors training to be GPs also says they do not expect still to be working in the NHS in five years, according to a survey by Pulse magazine of 310 trainees. Doctors are planning either to move abroad or to change career, according to figures that cast further doubt on government pledges to recruit 5,000 extra GPs by 2020.

Officials are trying to recruit 2,000 doctors from abroad after numbers in the NHS dipped despite rising demand from an older, sicker population.

Simon Stevens, head of NHS England, has pointed to an increase in GP trainees as an encouraging sign, but only one in ten surveyed wanted to work the eight half-day sessions considered full time, with a further tenth willing to work seven sessions.

All GPs should be signed off work for stress, argue GP leaders | News …

NHS has the west’s most stressed GPs, survey reveals | Society | The …

GPs get £20m scheme to help them cope with stress | Society | The …

Nine in 10 GP practice staff find work life stressful, poll finds | Society …

Inquiry into the GP workforce in Wales | National Assembly for Wales

£20,000 trainee GP offer to boost doctor recruitment – BBC News

22,000-patient practice forced to close over GP shortage – Carolyn Wickware  in Pulse 2nd August 2017

Neil Roberts in GPonLIne: Entire city’s GP services almost ‘unviable’ as 22,000-patient provider quits