Why do doctors in the NHS go on? I mean, what exactly is the fucking point? What is to be gained from slogging on day after day in the certain knowledge that the lying, cheating, evil, murderous scumcunts in power could not care less about anyone or anything except themselves.
It's not easy to know where to start with the news that the government is going to unilaterally rewrite the GP contract to force GPs to open evenings and weekends in exchange for less money after the BMA negotiators decided there was no fucking point in them going on either. So let's summarise.
In the early nougties there was a crisis in General Practice in the UK. Everyone was leaving practice - either by retiring early, or by resigning and doing locum work instead, or by emigrating, or by simply giving up and doing something else, or by really giving up and killing themselves. Experienced GPs were almost universally approaching their fifties as alcoholic divorcees, and those of us coming up behind them wanted none of it. The long hours. The endless unpaid work. The 24 hour demands of selfish twats who knew nothing of the post-war 'gift economy' that had produced the NHS but instead knew only the Cult of the Individual chant of 'I Want, I Want, I Want' and who cared not a jot that their desire to have their two week old ingrown toenail looked at at 4am would harm the care of more needy patients.
Dr Rant was a GP then. The practice budget was based on the archaic 'Red Book' of payments which no-one understood, but which had bizarre perversities to it. The collapse of General Practice seemed imminent. The negative cycle was as follows:
Five partner urban GP practice with 10,000 patients:
1. Stressed out GP number 1 burns out of practice suddenly.
2. The other GPs have to take up the missing GP's workload, so GPs 2-5 go from working at 120% of their maximum capacity to 145% overnight.
3. Practice advertises for a new partner in the BMJ (and bloody expensive it was too - BMJ must have been coining it in because the ads section for partners was the size of a telephone directory) but gets no response because no-one wants to be a GP partner.
4. Practice is forced to get in a locum to cover the extra workload. Locums are not easy to find either because of the sharp rise in demand for locums due to all the unfilled parnership vacancies. Locums can charge a lot of money as they are in such demand, so practice has to pay out twice what a partner would have cost.
5. Locums are very expensive (if available at all) overnight, so remaining partners have to increase the amount of on call work they do.
6. Because the practice is a partner down, and due to Red Book complexities, the partnership LOSES money from their NHS budget.
7. Remaining partners are now working harder for a lot less money and one by one they start to retire early or leave.
8. The partnership implodes as the workload for any remaining partners becomes unbearable (Last One Out Syndrome).
It was not immediately obvious to most people (certainly not the government) why the massive shift of GPs from traditional partnerships to locum work had the effect it had. However, the Locum Effect occured as follows:
1. Partners had to do whatever work they had to do. There was no way to say 'no' to extra work, and as the government cuts to hospital services gathered pace, more and more work was shunted onto GPs without any extra money.
2. Locums doctor's rates of pay had been controlled by the BMA, which was controlled by partners and so had an interest in keeping these rates low.
3. In 1999 the Office of Fair Trade ruled the BMA's setting of locum rates as anti-competative and the BMA was forced to abolish them.
4. Locum rates shot up, doubling and trebling within two to three years.
5. GPs now had, for the first time since the NHS started, an option that allowed them to work a reasonable number of hours and earn a good wage.
6. New GPs became locums in large numbers, exacerbating the shortage of principal GPs (partners in practices) caused by early retirement, emigration, and increased rates of death (from suicide and alcoholism, rates of which were both running at multiples of the national average).
7. Locums were doing less hours for more money, which meant that more GPs were required to do the same work as before. This increased the market value of locums even further, which meant locums could charge more, which meant they could work less to earn the same money, which increased their market value even more, which meant they could charge more, which meant....well, you get the picture.
As practices closed altogether (and some large practices closed as well as many, many small ones), the Primary Care Trusts assumed responsibility for their patients. The PCTs had only one option - they had to throw money at locum agencies to put medical bums on seats and avoid a total collapse in the service. This of course, made locums even more scarce for the remaining practices. Also, some GPs resigned as NHS GPs and simply went back as a locum to essentially the same job being paid a lot more by the PCT but for less responsibility.
The average time to fill GP vacancies was being measured in years (really) and the Primary Care Trusts were bankrupting themselves paying for more and more locums as everyone jumped ship.
This was a true crisis.
The solution came in the form of the 2004 New General Medical Services contract (New GMS, or GMS 2). There was much discussion on the medical forums regarding the new contract. Basically, the government wanted performance related funding (in the form of Quality Points payments) and an end to the crisis that was threatening to bankrupt the Primary Care service. Exhausted GPs wanted just two things in exchange: 1, to be able to give up out of hours care (it was literally killing some of them) and 2, to be able to say 'no' to new work unless it was funded (the so called 'No New Money, No New Work' requirement).
The Aquward Squad GPs at the time had concerns. Firstly, that the new contract could be unilaterally changed by the government without the agreement of GPs, and secondly that giving up Out of Hours - tempting as it was to exhausted and demoralised front line troops - would inevitably be fucked up by the government. There was also the concern that the government's real objective was to break up GPs' monopoly of primary care to make privatisation easier, and that they were willing to pay through the nose to achieve this.
However, unsurprisingly in view of the BMA's stance that there was 'no plan B', GPs voted overwhelmingly in favour of the new contract. As it turned out everyone was right. The BMA was right that the contract brought improved pay and better conditions for GPs which quickly reversed the crisis in General Practice recruitment and retention. The Government was right that they were able to use GPs high quality scores for political gain. The Awquard Squad was right that primary care was easier to parcel off to private companies now that GPs no longer had a contractual monopoly and that Out of Hours care would become a shambles.
And now the Awkward Squad's biggest concern has been proved correct. The main selling point of the new contact was 'no new money, no new work'. After years of being abused and put upon, GPs wanted control of their workload. They wanted to be able to say 'no' to being dumped on. They wanted to stop being the slave-like kicking stool of a government hell-bent on saving money by closing services and then dumping the work onto GPs instead. GPs were the cheapest labour in the NHS because they could be made to do an infinite amount of work for a flat rate of pay.
Well, as pointed out way back in 2003, if the contract can be changed unilaterally by the government at any time then you don't have a 'no new money, no new work' contact. What you have is the same slave-labour contract plumped up with a loss-leading hook of new money for quality work.
Lets not forget that the vast majority of patients report that they don't need evening and weekend appointments (even when asked in a loaded government questionnaire designed to get the opposite response), and those that do need them need them because employers have become much less willing to give employees time off to see their GP. (Is that really a reason to provide a worse service for the majority of patients?).
Now that every GP can see the new contract for what it really is.
Now that every GP can see that the media-blitz of lies and spin trying to claim that GPs are paid more for less work was an orchestrated artillery softing up before the battle.
Now that all the GPs are really, really, really fucked off.
What will happen next?
Who knows? But one has to ask, what is the fucking point of being a doctor in the NHS?
Continued in part 2.
It's not easy to know where to start with the news that the government is going to unilaterally rewrite the GP contract to force GPs to open evenings and weekends in exchange for less money after the BMA negotiators decided there was no fucking point in them going on either. So let's summarise.
In the early nougties there was a crisis in General Practice in the UK. Everyone was leaving practice - either by retiring early, or by resigning and doing locum work instead, or by emigrating, or by simply giving up and doing something else, or by really giving up and killing themselves. Experienced GPs were almost universally approaching their fifties as alcoholic divorcees, and those of us coming up behind them wanted none of it. The long hours. The endless unpaid work. The 24 hour demands of selfish twats who knew nothing of the post-war 'gift economy' that had produced the NHS but instead knew only the Cult of the Individual chant of 'I Want, I Want, I Want' and who cared not a jot that their desire to have their two week old ingrown toenail looked at at 4am would harm the care of more needy patients.
Dr Rant was a GP then. The practice budget was based on the archaic 'Red Book' of payments which no-one understood, but which had bizarre perversities to it. The collapse of General Practice seemed imminent. The negative cycle was as follows:
Five partner urban GP practice with 10,000 patients:
1. Stressed out GP number 1 burns out of practice suddenly.
2. The other GPs have to take up the missing GP's workload, so GPs 2-5 go from working at 120% of their maximum capacity to 145% overnight.
3. Practice advertises for a new partner in the BMJ (and bloody expensive it was too - BMJ must have been coining it in because the ads section for partners was the size of a telephone directory) but gets no response because no-one wants to be a GP partner.
4. Practice is forced to get in a locum to cover the extra workload. Locums are not easy to find either because of the sharp rise in demand for locums due to all the unfilled parnership vacancies. Locums can charge a lot of money as they are in such demand, so practice has to pay out twice what a partner would have cost.
5. Locums are very expensive (if available at all) overnight, so remaining partners have to increase the amount of on call work they do.
6. Because the practice is a partner down, and due to Red Book complexities, the partnership LOSES money from their NHS budget.
7. Remaining partners are now working harder for a lot less money and one by one they start to retire early or leave.
8. The partnership implodes as the workload for any remaining partners becomes unbearable (Last One Out Syndrome).
It was not immediately obvious to most people (certainly not the government) why the massive shift of GPs from traditional partnerships to locum work had the effect it had. However, the Locum Effect occured as follows:
1. Partners had to do whatever work they had to do. There was no way to say 'no' to extra work, and as the government cuts to hospital services gathered pace, more and more work was shunted onto GPs without any extra money.
2. Locums doctor's rates of pay had been controlled by the BMA, which was controlled by partners and so had an interest in keeping these rates low.
3. In 1999 the Office of Fair Trade ruled the BMA's setting of locum rates as anti-competative and the BMA was forced to abolish them.
4. Locum rates shot up, doubling and trebling within two to three years.
5. GPs now had, for the first time since the NHS started, an option that allowed them to work a reasonable number of hours and earn a good wage.
6. New GPs became locums in large numbers, exacerbating the shortage of principal GPs (partners in practices) caused by early retirement, emigration, and increased rates of death (from suicide and alcoholism, rates of which were both running at multiples of the national average).
7. Locums were doing less hours for more money, which meant that more GPs were required to do the same work as before. This increased the market value of locums even further, which meant locums could charge more, which meant they could work less to earn the same money, which increased their market value even more, which meant they could charge more, which meant....well, you get the picture.
As practices closed altogether (and some large practices closed as well as many, many small ones), the Primary Care Trusts assumed responsibility for their patients. The PCTs had only one option - they had to throw money at locum agencies to put medical bums on seats and avoid a total collapse in the service. This of course, made locums even more scarce for the remaining practices. Also, some GPs resigned as NHS GPs and simply went back as a locum to essentially the same job being paid a lot more by the PCT but for less responsibility.
The average time to fill GP vacancies was being measured in years (really) and the Primary Care Trusts were bankrupting themselves paying for more and more locums as everyone jumped ship.
This was a true crisis.
The solution came in the form of the 2004 New General Medical Services contract (New GMS, or GMS 2). There was much discussion on the medical forums regarding the new contract. Basically, the government wanted performance related funding (in the form of Quality Points payments) and an end to the crisis that was threatening to bankrupt the Primary Care service. Exhausted GPs wanted just two things in exchange: 1, to be able to give up out of hours care (it was literally killing some of them) and 2, to be able to say 'no' to new work unless it was funded (the so called 'No New Money, No New Work' requirement).
The Aquward Squad GPs at the time had concerns. Firstly, that the new contract could be unilaterally changed by the government without the agreement of GPs, and secondly that giving up Out of Hours - tempting as it was to exhausted and demoralised front line troops - would inevitably be fucked up by the government. There was also the concern that the government's real objective was to break up GPs' monopoly of primary care to make privatisation easier, and that they were willing to pay through the nose to achieve this.
However, unsurprisingly in view of the BMA's stance that there was 'no plan B', GPs voted overwhelmingly in favour of the new contract. As it turned out everyone was right. The BMA was right that the contract brought improved pay and better conditions for GPs which quickly reversed the crisis in General Practice recruitment and retention. The Government was right that they were able to use GPs high quality scores for political gain. The Awquard Squad was right that primary care was easier to parcel off to private companies now that GPs no longer had a contractual monopoly and that Out of Hours care would become a shambles.
And now the Awkward Squad's biggest concern has been proved correct. The main selling point of the new contact was 'no new money, no new work'. After years of being abused and put upon, GPs wanted control of their workload. They wanted to be able to say 'no' to being dumped on. They wanted to stop being the slave-like kicking stool of a government hell-bent on saving money by closing services and then dumping the work onto GPs instead. GPs were the cheapest labour in the NHS because they could be made to do an infinite amount of work for a flat rate of pay.
Well, as pointed out way back in 2003, if the contract can be changed unilaterally by the government at any time then you don't have a 'no new money, no new work' contact. What you have is the same slave-labour contract plumped up with a loss-leading hook of new money for quality work.
Lets not forget that the vast majority of patients report that they don't need evening and weekend appointments (even when asked in a loaded government questionnaire designed to get the opposite response), and those that do need them need them because employers have become much less willing to give employees time off to see their GP. (Is that really a reason to provide a worse service for the majority of patients?).
Now that every GP can see the new contract for what it really is.
Now that every GP can see that the media-blitz of lies and spin trying to claim that GPs are paid more for less work was an orchestrated artillery softing up before the battle.
Now that all the GPs are really, really, really fucked off.
What will happen next?
Who knows? But one has to ask, what is the fucking point of being a doctor in the NHS?
Continued in part 2.
Dr Rant
Dr Cardigan
Dr Blue
Dr Brown
Rev Dr Green
Dr Mustard
Mr Orange
Dr Pink
Dr Purple
Mr Salmon
Dr White
Mr Beige
Ms Scarlet
Dr Informed
Posts
12 comments:
Fuck me, I thought I was pretty pissed off - but you are clearly teetering on the edge...
This is the most concise telling of the "how things ended up this badly bollocks-ed" story I've seen, and laid out like that I feel like applying to emigrate tomorrow. I didn't vote for the contract (as I never tire of telling my partners), but I shan't be gloating about it now - it would be in very bad taste indeed.
I really do despair. What, indeed, is the fucking point of carrying on? Part of me says that the public has such a low opinion of us at present that we should say "fuck it" and go on strike, while the part of me that says this would harm the patients is the part that is shamelessly being exploited by the shits in power. I have rarely felt so impotent - how can we get the point across that Gordon Brown really does plan to destroy NHS General Practice and let in private companies to leech off its corpse? Why on earth can't people see this is a VERY BAD PLAN. You only have to read the lay press and watch the news to see why - no mention on ITV or Ch4, and BBC made Buckman look like a whinger as well as explicitly saying "with GP's earning salaries of £110k there is little sympathy for them". No wonder oily shite Bradshaw, invisible Johnson and the Clunking Fist think they can "win".
Guys and girls, you've got to follow the dentists. Resign en-mass and tell the government what you can do. The public no longer view us in the same way, i.e. as people dedicated to serving with a vocation, we're just another service to be abused and misused by many (clearly not all). Well, in this era when people will pay a sparky or a plumber a three-figure per hour sum, let them pay their doctor the same and then we'll see where people's priorities lie. Can you imagine the crap the govt would be in if they were the ones that finally drove general practice private?
You owe the govt. nothing. If I recall my lessons correctly, doctors wanted no part of the NHS in the first place but were persuaded to by Bevin. Seems like the doctors then were justified in their initial reservation.
Merry Christmas however.... spare a thought for the trainees in hospital or general practice who are not yet able to exploit the private option.
I couldn't have summed it better up. What is the point of carrying on? What keeps me going is a sense of responsibility. Clearly, neither the one-eyed Cunt, or any of it's acolytes give a shit.
no one, before you get your oar in, what keeps NHS Primary Care going is the goodwill of those working in it.
If you wish me to work 9 -5 and not care a shit then I am ready. Roll it on - as long as my pension is safe.
New Labour - may you roast in Hell, you hypoticral shits.
It's good to see you back in action, Ranting!
What a great, concise history of how the Nu-Laba tosspots have royally screwed up General Practice. Pity they never thought about the poor patients during their orgy of control-freakery in soundbite heaven.
Time to man the barricades and bring the bastards down.
I've missed my daily dose of Rant too much I see. Wonderful post to bring back the good memories (and me, of course, for more).
I know this isn't exactly the tone of the post, but Merry Christmas and a Happy Noo Yer, Dr Rant!
Thanks all.
Francis rediscovered his tongue, and there's a part two treat to follow, as well as an excellent guest contribution.
I wonder when private GP will emerge.
We are getting to hate New Labour and its minions ever more deeply. We hope rest of country is catching up on this.
In terms of GP hours and service to patients GPC offered HMG a workable solution that met most of what they wanted. Needless ot say Clunking Fist chose to have a battle instead.
Meanwhile MPs will pay themselves more, and police and GPs get less.
pity this masterly analysis will not be read by the majority of the patients. look forward to part two.
the only good thing to come out of the gms2 contract was the sudden increase in pay that automatically increased the pension, enabling a more comfortable retirement.
Worth thinking about why they have done this. It is a high risk strategy and has nothing to do with opening hours. personally I think they are desperate and don't know what to do, so pick a fight with the Doctors (cf miners in 1984). This kind of desperation usually occurs before total collapse.
Furthermore, I have been speaking to various members of the public who seem to be able to see through the spin. We are getting a stream of compliments at the moment and I suspect that the ordinary members of the public are terrified of us 'doing a dentist'. We may have a lot more support than you realise.
Remember people trust doctors. Trust is rarely used in the same sentence as politicians and Journalists
It's all very well GPs considering "doing a dentist", but I don't think most of the public does realise that this could happen. We take our GP services for granted the way we used to take our dental services for granted. I think doctors should be out there on YouTube etc. telling people what's really going to happen if we don't tell the government where to get off.
I'm not related to any doctors, my only interest in this is that I am dependent on doctors. That doesn't mean I'm always entirely happy with my GP. (For the Qof points he gets, and from them bonuses, my annual review was pathetic.) But I need medical care and I'd be uninsurable.
This blog is great, but you need other channels as well. I want to be reading what's happening to general practice all over the web.
Well said..........why do the fuckwit M.P's, all are guilty here, have to keep meddling with the NHS, all the changes are wasteful and are destroying it from within, my main gripe is with private sector managers joining the service, with no public service experience,for the salary and pandering to government targets rather than saying NO.........
cry cry fucking cry.....what fucking planet are you guys living on, everyone knows the goverment are fucked, you are educated people no need to state the fucking obvious do something about it, some people they cant be heard people like me no one will listen, they will listen to you!
But do me a favour whilst your worrying about your fat cat pockets just think, prehaps the goverment should ignore your pleas and hand it out to some people who work just as fucking hard as you and yet live on the fucking poverty line, maybe just maybe they need a little appreciation.
we dont need fucking doctors anyway your all shit, before you get ill you think "oh yeah medince today, oh its fantastic, and doctors they will look after me"
then your really ill and no one will listen, no one gives a rat arse, your not that doctors wife mother or child so what do you fucking matter. Thats the truth of it Doctors do not give a fuck and even when they do care ( very rare though) theres fuck all they can do any way so i emplore you go on strike no one cares the world will carry on rotating on its axis and people will still be born and die it doesnt make a difference if your there or not!
Would it help if I said how incredibly grateful I am to my family GP. They mange my chronic rhuematoid arthritis - mostly keep me away from the rheumatologist at the local hospital whom I detest (& I fear it is mutual)and cannot cope well with anyone under 50. They appreciate I am intelligent and capable of understanding the illness and making choices as to hwo I manage it so actually giev me choices and fought the PCT so I could continue to have the drug that worked and I can tolerate even if it is more expensive (I offered to pay the difference a whole £3.40pcm in the beginning but our useless Government won't allow that) and this week they vey promptly and effciently dealt with the chest infection that left me barely able to breathe and terrified. I am very grateful it is their management and skill that gives me my quality of life and keeps me in paid employment and incidentally still paying tax to fund teh Government circus.
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