Category Archives: Stories in the Media

Just because there are more GPs, it does not mean they work more hours!

The Wales GP information is available at GP-one – designed for General Practices in Wales. Just because  there are more GPs, it does not mean they work more hours! And the demographics mean we need more, with more time for more complex problems. There is an added problem in having a majority of female GPs and doctors, apart from their reduced hours, in that A&E, which involves shift work, is inadequately manned in all the peripheral DGHs. Not enough money, not enough doctors and nurses, not enough honesty, and too much denial. The collusion between the media and the politicians will perpetuate the problem: indeed its going to get much worse. The demand was not unprecedented. NHS reality has been warning about this under capacity for 7 years.

‘From what I can see patient care seems acceptable.’

  • The number of general practitioners in Wales (excluding registrars, retainers and locums) was 1,964 at 30 September 2018, an increase of 38 (2.0%) since 2017.  There were 6.5 GP practitioners per 10,000 population in 2016
  • 2,986 total GPs (all Practitioners, Registrars and Retainers plus Locums registered to work) at September 2018, 50 more or 1.7% greater than 2017.
  • 230 GP Registrars at 30 September 2018, a decrease of nine since 2017
  • 14 GP Retainers at 30 September 2018, a decrease of three since 2017
  • There are fewer practices in Wales than a decade ago.  In 2016 the number of GP partnerships was 11.1 per cent lower than in 2006.  The number of patients per practitioner has fallen by 3.2 per cent since 2006 but patients per practice have consequently risen.
  • In 2013 there were 470 general practices in Wales, a decrease of 4 practices (0.8 per cent) on the previous year (2012). In 2014 there were 462 general practices in Wales, a decrease of 8 practices (1.7 per cent) on the previous year 2013. There were 441 general practices in Wales in 2016 a decrease of 13 practices (1.7 per cent) on last year.
  • There were 778 GP Locums in Wales at 30 September 2018.
  • The number of GP Practitioners approaching state retirement age is low, with over 90% of GP Practitioners under the age of 60. The number of GP practitioners aged 55 or over has remained steady in the last five years, with around 22.2 per cent of the GP practitioner workforce falling into this age band in 2016.
  • The percentage of GPs who are female has increased. In 2005 female GPs accounted for 34.7 per cent of the total, in 2013 they accounted for 46.6 per cent. In 2014 female GP practitioners accounted for nearly half (48.6 per cent) of the GP Practitioner workforce, an increase of 378 (63.3 per cent) since 2004.  In 2015 female GP practitioners accounted for over half (50.4 per cent) of the GP Practitioner workforce, and increase of 365 (56.9 per cent) since 2005.  Females accounted for only 32.9 per cent of the total in 2004. In 2016 female GP Practitioners accounted for over half (52.4 per cent) of the GP Practitioner workforce, and increase of 375 (54.9 per cent) since 2006.  Females accounted for only 36.1 per cent of the total in 2006.
  • The Guardian 17th November 2019: NHS bosses accused of gagging staff during election campaign and Gove ‘lying’ about EU citizens’ NHS rights to gain votes
  • The Guardian 18th November 2019: NHS running short of dozens of lifesaving medicines
  • Is the NHS facing unprecedented demand? BBC news
  • Poor state of Welsh health. The experiment with devolution has failed….
  • How to reduce quality of care further: A 32 hour week is less than 25% of the whole…
  • No “healing” the country or the 4 health services yet

Loss of doctors. Poor retention …. The fun and variety in a job is important… Home visits need to be fostered and not rejected in an ageist society.

Whilst the different political parties use their energies on health bribes to get our votes (Matthew Paris in the Times 16th November) , it might do well to reflect on why we have too few staff, and why we have 1/6th of the number of scanners and investigatory plant of similar G8 nations.

The letters in the Times a re listed in reverse order, and in many ways the last one sent by Professor Goddard says it all. The call to reject home visits will lead to elderly people getting inferior diagnostic assessments for staff who are not trained in differential diagnosis. The only reliable answer will be for these elderly people to have private doctor visits where these can be bought. In poor and rural areas the private option will not be there, and a health divide will ensue. We would be creating an ageist spartan society in the modern world.

NHS WORKING HOURS
Sir, Dr Carole Luck (letters, Nov 15) may not know that four-day, 38-hour working weeks are the norm for junior doctors in Australian emergency departments. Their education isn’t damaged by this. Indeed they have sufficient energy to concentrate on their studies and their patients. This is one reason why so many British junior doctors leave the NHS for Australia. I should know. I was one of them.
Dr Jo Deverill

Sunshine Coast, Queensland

Sir, John McDonnell believes that NHS staff should be included in plans for a four-day working week (“Labour split over 4-day week for NHS staff”, Nov 14). The NHS has been brought to its knees by the introduction of the European working time directive allowing junior doctors to work no more than 56 hours per week. Junior doctors learn through experience but long hours and weekend shifts fill much of that time, so they do not have the benefit of all the teaching available during the week. A four-day week would seriously damage the education of young doctors and possibly sink the health service.
Dr Carole Luck
Retired consultant radiologist, Windsor

Sir, A four-day, 32-hour week for NHS workers is an admirable aim but with punitive pension charges putting consultants off overtime, a shortage of GPs and clinicians working significantly longer hours than contracts and acceptable norms, the service is in peril. The priority should be a safe service run by clinicians with sustainable working patterns.
Dr Michael Rooney

Stockport

Sir, Neither giving more funding to the NHS or outsourcing parts of it will make it better (“Labour will tax rich to give NHS billions more than Tories”, Nov 13). The NHS is a bloated public sector organisation with good intentions that costs the state more than £125 billion a year to run. It needs reform and buying time with more money will not change the direction of travel. How refreshing it would be if the NHS’s imperfections were admitted and careful apolitical steering towards an efficient and effective service could get under way. The NHS needs intelligent support, not political slogans.
Mark Scibor-Rylski

London SW6

GP HOME VISITS
Sir, May I make a robust defence of the GP home visit in response to the article “GPs want to remove ‘old fashioned’ home visits from their NHS contract” (news, Nov 12). The information gained from one home visit in terms of a social and psychological assessment of family dynamics is vital knowledge in managing the patient’s condition and is an efficient use of time and effort. Ten minutes spent in a patient’s home tells us so much that is impossible to glean in clinical consultations. It is also vital in managing many elderly patients at home, those with palliative care needs and in offering support to grieving relatives. It must remain an important part of the commitment a GP offers patients.
Dr Richard Morey

Postling, Kent

Sir, I am dismayed that some GPs are considering passing on home visits to other NHS workers (“GPs want to remove home visits from their NHS contract”, Nov 12, & letters, Nov 13 & 14). This is a huge disservice to the public. Our local walk-in centre, which offered an out-of-hours GP service, has become entirely nurse led, which limits what it can offer. I worked as a nurse for many years and learnt many new skills and diagnostic procedures such as prescribing medication, but even with extra training, nursing staff and paramedics will never have anywhere near the accumulated skills of a doctor.
Lesley A Malton

Sheffield

HEALING THE NHS
Sir, It may sound promising to hear Jonathan Ashworth pledging £1 billion more per year to train GPs under a Labour government (“Invest to stop people becoming ill in first place”, Nov 13), while the Conservative Party has also pledged to increase GP appointments (“Tories vow to cut waits with 50m more GP appointments”, Nov 9), but in reality, neither of these commitments will deliver more doctors for the NHS. It’s all very well to increase GP training places, but in exchange, which specialties will we train fewer of — physicians, psychiatrists or emergency medicine doctors? All of them have their own shortages.

We need a commitment from the next government to double the number of medical students so that when it comes to increasing the number of GPs, nurses and other medical professionals, there exists a sufficient workforce to do so.
Professor Andrew Goddard

President, Royal College of Physicians
London NW1

The Nuffield trust 3rd July 2015: Focus on: International comparisons of healthcare quality –  An analysis of 27 care quality indicators across 15 countries to explore what comparisons of international healthcare data can tell us about quality of care in the UK.

Beware the grizzled Marxists bearing gifts – The Sunday Times

The Tories and Labour are both trying to hoodwink the public on borrowing Tony Blair

How to reduce quality of care further: A 32 hour week is less than 25% of the whole…

If the potential of an employee is measured against the number of working hours in a week, which amounts to 168, then the ratio of work to total is a measure of potential. Productivity cannot improve if one is away from work!. Doctors who are self employed (GPs) often work many more m=hours than the public would expect. A 12 hour day is commonplace, so that 4 full days is well over 40 hours. Reducing the working week to 32 hours, as suggested by Labour, would reduce the productivity of all NHS staff. Self employed would be exempt, but the trend is to move part time anyway. What suffers is continuity of care, palliative and terminal care, mental health, and overall patient satisfaction.

The future for older people in the UK looks bleak.  We need more staff in nursing and care homes, and our conservative rulers are thinking of “cheaper, fast track visas to recruit staff for the NHS”. (The Times and Evening Standard 8th November). 

If the new staff work short weeks they will have to be paid more per hour to live, and already care home costs are beyond most families/people. Rationing by “means testing for social care” needs to be extended to medical care if the 4 health edifices are to survive, but all talk is of the opposite: adding social care to medical care as a “free” service…. UNREALITY. There just are not enough people and no magic money tree.

Boris will do the same as Theresa May if he gets his way, and both Boris and Jeremy are promising to spend recklessly.

See the source image

The Times leader on a potential 4 day week ( 14th November 2019 ) says that “…a 32-hour working week is impractical and would prove costly for taxpayers. It exemplifies an economic approach that would reduce living standards”. It would also reduce quality of care.

…Paying public-sector workers the same wage for fewer hours would require higher total expenditure and create labour shortages. The party maintains that a shorter working week would boost productivity and thereby allow workers to suffer no loss in real incomes. Yet Britain has had a stubborn problem of weak productivity growth since the financial crisis and both the explanation and the solution are far from clear. Moreover, it is harder to extract productivity gains from service sectors, which make up 80 per cent of the economy, than from manufacturing. NHS-funded social care, for example, is inherently labour-intensive. The Centre for Policy Studies, a think tank, estimates that the additional bill for the public sector would fall between £17 billion and £45 billion, depending on productivity gains…..

Letters to the Editor 6th November 2019:

Sir, You report (news, Nov 5) that Labour’s four-day week would cost taxpayers at least £17 billion a year. It would also be the death of the NHS. The chronic inability of the NHS to cope with ever-rising demands must be laid at the door of the European working time directive, which was embraced without thought of the unintended consequences.

Two previous presidents of the Royal College of Surgeons have declared the European working time directive to be the biggest disaster ever imposed on the NHS, and I agree with them. If Labour were ever to introduce a four-day week as outlined, it would have to explain to the public why this was preferable to saving “our” NHS.

The inability to recruit nurses and GPs is well known, but how many people are aware that 43 per cent of all consultant physician posts advertised last year were not filled, according to figures from the Royal College of Physicians. A four-day week would require 20 per cent more posts to be created, which would join those that we are unable to fill.
Professor Angus Dalgleish

Consultant medical oncologist, Cheam, Surrey

Sir, The wise words of Professor Carrie MacEwen (Thunderer, Nov 4), chairwoman of the Academy of Medical Royal Colleges, should be engraved on the lectern of every politician making a speech during the election campaign. Sadly, those vying for votes will doubtless continue to use the NHS as a tool to mislead and bribe susceptible voters.

It is self-evident that no politician knows how to run the NHS. It has lurched from one set of political priorities to another, and has rather surprisingly survived, despite repeated dysfunctional reorganisations. Department of Health initiatives rarely have much to do with patient need but a lot to do with votes and headlines. The workforce is ground down by politicians’ constant repetition of “our wonderful NHS” followed by yet another tinkering at the fringe.

Surely the time is nearing when we remove the NHS from politicians’ control and allow it to be run objectively by those health professionals and managers who know what they are doing. Perhaps a semblance of coherent planning and continuity might then develop. This would leave the politicians to play with other toys that they could break with relative impunity.
Dr Tim Howard

Past chairman, GMC fitness to practise tribunals; Corfe Mullen, Dorset

Sir, It is inevitable that when the NHS costs the taxpayer so much politicians will be involved and, at general elections, political parties may make extravagant claims of the type that Professor Carrie MacEwan deprecates. One of the problems of providing resources for clinical services is that it may be impossible to budget for a cost-effective service. Spare capacity is essential and therefore more money is required to allow for the fluctuations of clinical need. This means that the public and politicians must be prepared for empty beds and inactive clinical staff on occasion. But there is something the NHS can do now: management could be made accountable for the clinical services it provides instead of always blaming a lack of resources; and clinical staff might research the more routine aspects of clinical management for cost-effective solutions.
Dr Ramon Gardner

Emeritus consultant psychiatrist, Addenbrookes Hospital, Cambridge

ITV news (and the Times) 9th November 2019: 1.5 million older people “In need of care”, and have an “unmet need”.

Anita Charlesworth 13th November 2019: Politicians can’t shake a magic people tree to staff the NHS

See the source image

 

See the source image

A night (or two) on a hospital trolley is better than living on the street. Asda type performance will not help…

Aneurin Bevan would not have accepted a night on a trolley as a compromise when he set up the former NHS. The cost of looking after overseas visitors is minimal, and not an important financial loss, but it does signify how we expect nobody to pay anything at all! Politicians have big salaries, good holidays, secure pensions, and access to London hospitals. If they want to they can avoid the A&E waits and mistakes and go privately. They usually do…. It will all get worse unless our managers and Trust Board Directors speak out honestly. Co-payments are not as bad as a failing service..

Cartoon 11.02.2017

Michael Sainato in the Guardian 14th November 2019 reminds us of why we live in one of four “Mutualised health services”. ‘I live on the street now’: how the insured fall into medical bankruptcy – Having health insurance is often not enough to save Americans from massive debts when serious illness strikes

Iain Williams on 14th Feb 2015 opined: £1 coin for your hospital trolley? The NHS’s supermarket-style makeover – cartoon

A government minister has said the NHS should be more like Asda. Should we expect bogof deals on hip replacements?

No “healing” the country or the 4 health services yet

Whilst politicians argue about who can spend most on health, and since they are trying to provide a “quick solution” in too much of a hurry, there are wise heads in the profession who could be listened to. Unfortunately nobody who is voting for Brexit trusts anyone, which includes politicians, lawyers, and all and every expert. The fact that waiting times in A&E are the “Worst ever” only matters to those who have to use A&E. (We don’t have one as ours has been predesignated as “Emergency and Urgent Care” centre, which presumably excludes accidents and trauma…. Nobody locally knows this yet! Is A&E more important than General Practice? GPs have more experience than those who see you in A&E. The long term rationing of medical school places is to blame…

Professor Goddard in today’s Times  (14th November 2019 ) writes: 

HEALING THE NHS
Sir, It may sound promising to hear Jonathan Ashworth pledging £1 billion more per year to train GPs under a Labour government (“Invest to stop people becoming ill in first place”, Nov 13), while the Conservative Party has also pledged to increase GP appointments (“Tories vow to cut waits with 50m more GP appointments”, Nov 9), but in reality, neither of these commitments will deliver more doctors for the NHS. It’s all very well to increase GP training places, but in exchange, which specialties will we train fewer of — physicians, psychiatrists or emergency medicine doctors? All of them have their own shortages.

We need a commitment from the next government to double the number of medical students so that when it comes to increasing the number of GPs, nurses and other medical professionals, there exists a sufficient workforce to do so.
Professor Andrew Goddard

President, Royal College of Physicians
London NW1

Privatisation? Disclosures declaring an interest are not restricted to research or organisations; they also apply to individauls.

Aside from the fact that there is no NHS any longer, the question of how many services should be privatised is important. We know that more efficiency results from private provision, as profit has to be made. However, there may be a conflict between the short and long term, with privatisation simply helping to meet budget constraints, rather than raise longer term standards. Should Health Boards and Trusts be honest about this? Commissioners will always be tempted to ration by privatisation. 

In General Practice the meeting of reps is becoming rarer, but it does happen, and meetings are still subsidised. The reward for this is access to busy professionals, and influencing them.

In normal daily practice a GP, Consultant or a Physiotherapist may be restricted in the service provision that they deliver. If they know what they provide is inferior to what they would like, and if they are putting the patient at the centre of their concern, should they not come clean and declare the deficit? This is a disclusure that might not be so popular as it would expose the shortfalls and enhance private practice.

Image result for disclosure cartoon

The Nuffield Trust asks the rhetorical question “Is the NHS being privatised”? in its recent report. The BMJ reflects this in its own report; Is the NHS being privatised?

The LibDem approach was that the question was wrong….

In the BMJ Carl Henegan and Margaret McCartney argue in commentary that we need to record and manage conflicts of interest across healthcare. Decaring interests and restoring trust in medicine. BMJ 2019;367:l6236

A retrospective study , using data from the French Transparency in Healthcare and National Health Insurance databases, reports that GPs who received no gifts prescribed cheaper generic drugs and had better drug prescribing efficiency indicators than those in receipt of gifts….

the value of the Transparency in Healthcare database. Without it, gifts to French GPs from pharmaceutical companies would not be readily accessible for analysis.

….The French “Sunshine Act” (The Loi Bertrand) established the Transparency in Healthcare database that became publicly accessible in 2018. The law requires health products companies to disclose agreements with healthcare providers publicly within 15 days. Any benefit to the healthcare provider exceeding a value of €10.00 (£8.60) in cash or in kind must be disclosed within six months.15 Although no direct causal link was found between the gifts received and GP prescribing, Goupil and colleagues’ study shows the importance of disclosure legislation: gifts to French GPs are common (36 232/41 257 GPs (87.8%) listed in the database had received gifts) and are associated with poorer prescribing practices and increased costs to the healthcare system.

The influence of organisational or individual conflicts on clinical practice demands a system-wide strategy to manage and mitigate such conflicts.

Gareth Iacobucci in the BMJ asks the same question and gives a graphic answer: Is the NHS being privatised? BMJ 2019;367:l6376

The NHS is shaping up to be a key battleground in the upcoming UK general election….

How much has private provision in the NHS increased since 2012?

In 2014 The BMJ found evidence of a big increase in the number of contracts being awarded to private firms after the 2012 act (fig 1).6 But this didn’t translate into significantly increased spending on private providers, as many contracts were small in value.

Image result for disclosure cartoon