Fleeing Doctors

GPI was quietly dozing to the background of yet another documentary the other afternoon, this time one on the Australian flying doctor service. (well worth raiding the BBC 4 archive facility, some really interesting stuff hidden in there!) when I became dimly aware that almost every Doctor they interviewed was English. No wonder we were so short of Doctors here – the NHS train them, and they promptly take their skills overseas – then we import Doctors from overseas to fill the gaps!

Last year Jeremy Hunt did impose a four year period during which junior Doctors must work for the NHS after receiving their training. Not before time and it should have been longer!

Since the mid 90s, GPs have been required to publish their salaries, so it is not hard to find out whether it is the wage gap that is prompting this exodus.  In Australia they can expect to earn £156,000 -and the sun shines!

This Government wants to widen access to GP services to evenings and weekends. And it is prepared to redirect and add extra money to do so. Is this so unreasonable? The public perception of GPs is that they are wildly overpaid, a figure of £100,000 is often quoted – and indeed some GP partners in some surgeries may reach this figure, but it is not an average figure for all GPs. Many GPs these days are female, and they tend to work three day weeks, combining child care with their job – that means the surgery must pay locums to cover the extra hours. Sometimes two female GPs ‘job-share’ – nothing wrong with that except that the NHS has trained two Doctors to end up with the equivalent of one Doctor working!

The British Medical Association (BMA), the Doctors ‘Union’ has been described as ‘greedy, selfish, petulant, arrogant, pompous, elitist and out of touch’. I can’t expand on that, it cover all angles. The BMA passionately opposed the idea of a state-run health service such as the NHS  from the start, prompting Nye Bevin to later give the famous quote that, to broker the deal, he had ‘stuffed their mouths with gold’.  Sixty years later, the BMA opposed working an average of less than one hour extra each week in return for the best financial settlement GPs have ever been offered.

I think that in looking at the current situation with Doctors, one needs to separate the views of their union with those of the average Doctor, in the same manner that we separate the views of John McDonnell, with his calls for ‘revolution in the street’ from the views of the average Labour supporting working man.

I have talked at length with my own GP – he visits every day, and we usually end up talking about politics. He would love to ‘wind down gradually’ as he comes up to retirement. In order to do so, he must pay a higher rate of insurance premium for working less hours. Confused? I was. Apparently the insurance companies work on the theory that since he is not working full time, he is more likely to make a mistake, less likely to be fully aware of all the factors in a particular person’s care – thus more of a risk. I can just about follow the line of thought there – but it means that he will be penalised for working part time. The figure of £17,000 for mandatory insurance cover was quoted.

Whereas in the past, people were more willing to take the expertise and professionalism of those who cared for them as a matter of trust, today, post Harold Shipman, a better informed and more questioning society requires that trust to be underpinned by objective evidence.

So he must also – at his own expense – be required to revalidate at five year intervals, by producing evidence of his continuing fitness to practise. He must be able to demonstrate a minimum number of hours of continuing professional development; quality improvement activity such as an audit; feedback from 12 to 15 colleagues on what he is like to work with personally and professionally; feedback from between 28 and 34 patients; how he has learned from significant clinical events; and complaints or compliments he has received. Evidence of all these must be contained in his portfolio.

I cannot argue with any of that, all laudable aims  – but I think Shipman’s adoring patients would have ensured that he passed his box ticking exercise, and since his was a sole practice – there would have been no colleagues to put forward another view……..

Then there are the changes being made to his pension. The reduced cap means he will have to pay 55 per cent tax when withdrawing pension from April this year. The one million cap sounds generous – but will only buy a lifetime income, after tax-free cash, of just over £27,000 a year – with payments linked to inflation and protection for a spouse.

Andy James, head of retirement planning, at Towry financial planning said: “A lot of them have their eyes on the door.

Many GPs have set up their practice so they can pay up to 28.5 per cent of their earnings into their pension and when they look at the potential tax charge for continuing to do this, they are thinking: ‘What is the point of carrying on?’

You can see the factors mounting up on the ‘do I really want to go on working part time versus retiring all together’ page. I should stress that at no point does he resent the new measures being introduced – he is simply weighing up the virtues or drawbacks of continuing to provide his wide knowledge of patients in this area on a part time basis or retiring altogether.

In total 5,114 GPs have retired in England between 2011 and 2015. Across Britain, 10.2 per cent of full-time GP positions are vacant, according to figures provided by the Royal College of General Practitioners. With an ever increasing population, it can only get harder and harder to get an appointment to see your GP.

I am lucky, my GP is of the old school; this is a small village – many of the inhabitants he delivered as babies. Those he didn’t deliver he has known for a lifetime. When our local builder gashed his arm open helping someone moor a boat recently – it was straight round to the surgery and in between patients, he was duly stitched up and bandaged. Every day when he finishes his surgery he drops in here to see how I am, and to chew the cud over the latest political development and have a cup of tea. Yes, he is aware that I am writing about him – he has given his permission.

He hasn’t made his mind up yet as to what he is going to do. What would you advise him to do?

6 thoughts on “Fleeing Doctors

  1. I also live in a small village which has a medical centre with one full time doctor assisted by part timers who work in n a surgery in the nearest town. The last doctor who ran the practice made a fortune from buying property – he has 3 guest houses in village (2 with shops on the ground floor) and at least one other property and indeed used to use the flat over the surgery as an overflow for guests if the others were full – and retired to private practice where he does medicals for lorry drivers.

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  2. Recently I stumbled across this on my GP’s Surgery website: “All GP practices are required to declare the mean earnings (e.g average pay) for GPs working to deliver NHS services to patients at each practice.
    The average pay for GPs working at Lower Colostomybag Magna Group Practice in the last financial year (2015/16) was £70,005 before tax and National Insurance.”

    £70K?! Before, what, a 3rd goes in tax and NI ? I think my personal GP earns a bit more -perhaps 20K more as he is a senior partner or whatever doctor’s call them but even then, it’s not a lot of money for the job and the responsibility. Damn sure a German GP wouldn’t get out of bed for that amount…which maybe explains something about the 2 health care systems.

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  3. That’s a hard one. I think I’d be inclined, assuming I could afford any course of action, to carry on as long as I were enjoying the work over all. Once all the ‘requirements’ became such a burden as to render the job — seen as a whole — a drudge, I’d be off.

    ΠΞ

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  4. I had a wonderful GP who probably saved my life by sending me for a CT when I had no idea there was anything wrong and picked up an early cancer. Not allowed now, he would have had to justify it to the hospital boards and you can’t justify an instinct. He was very much old school and hated the way he had to lecture patients, said he didn’t go Into medicine to tell people how to live their life and could see the day when lifestyle would ration treatment. He was the senior partner and cut down to two days then took early retirement, the pension cap being another issue. I miss him and he is a real loss to the surgery. I have a nice female doctor now but she only works two days so hard to get an appointment so no continuity. As for a home visit! You would have to be dying!
    Carol42

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  5. Hi Anna
    Been away for a week or more but whilst away picked up on this essay on my wife’s smartphone. As always you raise an interesting and important topic that hasn’t really been addressed adequately by main stream media. From the anecdotal evidence I hear from my wife (you may recall she is an NHS Consultant) the situation is probably worse than you attempt to describe. My own view is that there is something of a cultural crisis in the NHS that arises out of something of a basic misunderstanding ….an elision encouraged by Politicians as to ownership of the personal skills of medical practitioners and can be best addressed by looking at that foul slogan of ‘YOUR NHS ‘ . Its coined of course to encourage the misconcieved notion that somehow ‘Joe Public’ has possessory rights in the skills of Doctors when of course they have no such thing. Interesting that the NHS apparently consider they have a ‘right’ to four years service from a newly qualified doctor which appears to me to be something along the lines of indentured labour ….gosh how many tens of thousands of £ to pay for ones education then a period of indentured labour , additional training to reach the financial omega point of £70K a year with managerial control over ones life such that one is viewed no more than an insignificant and replaceable cog in a state owned machine churning out the ‘commodity’ of medical care. Little wonder despite just about every Doctor I know not being able to imagine spending their lives in a more worthwhile way coming to the conclusion the game is not worth the candle. If I took just one central point out of my diatribe above it would be the notion of commodification of medical care and the notion that the practice of medicine is akin to churning out widgets or blodgits or whatever. This of course gives rise to the culture of managerialism ….the notion that its not those that own the means of production but those who control it. The non sequitur is that one cannot ‘own’ the personal skills of another and its pretty sick to think that one should see things that way.
    The delivery of medical services has become almost totally politicised ..in some ways THE major football in the political arena where it all about various individuals or parties showing they know best how to ensure the delivery of medical services ….just such a shame that those that actually deliver the services don’t tend to agree with them and are voting with their feet.
    Oh and just incase you think I am one of those rabid fee marketeers I am not …..just about every doctor I know reckons the NHS is the best model for delivery of medical services and I am not simply referring to little englanders but some senior professors ‘poached ‘ to the USA and elsewhere …..its not the model at fault just the way the model is operated.

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