on driving taxis

The Jobbing Doctor comments on today’s story in the Telegraph, which reports that newly qualified GPs are unable to find work as GPs and in one case is driving a taxi to make ends meet. As a salaried doctor myself I really had to comment on this.

It is certainly true that it is difficult to find a partnership nowadays. Ten years ago General Practice was in such dire straits that practices would get a handful of poor candidates when they advertised for partners. No-one wanted the huge workload of being a principal in General Practice responsible for the 24 hour seven day a week care of his or her patients. Good candidates did not walk into a job by any means, but they usually spent a few months locumming while looking for a partnership, and they were willing to move to an area where there was a vacancy. This meant that when GPs qualified they did not struggle to find work.

Since the advent of the new contract General Practice has become a much more attractive career option. With the option to hand over out of hours care to a cooperative, junior hospital doctors realised that General Practice could offer them a satisfying and balanced working life and the competition started rising for GP places. Partners had the option of taking on another partner, to share in the increased workload of the new contract, or of taking on a salaried doctor to do more of the clinical work, while they concentrated on the running of the practice – but in almost all cases, still doing a significant amount of clinical work. GPs have always been independent contractors – they can choose how they want their practice to be run – whether that be a true partnership, or following the lead of the solicitors and accountants and having a tranche of partners who own and run the business, and employing qualified non-partners to take on an exclusively clinical role. Meanwhile there was increased funding for the Department of Health and pressure from the government on training bodies to increase the numbers of GPs qualifying, as well as more freedom for EU doctors to come to the UK to train and work.

It made it much more difficult to find a partnership if that was what you wanted (remembering that just five years ago no-one wanted to be a partner as you had to do a huge amount of out of hours and weekend work). There are still huge numbers of GPs qualifying and now it is not only difficult to find a partnership, but difficult to find any full time employment as a salaried GP. Fewer jobs and more qualified GPs means more unemployed GPs.

I qualified as a GP in the last five years and I am truly grateful to have found a practice to take me on. I have friends who are struggling, like those talked about in the article, to find any work at all, as even the locum work has dried up. I would like to be a partner, but I have every sympathy with the partners in my practice, and others, who simply don’t feel they can take the risk of taking on another partner in the current climate. A single handed practice not far from us is five hundred yards from a walk-in centre which has beeen pencilled in to become a Darzi polyclinic. If this doctor’s patients decide they don’t want traditional GP care and they want to see any-doctor-now then his practice may not survive. Can you blame him for not wanting to take the risk of another partner? He may not even feel able to take on a salaried doctor and will make do with a stream of locums or a not-too-risky part timer.

The real story is more sinister. It’s the current government’s insidious attempt to split and disempower the profession. Increase the number of doctors qualifying but reduce the numbers of positions available. Now you have a bank of desperate doctors who’ll take lower paid salaried work which doesn’t give them any political power. Get the salaried doctors fighting GP partners, get the consultants bitching about the GPs, get the public thinking that GPs are rich moneygrabbers who only care about their next paycheque and that hospitals are only good for catching MRSA, and maybe no-one will notice when Virgin, Tesco and Boots start doing smear tests, diabetes clinics and cataract surgery. Maybe Tesco will want to open a GP centre and will need to find cheap doctors to staff it – and who better than disaffected and broke GPs currently driving taxis? Privatisation by stealth? You betcha.

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9 Comments

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9 responses to “on driving taxis

  1. no one

    darzi and the governments changes are not the correct medicine

    but the symptoms of poor GP service FROM THE PATIENT POINT OF VIEW are there for all to see who look hard enough

    good family docs and their relationship with their patients had many noble and good elements

    the reality for many patients is that they have a rubbish GP, an arrogant GP receptionist, and no real ability to choose another GP

    the system should self optimise if patients were given real choice, GPs could innovate and compete (offer different hours etc), and let the norms of the free market solve many of the issues, and bring in the extra cash to implement

    the status quo of many GP waiting rooms being full of the same old malingerers while the genuine needy cases struggle to get an appointment etc, its all out of step

    and as much as I know there are many great docs in the UK, standards here even from the most basic laymans view are very significantly sub the rest of the developed world, and as Brits travel more they believe the nhs proganda less and less

  2. NiceLadyDoctor

    Hi no-one, thanks for your input.

    I’m glad you are able to concede that the traditional model works well for many patients. I think it has the potential to work well for all patients but you may disagree on that one.

    Regarding choice you do make a good point. I think increasing choice is no bad things as you’re right, some patients do have a valid grip about access. However as I’m sure you know, the government’s own survey – designed to show that the public wanted more choice – did show that over 80% were quite happy with their GP and access to their GP. I think that would suggest that while a minority agree with you, the majority, who tend to be the less vocal about these things, are happy with the status quo.

    The thing is the patients who really need us to be there during the daytime are the patients less likely to be making a fuss. My surgeries are full of patients who do need to see doctors. There are some “malingerers” it’s true, but most of my patients (I’d say 80% plus) are the elderly, people who can’t work, young children and their young parents, and the disabled. They need me to be there during the daytime as that’s when they’re about. And moreover, they need ME. They don’t want to be repeating their life story to a new doctor every time; they rely on the fact that I know them their circumstances, in some cases I know all about other members of their family. And as time moves on this relationship deepens. It’s vital and is the heart of general practice.

    You may be interested to hear that my practice offers extended hours. Our Saturday morning surgeries are not as you might expect full of patients who can’t see us during the week. Our Sayturday morning surgeries are either not full at all, or they are a mixture of all of our usual patients who could if they wanted see us in the week. Where are all these disaffected patients who can’t see their doctor? In fact like most surgeries we can offer a routine appointment to anyone who asks for one, within two working days of them calling. In most cases that is adequate time to arrange time off work (as you’d do if you were seeing your solicitor or dentist), for others we have some advanced access appointments. This works and we know it works because our patients tell us that it does (in surveys that the governement has asked us to complete).

    I’m not dogmatic about the general practice or the NHS as a whole being a totally public entity, indeed in my most cynical moments I would say that in its current form it cannot survive. There are some problems with “choice” and “market forces”, however. Firstly, market forces. I would suggest that market forces cannot and should not apply to healthcare as it is not by its nature a profitable enterprise. It doesn’t generate money so “market forces” don’t apply in the same way. The way that they could work is for some kind of system whereby the traditional GP model (which does work, I think, for most) is protected from the risks of a purely market led system. how that might work, I don’t know. Any suggestions?

    Regarding other countries: I think you’re right and you’re wrong. The UK does fall behind some other developed countries when it comes to some important conditions – cancer survival being one. But you’d be wrong to deny that the general practice model works well with the limited funds available to us. Spending per head on health care remains below the European average and well below the US (this http://www.marketwatch.com/news/story/us-health-system-earns-d/story.aspx?guid=%7BC8565FAD-46D7-46AD-9FF4-7CE58DF41B47%7D&dist=msr_2 is an interesting article).

    I think a big problem (and a political and ethical hot potato) is that market forces/GCSE economics will tell you that if you make something free, demand is potentially infinite. We live in a country where older people remember having to pay the doctor so they ask of the NHS only what they feel that they need. Younger patients have grown up with the NHS; it doesn’t occur to them that every attendance costs money. That means that GPs are trapped in an unwinnable situation: on the one hand trying to do the best thing by the patient, on the other constantly aware that they have to keep within a budget. GP consultations are exceptionally good value for money – the cost per consultation is £14 pounds.

    In terms of the comparison with other countries, I’d point you towards the results of an international poll commissioned this year, and summarised nicely here: http://www.marketwatch.com/news/story/americans-rate-us-health-care-system/story.aspx?guid=%7B86F29D04%2DFC2D%2D466F%2DADF6%2D2435468CE406%7D&dist=morenews
    You will see that over the world there are countries with different health care systems but the one with the system that is most based on market forces has the unhappiest patients (or should that be customers?) – the US.

  3. no one

    re “minority agree with you, the majority, who tend to be the less vocal about these things, are happy with the status quo.”

    depends where you live
    depends whether you have a decent GP
    depends whether you have travelled enough and have the education to spot crap service

    just because people are “vocal” doesnt make them wrong

    and we have the english attitude where folk like my mother will wax lyrical about how great the doctor is, while at the same time winge to me about inability to get to see them, its a generational thing, never winges to the doc cos in her eyes the docs are gods

    other folk i know left to die by the nhs still to their dying day thank the nurses and docs, because they just dont know what treatment options they would have had elsewhere, that their treatment has been limited by lack of surgeons and much more, crying shame

    the nhs only reacts to folk who make a fuss, folk like me who never make a fuss to the docs or receptionists are always let down

    Where are all these disaffected patients who can’t see their doctor? er going private in london normally in my case when im in that much trouble ive pretty much given up on nhs GPs

    ive lived around the world (as lisa stansfield would say) and i can honestly say the UK is the only country where Ive ever waited days to see a doc, the only country with dirt obvious for all to see, the only country where violent police prisoners sit next to the most vulnerable

    the nhs is failing

    sorry im a bit short of time right now

  4. Oh, hello no one, fancy seeing you here. I have to admit “folk like me who never make a fuss” made me laugh for a moment, but then I read the next part of the sentence, so I guess you may be justified in that – it’s just that from what I’ve seen of you on blogs, you don’t seem the sort to sit quietly by and not make a fuss.

    As I’ve said before, I’ve never had much of an issue with my GP, nor do I know anyone who has, so maybe it’s a local thing.

    Niceladydoctor, great post as usual – I have to admit I find this privatisation by stealth terrifying. All is well in the NHS, comrades!

  5. Which government are you referring to? I think you’re exactly right. I’ve seen similar signs in America. But I’m not sure that you’re referring to the USA.

    All of the media talk about nationalized health plans has me nervous. I foresee some hard times for both doctors and patients if government drones are given the power of HMO’s and PPO’s.

  6. NiceLadyDoctor

    citystreams – thanks for your comment. I’m in the UK.

  7. Kaz

    Where have you gone? Please come back soon!

  8. It’s the current government’s insidious attempt to split and disempower the profession.

    That’s the bit which is within our gift to address. We don’t need to draw out long knives and stab colleagues in the back. Most medics are savvy enough to see the mire of problems before them might manifest as dissonance with medical colleagues but it is in fact orchestrated centrally. And that’s where cohesive vitriol should be placed, rather than at the door of our colleagues. In my corner, thankfully, that’s the case. GPs and Consultants and the PCT do really seem to get along pretty well.

  9. Great post. We have been discussing this today at my practice. We are one of the few (only?) practices I know that are choosing to get round our need for more doctors (people getting pregnant – shocking – and dropping sessions) by taking on more partners rather than salaried doctors but I have to agree that it is with a degree of nervousness that, in the current climate, we could be really shooting ourselves in the foot financially….

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