GP premises are long term projects, but GPs are now thinking short term.

The basis of the Notional Rent scheme for GPs is that premises will last for longer, and be better maintained, if there is an incentive for the owners (The Doctors or public/private finance ) to look after them well. GPs being self employed, are businesses that take profits. When a GP starts he may incur a debt to buy into a premises, but this debt reduces as he progresses. The interest is tax deductible, and if any profit is made on sale it is subject to business entrapaneurs tax relief. The financial incentives apply to GPs who commit to and stay in a community. The new GPs do not think they will stay in the same practice or job for life. They will need flexibility and the scheme for purchase does not lend itself to short term posts (less than 10 years). There is an argument that the Notional Rent is a form of PFI, and as companies use it to make their profits, the argument becomes stronger. If the state were to build GP premises I would recommend a good concrete slab with all the services ducted in, and above ground a plastic and cardboard structure designed to be ripped down and replaced every 10 years. Whatever the criticism of the current scheme, premises have lasted longer without changes than PFI hospitals. What GPs need is either more doctors, or less patients… I suppose letting a practice become a ruin could mean less patients attended…. a long term argument for state ownership?

Chris Smyth reports in the Times 9th August 2018: NHS bid to raise cash for super-surgeries sparks fresh PFI fear

The NHS is in talks with private GP landlords over increasing rents to fund a £3.3 billion overhaul of crumbling surgeries, despite fears of a repeat of the private finance initiative controversy.

Some health chiefs believe that private money is the only way to fund super-surgeries where specialists can be based to help to keep people out of hospital. Others fear that the deal could lead to a repeat of the deals that have lumbered the NHS with years of inflated payments to private companies.

Simon Stevens, the chief executive of NHS England, wants to put therapists, pharmacists and diagnostic tests in GP surgeries to ease pressure on hospitals and help to save £22 billion.

However, this would require upfront cash to improve cramped or poorly maintained buildings, at a time when infrastructure budgets have been raided to bail out overspending hospitals.

An official review by Sir Robert Naylor, the national adviser on NHS property and estates, concluded that £10 billion in capital funding would be needed to implement Mr Stevens’s plan, but Philip Hammond, the chancellor, is loath to add such a large sum to the government balance sheet. The Times disclosed in April that health officials had discussed raising some of the money from hedge funds.

Now three big landlord companies have said they are willing to spend £3.3 billion on 750 new medical centres in exchange for being allowed to raise rents by £200 million a year. Between them they own 850 surgeries that care for nine million patients.
Tim Meggitt, director of Octopus Healthcare, which is proposing the deal with Primary Health Properties and Assura, a healthcare property investment trust, said: “This investment in the primary care estate could ensure that government priorities of delivering necessary efficiency savings and keeping people out of costly hospital wards and in the community are met.”
Some officials involved in discussions with the companies have privately expressed nervousness, comparing the offer to the Blair-era initiative that led to the NHS being locked into long-term payments to the companies that rebuilt hospitals. Such deals will cost £2 billion this year, rising to £2.6 billion in 2028.
The companies insist that the latest offer is different because they will be responsible for all risks and maintenance.
Gavin Ralston, head of GP premises for the British Medical Association, said that many GP buildings were too cramped to provide first-class care but that ensuring money promised in the past by the government was properly spent would be a better bet.
“Urgent investment is undoubtedly required, but we should treat these proposals with a high degree of caution,” he said. “A considerable question mark exists over whether PFI-type deals deliver good value for money to the taxpayer.”

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“You cannot oppose something you did not know was going on”…. PRIVATISATION derided

English Health Service to reject more PFI – but not the hedge funds!

Ending the Blair/Brown short term mania for PFI Hospital Builds

Campaigners urge bosses not to use PFI to build new Royal Liverpool Hospital

Incompetent bosses wrecking NHS, says troubleshooter: “We have an unsustainable healthcare system..”

Corporate collisional denial – and on a greater scale than the holocaust.

NHS rationing: NHS hospitals face massive deficits and demands for further cuts

entry was posted in Uncategorized on February 4, 2015 by .

The people of Norfolk will need more doctors – so will we all if GPs are all going to work weekends and Bank Holidays


There are still not enough medics – even with a 25% increase

The BBC news reports 9th August 2017: Medical school places to increase next year

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but this will still not be enough, and we need a realistic approach. Given that 80% on medical students are undergraduate appointments, and 80% are women, we need at least a 250% increase in medical student intake. If we change to graduate entry a 200% increase might be enough. Students can be trained in localities using the internet. Only intermittent assessments and exams need to be centralised, (if they are practical) but the theory exams can be “on line” from local driving test centres. The 2 in 11 successful applicants to medical school needs to change to 5 in 11 immediately, and to 10 in 11 if we are to accept the current drop out rate and gender bias. It is good news, but limited and unimaginative.

An extra 500 medical school places in England have been confirmed for next year by the government.

The Department of Health announced in October it planned to add up to 1,500 more places each year – a boost of 25% on current student doctor numbers – and says it will hit that target by 2020.

It is part of a plan to use UK-trained doctors to ease NHS staffing pressures.

But the British Medical Association says the plan will not address the immediate shortage of medics.

Training to become a doctor takes at least five years and currently about 6,000 graduate each year.

Diversity drive

The government wants many of the new training places to go to students from disadvantaged backgrounds to improve diversity in the medical profession…..

….Prof Wendy Reid, from Health Education England, said the extra places would help the NHS meet the diverse healthcare needs of patients “up and down the country”.
Shadow health secretary Jonathan Ashworth said: “Ministers have repeatedly announced plans to increase doctors’ training levels and in many key medical specialities they are failing to fill the places already on offer.
“The government need to get a grip and put in place a long-term workforce plan backed up with significant new investment for the number of staff needed to deliver services safely.”

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The ‘perfect storm’ facing general practice

Letters in The Times 8th August 2017 and the original letter sparking the response. Rationing of places has been prolonged and it’s too late to stop the two tiers of health care now… The GP situation now HAS to get worse, because if the numbers needed are imported they will not be trained for British General Practice.

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The ‘perfect storm’ facing general practice

Sir, Elizabeth Clarke (letter, Aug 5) fails to appreciate the “perfect storm” facing primary care. With the ageing population, demand for GP appointments is steadily rising, up 25 per cent in six years. At the same time medical defence fees are rocketing and we are still expected to carry out complex consultations often involving patients with multiple conditions in ten minutes; my working day is never less than 12 hours.

If general practice were so lucrative we would have lots of eager young doctors wanting to enter the profession, but there is a huge number of vacancies in GP training posts, and retiring GPs are not being replaced, resulting in practices closing.

There is a crisis in primary care and it is catastrophic that little is being done to tackle it, with the exception of Jeremy Hunt’s plan to harvest 5,000 GPs from the “magic GP tree”.

Dr Stewart McMenemin

Sir, I was dismayed to read Elizabeth Clarke’s suggestion that GPs’ earnings are so great that they need work only three days a week. If this is the case, why are a growing number of partnerships unfilled and why are some practices declaring themselves no longer viable? After 25 years in general practice I am seeing more patients, more often and for longer, while my pay remains the same as ten years ago. Were I younger I would certainly be considering other occupations or emigrating. As it is, I await retirement.

However, ill-informed comments reduce morale still further and I seriously believe that general practice, as we know it, will shortly cease to exist. Some may believe that this a good thing. If so, the best of luck to them in their old age.

Dr Roderick Shaw

Sir, As a fourth-year medical student I was disappointed by the implication that doctors are shirking their duties to society. Even my brief experience of general practice has given me huge admiration for the way GPs cope with the stress of an emotionally draining job where one mistake, in ever-shortening consultations, could lead to someone’s death. It’s hardly surprising that some of them, both male and female, feel unable to work full-time. The vast majority of medical students are motivated by a commitment to do their best for patients, rather than personal gain, so it is disheartening to feel that there is no room for doctors to be human.

Katherine Read
Imperial College London

Sir, I am a young GP who is “part-time”. But though I see patients for just six morning or afternoon sessions, each clinical day lasts more than 12 hours, equating to 36 hours of work. There are then insurance reports and benefits assessment forms to complete, cluster meetings (these would be commissioning meetings in England) and mandatory educational meetings for my appraisal, which all takes an average of another ten hours a week. In what other profession is a 46-hour week considered part-time?

Dr Alec Jones
Llangollen, Denbighshire

Sir, Many part-time GPs, myself included, are women with young families. If we could not work part-time we would not work at all: what a great loss to the profession that would be. It is better to have a part-time GP than no GP at all.

Dr Annie Middleton
Tunbridge Wells, Kent

The original letter 5th August:

Sir, The obvious way to ensure that GPs work full-time is to pay them less. Full-time earnings for GPs are so great that most can have the luxury of a very comfortable life working only three days a week.

If they feel that their work is too stressful to work any longer, perhaps they should try some of the occupations that pay half as much as theirs.

Elizabeth Clarke

and on the same day PART-TIME GPs

Sir, I am not surprised that trainee GPs find it too stressful to work full-time (report, Aug 2). Many have or want children and many have well-paid husbands. When I was a medical student less than 10 per cent of my colleagues were female. Is it not time someone insisted on medical schools recruiting at least 50 per cent males?

Dr Tony Barson

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

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

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

The history of denial in GP recruitment: over 50 years. The result of a sustained collusion of denial.. It’s going to get worse..


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Mental Health – Its going to get worse.

Mental Health patients have a stark choice, if they are deemed capable of making one, and this is between inadequate state provision, and private health care they cannot afford. Just as in infertility in the previous posting. The two tier unofficial system thrives. In addition to which ministers cannot do their maths correctly. Labour’s pretence that the under planning has nothing to do with them is derisory, as the underfunding has been continuous over 10 administrations over 30 years… Communication and cultural identity are essential as well as caring in psychiatry. We must make the new jobs attractive to our own.

Story image for mental health cartoon from Redding Record Searchlight

Peter Yeong in the Times 7th August writes: NHS abuse of mental patients ‘endemic’ – Warning over use of force amid record violence

and in support of this is the report on Connor Sparrowhawk by Jash Holliday  from East Sussex.(The Guardian)

Record levels of violence and abuse against vulnerable patients at mental health trusts were reported last year amid accusations of “endemic” use of force in the NHS.

More than 5,000 serious incidents involving both children and adults were investigated, including hundreds of suicides, dozens of killings, more than 2,000 cases of self-harm and even deaths of children.

The figures, obtained by The Times through freedom of information requests, have shocked a sector reeling from accusations of flawed care after the High Court judge Sir James Munby lambasted the “disgraceful lack of provision” last week for a teenage girl at acute risk of taking her own life.

Most of the serious incidents relate to the quality of treatment and patient safety, and showed:

● More than a thousand complaints relating to care, including delays and use of medications.

 2,170 incidents of self-harm.● 371 suicides.

● 198 confidential information leaks.

● 199 cases of abuse of patients.

The Times has categorised each serious incident report and found that the number involving abuse of patients rose from 106 in 2013-14 to 199 last year. Investigations carried out into abuse of child patients rose from 9 to 39 in a single year. NHS figures show that 103,027 people spent time in specialist mental health treatment in 2015-16.

Norman Lamb, the former Liberal Democrat health minister, said that force was used “far too much” in mental health treatment.

He added: “It’s just intolerable — the trusts need to be accountable. The use of physical force is endemic in the system. Abuse of patients, on the face of it, can be characterised as gross misconduct. The system is under an impossible strain and it shows that we’re not providing enough resources to good, preventive care.”

Approximately a quarter of people in Britain will experience a mental health problem every year, according to the mental health charity Sane. In the first official estimate of its kind, the children’s commissioner for England has said that more than 800,000 children have mental health problems.

Anne Longfield, the commissioner, said that the experience of child patients in mental health services is of “rattling around a system that feels completely incoherent”.

Expressing particular concern over the number of child deaths, of which there have been more than 100 since 2011-12, she added: “One of the ways that these children are being let down is that as professionals we are not demonstrating the right levels of curiosity and determination about their treatment.

“I don’t think the government is moving fast enough on this, showing enough determination on this or indeed putting enough money into this.”

The figures from NHS England in 2015-16 met the serious incident guidance, meaning that they are significant enough to warrant an investigation, outlined by the health service’s regulator. NHS bodies must investigate all “adverse events, where the consequences to patients, families and carers, staff or organisations are so significant . . . that a heightened level of response is justified”.

Luciana Berger, MP, president of the Labour campaign for mental health and a member of the health select committee, called the figures staggering and said that they should serve as a wake-up call for ministers.

The serious incident reporting guidance has been updated twice since 2013 to transfer monitoring powers to clinical commissioning groups and NHS England after the closure of the strategic health authorities and primary care trusts and to amend incident categories.

A spokesman for NHS Improvement said: “We are looking at ways to transform mental health services, tackle the stigma attached and establish a way of working that can support the mental health workforce.”

A Department of Health spokesman said: “If there are serious incidents where patient safety has been put at risk, we expect mental health trusts to investigate immediately. Serious incidents remain rare across the NHS and our guidance makes clear restraint should only be used as a last resort.”


When will public anger over the NHS reach a political tipping point? More NHS mental health patients treated privately…Mental health recruitment plan ‘does not add up’, nurses say

Sky News 31st July 2017: The Government says it wants create 21,000 new jobs, but the nursing union questions how the target can be met by 2021.

The Guardian 6th Dec 2016: The government is breaking promises on child mental health

A nation choosing to have fewer children, and to import fewer workers for the health and social care services. It does not stack up.

We are a nation choosing to have fewer children, and to import fewer workers for running the health and social care services. It does not stack up.

Things have to get worse unless we export our elderly for warehousing abroad, or they are managed by robots.Image result for nuclear family cartoon

Fay Schopen reports in the Guardian that “IVF was stressful enough even before this new post code lottery. (NHSreality points out it’s not new and is only getting worse and more unfair as predicted)

Fay is paying for private care and pints out the two tier system which is the national effect of current policy.

Ironically, the Economist points out that fewer women in the west are choosing fertility. More and more have either one or no children. Is society getting compassion fatigue for those who choose to have large ffamilies?

The Rise in Childlessness is available in the Economist 27th July but also below.

Childlessness – Economist

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Change the Rationing of Infertility treatments from covert to overt: Schools should tell girls to try for a baby before 30, says fertility expert – and prospective professional be warned..

Patients suffer in GP funding lottery. Anger and civil unrest to follow?

You never knew it was “unavailable” until you needed it.. and then it’s too late

Women denied IVF as 80 per cent of NHS trusts ration fertility treatment

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Women in NHS ambulance service ‘hounded for sexual favours’

Haroon Siddique in The Guardian August 4th reports: Women in NHS ambulance service ‘hounded for sexual favours’

Report finds South East Coast ambulance trust has highly sexualised behaviour ‘embedded’ at management level

Female NHS ambulance staff say they have been hounded for sexual favours in return for promotion.

The allegations, which include “highly sexualised gazing” in front of patients and “sexual predators” who “groomed students” for sex, emerged in a report which revealed widespread bullying at South East Coast ambulance service NHS foundation trust (Secamb).

Researchers were told that sexualised behaviour was embedded in parts of the management structure. The independent report was commissioned by Secamb after concerns were raised in the trust’s staff survey and a report was published last year by the NHS regulator, the Care Quality Commission (CQC).

More than 40% of about 2,000 staff who took part in the research said they had experienced bullying in the last 12 months.
The 69-page report, produced by Prof Duncan Lewis from Plymouth University, detailed “overt and covert sexualised behaviour” extending from former senior leaders through to frontline managers and the general workforce. Some of the senior staff interviewed believed those responsible had left the trust, but the report said researchers were told the culture was embedded at management level in some areas of the organisation.
“For example, female staff talked about sexual favours being sought in return for career progression whilst others were hounded by managers seeking sexual favours for personal reasons.

“Several female staff felt that such behaviours were the norm, with some stating ‘my arse was slapped regularly’ and others who felt they were demeaned by highly sexualised gazing in front of colleagues and even patients.
“Some female respondents talked about ‘sexual predators’ among m

Researchers were said to be shocked at the number of staff reporting poor behaviour.

“The researchers were extremely distressed to hear of the experiences of several female Secamb employees,” it said: “The trust may not of course be aware that such a culture exists as employees are often extremely fearful of speaking out against such practices.

“However, as has been shown time after time, ignorance is no defence and too many British institutions have demonstrated failure to take matters seriously when it comes to sexual abuse.”

The report said the trust’s executive must now commission further investigations and take action “as an urgent priority to protect employees who are living in fear daily”.

Secamb, which covers Kent, Surrey, Sussex and north-east Hampshire, was put into special measures last September after the CQC ranked it inadequate.

In 2015, it was embroiled in a scandal over its delays and misreporting of 999 attendance figures. As an “experiment”, Secamb delayed sending help for some calls to allow extra time for patient assessments but it ended in failure.

ale colleagues who ‘groomed students’ for sexualised ends. Some managers felt there was a history of comments being turned to lewd remarks but slowly these were being addressed.”


Access to care is not equal. An unofficial 2 tier system is worse that an official and regulated one.

Healthcare has never been equal, but from 1948 we really attempted to make it so. Without short waiting times and high standards, and choice, the inequality will rise as more and more choose to pay. An unofficial 2 tier system is worse that an official and regulated one.

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In a letter to the BMJ S Michael Crawford explains: Access to care is not equal (BMJ 2017;358:j3653 )

When more patients than previously are being denied access to care and some of them are consequently initiating exceptional or individual funding requests,12 the question of fairness arises. We already know that access to joint replacements is lower in deprived areas.3 Perhaps patients from the articulate and assertive end of the social spectrum are more likely to ask their GPs to pursue an individual funding request.

Socioeconomic status is known to determine health, but its effect on uptake of healthcare is rarely highlighted. Michael Marmot, in his book The Health Gap, says that survival of poorer patients with cancer after treatment is inferior, but he discounts the possibility that this might be related to access.4 Evidence indicates that residents of poorer neighbourhoods have reduced access, which is exacerbated by distance from services.5 A study, reported in The BMJ as Research News, showed that many patients who present to the emergency department with cancer have not seen a GP, and this was commoner in those from deprived areas.67

Nine further studies appeared in The BMJ in the first six months of 2017, either as research papers or reported as Research News, which looked at patients’ access to services in relation to deprivation.8910111213141516 Other reported studies that used big data mention using deprivation scores to adjust the statistical model in the analysis of their topic of interest, potentially forfeiting important understanding about the effect of socioeconomic status in patients’ access to services.

The assumption that the NHS is equitable must be tested. International comparisons show us to have a small, inexpensive healthcare system. It inevitably functions as a competition between patients. We must measure the different effects of increasing financial pressures on the varying strata of society.

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