Category Archives: General Practitioners

The Health Services in “Reality”: even the chief says it’s broken

How on earth did we get here, to this point in denial and lack of long term thinking. Now, if we employ GPs directly from overseas, we will be negating years of training and Improving standards. Teaching Hospitals and Deaneries will be irate. In the longer term the places filled from overseas will be blocked to UK trained doctors. History repeating itself from the pressure in the 1950s? The Health Services are in “Reality”: even the chief says it’s broken. More money will not make more qualified doctors and nurses. The options outlined do not include rationing health care overtly. A knee jerk response tells me it may happen suddenly and unfairly, and without a national debate on the best way to achieve fairness within rationing.

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Chaand Nagpaul, in the BMA Blog in the BMJ opines: A crisis acknowledged and a political choice

Last week, in a speech at the NHS Providers conference, Simon Stevens – chief executive of NHS England – broke ranks from his political masters and laid bare the full extent of the crisis in the health service.

Far from the ‘we’re spending more than ever in the NHS’ rhetoric, or the illusory mantra of politicians promising world-class convenience on second-class funding, Mr Stevens was unequivocal that the NHS was broken, declaring that the current budget ‘…is well short of what is currently needed to look after our patients and their families at their time of greatest need.’

He was openly critical of the impact of austerity on the NHS, describing it as ‘the exceptional choking back of funding growth of the past seven years.’

He mirrored the BMA’s own analysis of the NHS being woefully underfunded compared to European counterparts, arguing: ‘If instead you think modern Britain should look more like Germany, France or Sweden then we are underfunding our health services by £20bn to £30bn a year.’

Indeed I felt a sense of ‘at last’ in hearing language that could have been lifted from the BMA’s own NHS at breaking point campaign.

And as Mr Stevens made patently clear, we are not arguing simply about a number here but about the impact on the health of millions of lives, including explicit government priorities, saying that ’on the current funding outlook it is going to be increasingly hard to expand mental health services or improve cancer care’.

He went further to state it was a ‘duty of candour’ – relating to speaking up when patients were at risk – to ‘explain the consequences’ of this starvation of funds to the NHS.

He also spoke of the impact of inadequate resources on workforce: ‘On the current budget, far from growing the number of nurses and other frontline staff, in many parts of the country next year hospitals, community health services and GPs are more likely to be retrenching and retreating.’

And instead of the usual DH pronouncement of a wishful 5,000 more GPs he was candid: ‘GP numbers over the last seven years have actually fallen but their workload has risen’ – exactly what the BMA GPs committee have been warning of repeatedly.

Mr Stevens also argued for the ‘clinical and the financial logic for integrated care rather than fragmented competition’ – in doing so he reflected 25 years of BMA lobbying opposing the market-driven purchaser provider split.

I hope that he will now go one step further and unequivocally call for an end to competition law enshrined in the Health and Social Care Act – only that will put an end to fragmented care and the billions wasted in the transaction costs of competition.

It is these procurement rules that allow private companies to provide cherry-picked services in the NHS, and also mean that the future proposed accountable care organisations could be sold off to multinationals.

Mr Stevens speech crucially reinforced what the BMA has always argued – that with the UK being a leading health economy globally, the level of funding of the NHS is a political choice by Government. He said: ‘No-one disputes that these are choices that a chancellor could make.’

More specifically he claimed that next year’s funding gap is likely to be £4 billion, citing the analysis of three leading think tanks (the King’s Fund, NHS Providers and Health Foundation).

He asserted this should not be a challenge for the politicians, since it would only bring the NHS back to historic norms. ‘[The independent analysts] show there’s nothing out of the ordinary about needing such a sum. In their words, it would just be a return to the average increases of the first 63 years of the NHS’ history.’

Mr Stevens also rightly reminded government of the promise to the nation of an extra £350m per week paid into the NHS to leave the EU – at a time when indications show the antithesis that Brexit is likely to act as a further drain on NHS resources.

He called on the Government to meet this funding pledge on the fundamental matter of not undermining public trust: ‘You voted Brexit, partly for a better funded health service. But precisely because of Brexit, you now can’t have one.’

It is probably no accident that Mr Stevens’ comments came ahead of next week’s budget; so it’s over to the chancellor, health secretary Jeremy Hunt and the prime minister. The case for investment is overwhelming, as is the daily experience of an NHS that is failing patients, doctors and other NHS staff.

The Government has a choice, of whether to acknowledge the evidence it faces and whether to heed the clear message from the boss it appointed to run the NHS. And a choice between punishing patients or belatedly properly funding the health service this country needs, deserves and which the government itself has promised.

Chaand Nagpaul is BMA council chair

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would the British public be happy to swap a shorter GP consultation time for a longer one that involved payment of it and additional services?

The quality of your GP appointment is important. This of course includes clinical skill, communication and cultural affinity, and understanding “where the patient comes from” or in RCGP terms their “ideas,concerns and expectations”. Older and more complicated patients need longer than 10 minutes, but the RCGP exam is predicated on this time for each consultation. Brutalising the profession is also brutalising the patient, but this is more likely when there is general and longstanding undercapacity. Sweden and New Zealand have shown that co-payments reduce demand. A pragmatic compromise thus encourages patient autonomy and self-sufficiency, allows resources to go further, and consultations to be longer. Should the price to ration appointments by co-payment be equivalent to two pints of bitter ad a packet of 20 cigarettes?

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Sarah Kate-Templeton reported 8th January 2017: GPs tell patients: Just one illness per appointment and then Chirs Smyth, also in The Times, reported 9th November Patients in Peru get more time with their GP than in Britain

LENGTH OF GP APPOINTMENTS – A Times letter from Annika Nestius-Brown 11th November 2017
Sir, You report that British patients visiting their GP are allocated half the time of people in places such as Sweden, where patients are given 22.5 minutes (“Patients in Peru get more time with GP”, Nov 9). What is missing from this information is the context. How and why can Sweden offer this superior service? Perhaps it is because patients in Sweden pay part of the cost of visiting their GP at each visit, and do so even if they are unemployed, a pensioner or a child. Patients in Sweden also part-pay for their stay in a hospital, such as in the case of my 76-year-old father, who received a nominal invoice for his week-long stay when he had a brain tumour removed last year. Moreover, some local authorities in Sweden also charge a small fee for transport to the hospital by ambulance or helicopter.

In Sweden, not even the chronically ill two-year-old child of a single unemployed parent is exempt from prescription charges, although these are capped at an equivalent cost of about £100 a month.

Which raises the question, would the British public be happy to swap a shorter GP consultation time for a longer one that involved payment of it and additional services?
Annika Nestius-Brown

London W14

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Desperate situations require desperate measures. Virtual consultations are without evidence, risk GP burnout, errors for patients, and increased litigation costs..

Update 8th November 2017: Huw Pym 2 days ago for the BBC News: Online GP consultation: Opportunity or threat?

NHSreality has told readers that it is going to get worse. The evidence of a fractured system is in front of us all. When I was a trainee GP in Sussex, my Trainer had a weakness: when under time pressure he would not examine patients. The result was the odd error, late diagnosis or mistake. Patients in the 1970s did not expect perfection, and he got away with it, because he knew every patient and their families. Disgruntled patients are much more likely to sue and complain about someone they do not know, as is the case in todays Primary Care.  So over the patients head, on the wall behind them, was a reminder: “Every patient deserves an examination”. This helped him to reflect and to avoid playing to his weakness. Now we have a government encouraging “no examination”. As with telephone triage, all that happens is the demand and expectations will rise. Many GPs tried triage and found they could not live with the increased uncertainty of not examining the patient. Some doctors will take to the change naturally, until they have a complaint and litigation gets involved. Desperate situations may require desperate measures, especially in rural and remote areas without doctors. But virtual consultations risk GP burnout, errors for patients, and increased litigation costs, without any evidence it is any better.. The young and healthy are not the patients who take up most time, but they still deserve an examination.. The Times letters 7th November are correct…. and “simple needs” are what patients should be trained to look after themselves. 

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Chris Smyth reports in The times 6th November: The doctor will see you now: NHS starts smartphone consultations

Millions of NHS patients will be offered the chance to consult family doctors around the clock by smartphone as the first “virtual GP” goes live.

Video consultations are promised within two hours by doctors who say that they are finally bringing the health service into the digital age. However, the project has raised fears among senior GPs that it will create a two-tier NHS, disrupting personal relationships and siphoning off fit, young patients, leaving traditional practices to deal with the frail, elderly and mentally ill.

However, NHS bosses have signed off the scheme, saying that “one size does not fit all” for GP care.

Mobasher Butt, a partner in the “GP at Hand” service, said: “We do everything from grocery shopping to our banking online yet when it comes to our health, it can still take weeks to see a doctor and often means taking time off work. With the NHS making use of this technology, we can put patients in front of a GP within minutes on their phone.”

The scheme involves a deal between an ordinary NHS surgery in Fulham, west London, and Babylon, a technology company that offers a smartphone GP consultation service to private patients.

Like any other NHS GP practice, GP at Hand is paid a flat rate for every patient who is registered with it, but uses the money to sub-contract to Babylon, saying that it will not cost the health service “a penny more” than traditional surgeries.

“I think this is the beginning of the end for the old-fashioned way we use healthcare,” Ali Parsa, founder of Babylon, said. “It’s like going from a Nokia to an iPhone. Maybe next year 10 per cent of people will have one and in five years it will be everybody.” He argued that using a symptom-checking artificial intelligence chatbot and more efficient systems could free GPs from paperwork, allowing them to see patients more quickly. “I think normal NHS GPs will see this works and convert to doing things this way,” he said.

After a pilot scheme involving 3,000 patients, the service is opening to any NHS patient in London who wishes to register. If a patient needs a face-to-face appointment, they must travel to clinics in commuter hubs. The virtual practice has set no limit on how many patients it will accept, saying that this will be guided by how many it can safely treat.

Matt Noble, another of the GP partners, said that the promise of seeing an NHS doctor within two hours at any time would not lead to the service being overwhelmed by minor ailments. “People do value the fact that they can see a GP when they want to, but it doesn’t lead to a massive increase in demand. What it does do is ensure people are seen much quicker,” he said.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that despite benefits for commuters it could make family doctor shortages worse by “luring GPs away” from surgeries.

She said: “We are really worried that schemes like this are creating a twin-track approach to NHS general practice and that patients are being ‘cherry-picked’, which could actually increase the pressures on traditional GPs.”

The service accepts that it is not necessarily suitable for people with dementia, mental health conditions or who are pregnant, but Professor Stokes-Lampard said that these were “the essence of general practice”.

NHS England said: “GP practices are right to carefully test technologies that can improve free NHS services for patients while also freeing staff time.”

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BEHIND THE STORY
This is the second time Ali Parsa has tried to shake up the National Health Service (Chris Smyth writes). He sometimes struggles to hide his frustration with inertia in the NHS and makes no secret of his view that within a few years computers will perform better than doctors at making diagnoses.

Mr Parsa is also undaunted by the experience of Circle Health, the company he founded after leaving finance. Billed as the John Lewis of health because it was half-owned by its staff, Circle became the first private company to take over management of an NHS hospital, Hinchingbrooke in Cambridgeshire.

However, despite positive initial reviews, Mr Parsa was ousted amid disappointing financial results. The hospital was then slated by inspectors before Circle abandoned the contract, saying it was no longer financially viable. Mr Parsa insists that this time it will be different.

Q&A: Don’t smartphone GPs already exist?
Yes, but this is about letting patients make it their main NHS GP.

How can this service offer appointments so quickly?
Babylon says that 40 per cent of queries through the app are dealt with by an AI symptom checker.

Surely some consultations need to be face-to-face?
The service estimates that only about a fifth of problems need a doctor physically present.

How can the NHS afford to do this?
GPs are paid an average of £151 a year for each registered patient but Babylon charges private patients £50 a year.

Can I get this service without switching GPs?
No but Babylon is hoping that demand for it will force other GP practices to strike similar deals.

What about the elderly?
GP at Hand concedes that its service will not be suitable for some patients.

Julia Kellewe on Sunday 2nd August in the Guardian: Dr Now: the smartphone app that puts you in touch with a GP – for a fee – New health apps exploit gaps in overstretched NHS by offering subscribers virtual consultation with a GP

Chris Smyth reports 7th November: Virtual surgeries ‘favour young and generally healthy’

Virtual GPs and consulting by smartphone (Times letters 7th November)

Sir, In your report (Nov 6) on the NHS starting consultation by smartphone, Ali Parsa, the founder of Babylon, says that “this is the beginning of the end for the old-fashioned way we use healthcare”. He hopes that in five years everyone will be consulting by smartphone. This is my idea of a nightmare. Some patients will like a quick call to an anonymous GP but this is likely to increase demand on the NHS from people who would not have sought help in the first place.

Previous research consistently shows that new interventions intended to reduce demand on regular NHS services — such as phone consulting, walk-in clinics and NHS Direct — may be popular with patients but they tend to increase the overall workload. For those who most need the NHS (the elderly, the sick and the mentally ill) the smartphone consultation will be a poor shadow of a personal interaction with a doctor they trust. We should allow Babylon to offer this additional service but we should not imagine that it will ease the demand on NHS services or be a substitute for the type of doctor-patient relationship that people value most.
Martin Roland

Emeritus professor of health services research, University of Cambridge

Sir, “One size does not fit all” for GP care, as your report rightly says. GPs are contractually obliged to accept everyone living within their practice boundary on to their list except in very unusual circumstances. If I were allowed to cherry-pick 3,000 fit and healthy young adults and charge £50 a year I would do very nicely and at the same time improve my golf. However, I do not think I could look local colleagues in the eye who would be left struggling with the complex chronic conditions that are the core business of GPs.
Dr Andrew Holden (GP)

Petersfield, Hants

Sir, The relationship between doctor and patient is essential in clinical practice. Knowledge of clinical history and physical examination of the patient are equally important. Further, a doctor should be able to understand and share the feelings of the patient, which can only be achieved during a consultation in person. How does a smartphone app let a doctor examine a toddler with severe earache?
Dr Sam Banik, FRCPath

London N10

Sir, Providing convenient access to a GP is laudable, and the “GP at Hand” service, via a smartphone app, is something that many patients might love to have. It is worrying, however, that patients will have to transfer their NHS registration from local GP to virtual provider. This could have serious unintended consequences.

The GP at Hand service targets those with simple needs. But needs change: what happens to the person who develops a complex condition or needs in-depth investigations?

Meanwhile, local GP practices will lose the income from those relatively “well” patients, and have to manage a higher ratio of people with complex needs, putting quality in jeopardy.
Don Redding

Director of policy, National Voices, a coalition of 160 health & care charities

Sir, I assume the government will give a grant to those who cannot afford to buy a smartphone. This will be the unemployed and pensioners; the latter are among the most frequent visitors to their GP. Also, such patients will need lessons on how to use a smartphone. Perhaps the NHS will subsidise these costs from the money that it will save.
Thea Valman

London NW11

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It’s about to blow up. There is no Mr Fawkes to arrest, blame and punish (hang draw and quarter) for the coming NHS failures

If you are planning a holiday rather than saving that heard earned cash, you might want to consider the true cost of health care, what will not be available to you in your particular Post Code, and what you could afford to buy straight, or insure for. Being off work for long periods, especially for mental health problems is soul destroying, and reduces standards of living. Houses have to be re-possessed, and re-employment is difficult. Only the large state employers seem to ignore the mental health record. Small organisations are unlikely to keep those who keep needing time off unpredictably. If you do go on holiday, especially to Greece, take cash! The bomb under the health service is about to go up, and there is no Mr Fawkes to arrest, blame and punish (hang draw and quarter) for it’s failures. If, like most people you cannot contemplate a life without mutual health cover, find out what your premium would be and take it off your income… scary. “The sums involved are colossal” – see below, and tinkering with fraud and overseas patients are distractions.

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Tony Stubbington reports in The Sunday Times 6th November : NHS cash crisis reveals the fractures in our finances. The chancellor has little room to prop up the health service in his budget

At Birmingham Children’s Hospital, staff who go the extra mile get the chance to be named “Star of the Month”. Looking through the recent nominations for the award, Sarah-Jane Marsh noticed a worrying trend. The number of people who were nominated for working through weekends or holidays without extra pay was “unbelievable”, said the chief executive of Birmingham Women’s and Children’s NHS Foundation Trust.

“We are running on goodwill,” she said. “People don’t take breaks. They work through annual leave. Over the past two years we’ve been cut to the bone.”

The trust’s funding has not kept pace with steadily rising patient numbers and the soaring cost of ever-more sophisticated treatments, according to Marsh. Staff have stretched themselves, but the cracks are starting to show. In the three months to September, the trust missed its target for A&E waiting times for the first time since 2003, she said.

Her complaints cut to the heart of the dilemma facing Philip Hammond as he prepares for an extremely politically charged budget on November 22. Most government departments claim they are at breaking point and have started leaking stories about the strains on policing, social care, prisons and creaking infrastructure.

Yet there is simply not enough money to throw more than a bit of cash at some minor problems and hope for the best. The chancellor already faces a productivity slowdown expected to blow a hole in plans to balance the budget by the middle of the next decade. A cash injection for the NHS could sink these plans.

 

Image result for cash crisis cartoonThe Sunday Times 5th November reports on child and adolescent mental health with:

Parents beg universities for help after rash of suicides.

Crisis in child psychiatry as vacancies soar.

Coroner attacks failures of care for anorexic teacher.

But these are the thin edge of a very large wedge. No commissioning group fails to accept that child psychiatry is core health service provision, but in a cradle to grave and un-rationed NHS, why is dementia excluded? Why is palliative and terminal care funded by charities? Why is psychiatry (40% of GP work, and rising) not part of the training for all GPs? We know it is unpopular, but it becomes much less o once doctors are exposed to it as a speciality. I wonder how many of our UK psychiatrists trained in a UK medical school? This is a speciality that needs good communication and cultural awareness…. Even in Germany they have trouble with “fakes” which makes me wonder about quality control…

Shortage Occupation List – Royal College of Psychiatrists

1,000 more psychiatrists needed to tackle ‘unacceptable failings’ in care

Shrinking: The Recruitment Crisis in Psychiatry | The Psychiatry SHO*

Why Don’t Medical Students Choose Psychiatry? | The Strangest Loop

Psychiatric nursing: an unpopular choice. – NCBI

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Counting the cost: NHS cuts to cataract surgery can be fatal

We were made with two eyes, and two ears for a purpose. Reducing vision to one eye means there is less visual stimulation, and the same is true for only one ear or hearing aid. Besides the falls and accidents, there is a possible dementia potential…

In the kingdom of the blind, the one-eyed man is king. - Desiderius Erasmus

Chris Smyth reporting in the Times October 26th 2017: Counting the cost: NHS cuts to cataract surgery can be fatal

If analysis of cost effectiveness is a little technical for most patients, then it does not get any starker than this: cutting back on cataract surgery could cost lives.

The latest research from the US does not prove that fixing cataracts directly cuts the risk of early death by 60 per cent — but patients whose cataracts are not treated are known to injure themselves more and generally disengage from the world. It is powerfully plausible that for some this proves fatal.

The study appears just as the National Institute for Health and Care Excellence publishes guidelines that tell the NHS that rationing is unjustified. Its calculations are unequivocal: fixing cataracts is almost always a good use of NHS money.

The problem is that the NHS’s resources are being spread ever thinner. It is striking that health officials no longer bother to dispute the evidence nor claim that their policies are not really about cost cutting. With admirable honesty, they now simply say they cannot afford to treat everyone who needs it, even for something as basic as 20-minute cataract surgery. Even if it means those patients are more likely to die early.

So far voters have tacitly accepted this. The big political question is: for how much longer?

The Telegraph: Stop rationing cataracts until patients are nearly blind, NHS warned

The Mail: End of the cataract postcode lottery: NHS are told to halt rationing

Doctors forced to plead with NHS for treatments for patients, BMJ finds …Growing healthcare rationing means GPs are having to submit exceptional requests for treatments including cataract removals and new hips and knees

Many NHS trusts ‘rationing cataract surgery’ – BBC News

Hearing loss and dementia: more research is needed. Patients with hearing aids in hospital need special consideration, and for over 70s, that’s over 60% of us …

 

A loss of personal continuing care. 700 practices in 5 years. Is the GP going the way of the Dodo in the past, or the Salmon in the future? We need to rediscover it’s value.

GP numbers are falling (Trends in the NHS) , and over 700 practices have closed in the last 5 years. This means that list sizes are rising. This information dates to 2015, so is 2 years out of date. The rationing of places at Medical School, over 30 years and 8 administrations is to blame, along with poor selection age.

An example of a table of data is from Wales: 

In Wales there are 454 Practices, which consist of 1663 GPs, 334 other GPs (assistants), 3,187,000 patients, 7021 average patients per practice, and a residential population 3,099,000. This gives an average population per practice of 6826.

There are several issued hidden in these figures. There are more patients registered with Welsh GPs than there is population in Wales. This is because of the border issues, where patients in Wales get free prescriptions, but those eligible in England pay. There are many more part time GPs than there were 10 years ago. The figures, in rough terms, just have to be multiplied by 20 for England, and by 2+ for Scotland as the whole UK is under doctored.

The number of GPs up to 2011 is shown here (Nuffield Trust), but is of course 6 years out of date.. It is interesting that even professional reporters cannot find up to date comparison figures from the UK Regions to compare with England, and this emphasises that we have no “National” in our health services. There have however been consistently more GPs in Scotland

Another problem is the definition of a GP. WONCA had a go in 2005. Many different countries have many different interpretations. In the UK he has to be “Competent and Capable” (RCGP), able to work “Independently” and traditionally to provide continuity of care for families. This “cradle to grave” image is fast disappearing, and the reality of part time GPs who may not know their patients has to be faced. Is the GP going the way of the Dodo in the past, or the Salmon in the future?

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Laura Donelly and Patrick Scott reports in the Telegraph 16th October 2017: Rise of the ‘super-size’ GP surgery as quarter of practices now deal with more than 10,000 patients

New figures reveal the rise of the “supersize” GP surgery, amid the closure of almost 700 practices in five years.

Family doctors said they were being forced to handle far more cases than they could cope with, with one in four practices now seeing more than 10,000 patients.

The proportion of surgeries with such list sizes has risen by 27 per cent since 2013, the NHS data shows.

It follows admissions from the Health Secretary that the traditional family doctor role has been eroded by decades of underfunding.

Jeremy Hunt told a conference on Thursday that the “magic” of general practice was under threat, with GPs burned out and left feeling “stuck on a hamster wheel” with up to 40 patients to see daily.

The statistics from NHS Digital show that 28 per cent of GP practices in England have a list size of at least 10,000 patients – including some with more than 20,000 cases on their books.

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said family doctors were left overloaded, and too often unable to meet the needs of their patients.

It follows admissions from the Health Secretary that the traditional family doctor role has been eroded by decades of underfunding.

Jeremy Hunt told a conference on Thursday that the “magic” of general practice was under threat, with GPs burned out and left feeling “stuck on a hamster wheel” with up to 40 patients to see daily.

The statistics from NHS Digital show that 28 per cent of GP practices in England have a list size of at least 10,000 patients – including some withmore than 20,000 cases on their books.

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said family doctors were left overloaded, and too often unable to meet the needs of their patients.

She said: “The phenomenon of growing patient numbers, and a lack of GPs to deal with growing demand is a long-running trend, and something the College has been drawing attention to for many years.

“As a result, many GP practices are seeing escalating patient lists they they simply can’t deal with – although we must recognise that sometimes increasing list numbers are due to practices merging and pooling their resources,” she said.

Prof Stokes-Lampard said there was a desperate need for more GPs and practice staff.

Dr Richard Vautrey, GP committee chairman said doctors were struggling to cope with an extra 2.6 million patients registering in the last four years, while funding and staffing levels had not kept pace.

“GP services are struggling to cope with unsustainable workload and deliver the care their local communities need,” he said.

A recent BMA survey found that more than half of GP practices were considering closing their patient lists as they could no longer provide safe care to the public.

The figures show the total number of practices registered with a GP has risen from 56.2m to 58.7m in five years. Meanwhile the number of practices fell from 8,032 to 7,358.

Of those, 2,082 have more than 10,000 patients on their books – including 157 with more than 20,000 patients.

On Thursday Mr Hunt said many GPs were at the ‘end of their tether’ and dropping out of the profession. He said: “Too many of the GPs I meet are knackered, they are often feeling at the end of their tether.

“They feel that they’re on a hamster wheel of 10 minute appointments, 30 to 40 every day, seem never ending.

“They don’t feel able to give the care that they would like to to their patients and increasing numbers of them are choosing to work part-time and at worst to leave the profession.

“We have to think really hard about how to stop that happening if we’re going to use the magic of general practice to do what we need it to do for the NHS.”

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The decline of General Practice.. Bribes may be too late…

Update 24th October.

Tara Russell in the Daily Echo reports: GPs to be given £20,000 ‘golden hello’ for working at the coast or countryside.   

and the BMJ Zosia Kmietowicz reports: “Golden hello” of £20 000 to be offered to 200 GPs a year, says health secretary

There will be many post mortems once the old fashioned GP has disappeared, but it is not only about numbers, but also about experience and reduction of waste. A good GP reduces unnecessary referrals and investigations, lives with uncertainty and is trusted to use time as a diagnostic tool. 20 years ago most countries envied our primary care GP system of gatekeepers, but we have steadily destroyed it. In Folkestone, (and many other places) the population is in dire need. The goose that laid the golden egg for efficiency has gone… Perhaps readers should ask their MPs 1: “Why have 9 out of 11 applicants for Medicine been rejected for 30 years, when we continue to import so many doctors from overseas? 2: “Why are 80% of Medical students women, and should this be addressed by graduate entry, or adverse selection. The answers are short termism and rationing.

In the last week I have heard and witnessed two stories close to me. A citizen had renal colic and was getting  better when seen at home. After 8 hours in Casualty, an USS, a CAT scan and bloods as well as urine dip test (not available to the paramedic visiting) he was sent home. The other was a case of acute orchitis who had 3 courses of antibiotics, investigations ++ and 6 consultations in A&E and GP. An experienced GP would have dealt with both these cases much more efficiently.

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Shane Brennan interviews Dr for the Daily Post 19th September 2017: The North Wales doctors surgery … with no doctors

Reliance on locums since GPs retired means some days there are four available, but some days only nurses

Nurses are having to stand in for GPs at a surgery where on some days there are no doctors available to see patients.
The Pen y Maes medical centre in Wrexham is being run by Betsi Cadwaladr since its doctors retired last year.

The health board has had to draft locum GPs in to do the work, but according to local councillors and patients, on some days there are none available.
Fed up patients are now planning a protest to voice their frustrations with health board bosses, who say they are looking to recruit GPs to take over the practice.
Councillor Gwenfair Jones, who represents Gwersyllt West – one of the wards hit by the problems at the surgery – said: “Despite repeated requests we are not getting the service that we deserve, a total reliance on locums means that some days there are four GPs other days there are none.”

She added: “The Health Board is meeting this Thursday at 10am at the Catrin Finch Centre at Glyndwr and we will be there to give them a warm welcome and to make sure patient’s voices are heard”
Dr Sophie Quinney from campaign group GP Survival (Wales) welcomed the protest, she said: “Patients are absolutely right to be concerned by the direction of travel for primary care across North Wales. It is well accepted that surgeries run by family doctors are more cost effective and for the most part deliver a superior service to those run by administrators.
“Sadly, Welsh Government has offered too little too late by way of funding and resources to help ease the ever-increasing burden on these doctors, and they are voting with their feet.

“What is urgently needed is dialogue between GPs and their patients, so that the public can get behind this important cause and exert the type of pressure that is needed to turn this sorry situation around.”

A spokesman for Betsi Cadwaladr University Health Board said the board was trying to find a solution that would see full time doctors take over at the practice.

He said: “We remain committed to providing a high quality service at Pen y Maes, which includes working to fill vacant posts at the practice. We are actively looking to fill vacant salaried GP positions at the practice, and will be interviewing for Advanced Nurse Practitioner posts next week.

“We continue to work hard to develop a plan for the long-term future and success of the practice, and apologise for any difficulties patients have had in booking appointments.”
A Welsh Government spokesman said: “We expect all Health Boards to provide primary care services which meet the needs of their populations. Investment in general medical service has increased by approximately £27m as a result of the agreed changes to the GP contract for 2017/18. This provides a strong platform for GPs to continue to provide high quality, sustainable health care across Wales.”

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Reasons behind the decline (Letters in The Times 14th October 2017)

Sir, You report that Jeremy Hunt is proposing to pay golden hellos to a limited number of younger doctors (“GPs offered £20,000 bonus to stay in neglected areas”, Oct 12), and that GPs who know patients personally are at risk of dying out (Oct 13).

I retired from my general practice in 2015 at 57 but carried on working as a locum until October last year because I did not feel ready to stop doing the job that I had previously enjoyed for most of my career.

Before my eventual retirement I had worked as a “family doctor” for 30 years in the same practice. I have never been afraid of hard work and many of my patients will remember the days when doctors were called out from home or would visit out of hours. But towards the end the pressure of the “day job” was starting to affect my health and was putting me at risk of “burn out”. I was also spending not much more than 50 per cent of my time in “real” patient contact.

To the many patients who would ask why I was retiring early, I would reply that the problems of general practice go back at least ten years, with governments of all political persuasions failing to listen to GPs. I would often say that the failure to listen to GPs went back as far as Tony Blair’s government, if not before that.

Although the government is beginning to make some belated proposals to improve GP recruitment I can also only guess how many GPs of my age and experience have been lost to the profession because of the inaction of successive governments.
Dr A G Bennett

Leek, Staffs

Sir, For a brief moment after the GP contract of 2004 was implemented GPs felt valued, but then the attacks began: an onslaught of criticism, started by Labour and continued by the Conservatives. It felt like a strategy: an intention to demoralise GPs. If so it worked, as general practice is now in crisis, with problems with recruitment and retention. And yet the health secretary states that GPs are the heart and soul of the NHS — if general practice fails, the NHS fails. What on earth was the GP bashing of the past 13 years all about?
Dr Bruce Halliday

Dumfries

GP practices close in record numbers – Wrexham patients protest about GP staffing levels. This is only the beginning….

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

How to kill the goose and create a shortage of 10,000 GPs – Patients kept waiting as new doctors shun GP jobs

Image result for killing the goose laying golden egg cartoon

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..