As a GP in training, I read with interest the recent articles detailing the return of ‘golden hellos’ to certain practices that can’t seem to recruit partners. These incentives are anything from £5,000-£20,000, should the partner remain for a requisite time period. Will anyone really be won over by an extra £1,250 approximately a year after tax? Ultimately, it’s going to be less of a bind, doing a couple of locum shifts. I’d see it as a nice bonus at best, but it’s hardly a golden ticket.There is a shortage of GPs, which means there is always going to be some sort of work available. As more senior GPs take their retirement early in wake of the changes to our pension scheme (among other things), the number of vacancies will only increase and so there will be that much more choice for those left. That, in turn, means that those looking to recruit must compete against one another, and we’ll see more cases of golden handshakes, golden handcuffs and the like.I don’t plan on applying for a partnership when I complete my training. There are several reasons for this. Firstly, I’d like to try working for different practices. This seems to be what the majority of newlyqualified GPs do. It makes good sense to know that the practice you’re committing to is where you want to remain. Secondly, there is more scope for working part-time, or to a particular working pattern which lets me put the children to bed at least a few nights a week. Thirdly, and this is true for a lot of doctors, my partner is also a doctor, albeit a hospital doctor. We must both fit our careers in, and as there are that many more jobs in primary than secondary care, we will be more governed geographically by her place of work than by mine. Fourthly, from what I gather there is almost no benefit, financially at least, in becoming a partner. Coupled with the additional pressures and workload this brings, it’s easy to see why most people aren’t jumping in with both feet. And finally, there is the consideration of relocating overseas. Many of my friends have done this; most go for the experience but end up staying as they have found so much more job satisfaction and work-life balance. There was a time when talking about relocating overseas would give me a pang of guilt; the National Health Service is very close to my heart, and I think we should all be proud to work for the values it embodies.Unfortunately, the NHS is no longer an ideal employer, and thinking of it in purely careerist terms, , that pang of guilt I feel about emigrating goes away quite quickly. When I substitute ‘NHS’ for, to pick a random example, Tesco, things start to sound pretty unappealing. For example, ’Tesco staff told no pay rise for three years’ sounds entirely unacceptable. Why, then, would people still work for such a company? Increasingly they are not. Doctors are leaving the NHS for greener pastures at all stages of their careers. A significant number of the people I qualified with have left medicine altogether, and not for glamorous careers elsewhere. I know of consultants leaving to become photographers, or personal trainers. And now, of course, there are a lot of doctors preparing to take early retirement. Clearly, the NHS is no longer an attractive employer.I’m not sure I know how to fix the situation. Recruit more doctors? Retain the ones we’ve got?Certainly, any form of golden handshake would probably need to start on the first day of medical school to have any meaningful sort of effect. The military use it as a recruitment tool - perhaps the NHS needs to as well. Only when there are enough people staying in the NHS will there be enough people to recruit from. But only by changing the way the NHS treats its staff will people stay in the long term. Doctors are not volunteers and the NHS is no charity - most obviously, charities still provide their employees with pay rises.If nothing happens to improve things then the situation will continue its downward spiral. Shortfalls will put more stress on those in post, who will in turn look to get out for their own sake, be it by going abroad, switching careers or retiring. With such uncertainty, it is not surprising that few people want to commit to partnerships.Ultimately there may be few things that can be done to attract new partners, but I think any prospective surgery would need to be supportive and caring. It may sound twee, but getting on with the people you work with and the culture at your surgery make a big difference to any GP’s morale. People don’t mind hard work, provided that they feel valued. (That, and a big fat cash incentive.)Dr Tim Cassford is a GPST1 in Chichester.
For example 'privatisation' of the NHS was something like 4.9% under Labour and has increased to 6.1% under this government, but the representation of the 'privatisation' is very, very different i.e 'it's the Tories wot done it'.
Quote from: Sloper on January 07, 2015, 09:32:00 amFor example 'privatisation' of the NHS was something like 4.9% under Labour and has increased to 6.1% under this government, but the representation of the 'privatisation' is very, very different i.e 'it's the Tories wot done it'.And what was it under the Tory government that preceeded Labour? If it was 4.9% when Labour took over then such representations are perfectly justified. If you could cite your sources I'll go and look this up.(I don't really care who is responsible for the greatest amount of privatisation, its petty tit-for-tat bickering since both parties are as bad as each other, but I do think that its bad practice to cherry pick statistics and ignore others in order to support ones point of view).
The issue with privatisation and the NHS is that the 'system' needs to be integrated. For example, A&E crisis partly due to elderly patients not being able to be released due to reduced council care budgets, therefore no beds, therefore A&E clogged, therefore people waiting in ambulances, therefore ambulances in use so hour plus waits for 999's etc... The £££ for treatment needs to go with the person not the facility... (almost like an insurance policy... more later..). if GP, Hospital, Social care/Rehab are all funded separately then there is little or no incentive for any integration between the various organisations. Another example, GP's under strain (financially or other), so people bumped onto A&E... many of GCW's examples (in previous posts) show the lack of integration. Even at a higher level, examples on C4 news last night where trust execs saying how in the past other hospitals would pitch in and help those in trouble - now there is less/no incentive for those from another trust to help..This is my biggest beef with the privatisation - its fucking cack handed.... It needs a way to ensure that the transition between the various parts of the service are good and smooth. If you had one (decent) company running everything - overseeing stuff from top to bottom (an insurance company for example??) then I can see that working to a degree - but at the moment it appears to be all over the shop... Oh - is that what NHS trusts are supposed to be?I dunno. Its depressing stuff... listening to R5 this morning and a A&E consultant saying how he saw a stroke victim who put off coming until 12 hours after his symptoms came on to try and save A&E pressure - and in the docs words "missed his window for recovery"... I've a wonky back and in an ideal world would like to get a proper scan and diagnosis - but no point even bothering my GP about this ~ 2 week appointment time at the moment. Yet MrsTT (Different city, different surgery) has just completed a 6 week hydrotherapy course for her (very much less) wonky back referred from her GP.. My parents both suffer from AMD and fortunately (postcode lottery) get the £££ jabs in the eye every month or two to treat it. Yet disabled brother in law is withering away (sadly literally) waiting for a delayed op to drain fluid on the brain... Sorry the last bit was a bit of a rant rather than anything constructive - I guess my point is that there seems no logic or consistency in what happens...
Quote from: slackline on January 07, 2015, 09:42:46 amQuote from: Sloper on January 07, 2015, 09:32:00 amFor example 'privatisation' of the NHS was something like 4.9% under Labour and has increased to 6.1% under this government, but the representation of the 'privatisation' is very, very different i.e 'it's the Tories wot done it'.And what was it under the Tory government that preceeded Labour? If it was 4.9% when Labour took over then such representations are perfectly justified. If you could cite your sources I'll go and look this up.(I don't really care who is responsible for the greatest amount of privatisation, its petty tit-for-tat bickering since both parties are as bad as each other, but I do think that its bad practice to cherry pick statistics and ignore others in order to support ones point of view).From memory the 'siphoning off' was about 0% of the NHS budget under the Tories (yes there was contracting out of non care services, cleaning IT and the like) but the use of NHS buget for what would previously have been w/in the NHS care started following (from memory) the 2003 Act and increased after the 2007 Act. I'm sure the Kings Fund did a paper on the Independent Sector Treatment Centres in 2006/7 showing the inefficiency resulting from the poor contracting process.Fatdoc is probably well placed to comment on the transfer of elective surgery >2003
You say to run general practice privately will cost more but it IS run privately, as you yourself say partners put money into the business and will get a return on that investment*: how would stripping out partner equity and return on equity make the system more expensive?
Large GP practices in towns and citys are probably quite profirable if well run but smaller practices in rural areas will be probably on the margins of profitability if care is to be adequate.
Quote from: Sloper on January 07, 2015, 09:32:00 amYou say to run general practice privately will cost more but it IS run privately, as you yourself say partners put money into the business and will get a return on that investment*: how would stripping out partner equity and return on equity make the system more expensive? The current system costs £50 odd quid per patient per year for core work, for infinite access to a GP. It's a flat rate, plus bits of performance related pay on top. A single private GP appointment at our local private provider is £80, and that doesn't include tests or prescription. If a private provider ran the system, there is no way they could maintain this service (which is what is happening in the current system) and make a profit. Quote from: Sloper on January 07, 2015, 10:41:31 amLarge GP practices in towns and citys are probably quite profirable if well run but smaller practices in rural areas will be probably on the margins of profitability if care is to be adequate. We are talking about an average sized practice having a turnover of £1.5 million if that - it's small fry stuff. A lot of rural practices receive an addition funding to support them - this is now being pulled and a LOT of these guys will make a loss very soon and thus close. Virgin won't touch these with a stick.
This comes down to what I've been saying for years - the whole idea is to stop doctors being independent contractors, and to make everyone a salaried employee by forcing the system to fail. Then it can be taken over by private providers - but it will mean we all have to pay for the care in one way or another (not via NI) in addition to what we now pay, and the cost to the government to run it will skyrocket.
because they only commit to paying the provider for the length and targets of the contract, with the provider then being responsible for sorting out redundancies which result from reductions in funding?there must be some reason
Redundancies don't arise due to a lack of funding they arise when the job function is no longer required.
