Labour attacks the GP partnership

I see nothing wrong with the idea that GP s form partnerships, finance their own surgeries, can run their own pharmacies and have a contract to supply services free to patients paid for out of taxation via the NHS budget.

It was decided by the post war government not to nationalise doctor practices in order to secure their agreement to the idea of the NHS. It left GP s free to offer private services in addition to the work they do for the NHS. It means we have thousands of GP small businesses innovating, offering variations of service and providing some choice for patients. The  closer we move to an all salaried profession with GP s as employees of a centralised NHS  the less choice and innovation will be on offer.

One of the problems today is the reluctance of younger doctors to take on the responsibilities of co ownership and management of a partnership. Many opt for part time salaried employment.This makes it more difficult to provide sufficient cover and irregular hours which Home visits and emergencies can entail.

There is also an issue over early retirement. Some GP s argue that the reduction of limits on tax free pension saving stops them working more years to build a better pension pot. Many GP s are also in the pay band above £100,000 where the effective marginal tax rate is 60% , discouraging full time or longer hours working.

Government needs to listen to GP s over tax and pensions, and look at a range of ways to facilitate more GP surgeries and practices. We are short of capacity. GP surgeries can be places where a whole lot of tests, diagnoses, treatments and procedures can be successfully carried out relieving pressure on hospitals and providing a service close to home for more people.

199 Comments

  1. mickc
    January 8, 2023

    The argument over “privatising the NHS” has always been false. It was “privatised” at inception, the GP services being delivered by individual GP businesses.

    1. Iain gill
      January 8, 2023

      The private sector works when individual end consumers have buying power, and can iteratively force big improvements on providers with countless small decisions, that is the main thing that won the cold war. It doesn’t matter so much who owns the providers, unless the state is competing unfairly and undercutting anyone else.

    2. glen cullen
      January 8, 2023

      NHS GPs private, NHS Dentists private, NHS Consultant Doctor salaried & private, NHS Locum Doctors self-employed, NHS Bank Nurses self-employed …not a lot of people know that
      Lots of Porsches in the car park

  2. Javelin
    January 8, 2023

    There are two problems here. (1) the business models (2) the costly consultants who recommend the business models.

    The only solution to me to enable doctors to operate like any other employee. Some want to work for an employer, some want to set up a small business, some want to contract on a short term basis and some want to work for an agency on a daily basis.

    Trying to control doctors has the opposite effect of driving them out of their career.

    1. PeteB
      January 8, 2023

      Indeed Javelin. Although I’m always amused by the comments around the 60% effective tax rate at £100k and the effect of pension rules on GPs. It seems doctors are the only people important enough to need exceptions here. Anyone one else… tough luck.

      1. Iain gill
        January 8, 2023

        Ir35 for everyone else with one customer too…

        1. glen cullen
          January 8, 2023

          thought that was law …maybe

      2. a-tracy
        January 8, 2023

        PeteB and they got a small uplift during the pandemic, they were the only people working throughout that got it as far as I know.

        https://www.pulsetoday.co.uk/news/practice-personal-finance/government-to-uplift-gp-pension-contribution-thresholds-from-next-month/

      3. rose
        January 8, 2023

        PeteB: Let us hope our Dutch friend is reading you. He described those on 45% plus all the other taxes as the super rich and said the world was shocked that they should be relieved of a tiny bit of their burden by Mr Kwarteng.

      4. Hope
        January 8, 2023

        Two goods articles in TCW John Hale and LLewellyn. Sums up the current situation perfectly.

  3. Mark B
    January 8, 2023

    Good morning.

    There is another area to look at but one that is afar more tricky to resolve – Female GP’s.

    I am not questioning the ability or the rights and wrongs of female GP’s, but I do wish to highlight that female GP’s tend to be the ones that have, like all women, have a greater involvement in family life and especially children. This makes them less likely to be available compared to men. The same can also be said in other areas and women traditionally have tended to move to part-time work.

    I think it is time to look at this and to limit the number of part-time GP’s we may have or, to have contract that guarantee a minimum number of hours a GP is willing to give to the NHS.

    It is clear that efficiencies do indeed need to be made right throughout the Public Sector, which is made even more difficult given that it is so heavily unionised. One only needs to look back to the car industry of the 60’s and 70′ for example to see what I mean.

    1. Martin Ward
      January 8, 2023

      You are so right. The solution is to require doctors to pay for their training with a loan. They may think twice then if they are only intending to show up a couple of days a week.

      1. Hope
        January 8, 2023

        M,
        Do not forget EU level playing field on employment rights. This shower will gold plate EU laws, rules and regs.

        1. Dave Andrews
          January 8, 2023

          Not sure about the EU employment rights. They will quite happily exploit Eastern Europeans on low wages. The level playing field should ensure they get the same minimum wage as Germany, France or the UK.

      2. Medic
        January 8, 2023

        Doctors pay for their medical degree and for much of their post-graduate training. The NHS has always exploited junior doctors and offered low salaries for long hours providing medical cover with poor working conditions. Medical graduates will leave to train abroad if doctors are forced to pay for their clinical training in the NHS.

        1. a-tracy
          January 9, 2023

          Medic, it is very unfair on all English students that they accrue a cost towards their degrees, especially when in our Union the Welsh, Scottish and Irish trainees don’t.

          Where could they train abroad for free?

    2. glen cullen
      January 8, 2023

      GPs should only be open at evening and weekends to allow working people to attend – the current opening hours are for the convenience of the doctors and not the working patients

      1. Iain gill
        January 8, 2023

        The whole NHS is like that

    3. formula57
      January 8, 2023

      @ Mark B – how is anyone advantaged by seeking ” to limit the number of part-time GP’s we may have “?

      Anyone wishing to work part-time or offer a part-time job is free to do so and prima facie it seems very wrong to curtail that freedom just because the work is providing GP services. Moreover, a GP partnership is typically advantaged by having some part-time GPs since those may well be able to all the more easily provide cover when full-timers are absent etc. as well as perhaps seeing a greater range of specialisms and experience within the partnership.

      If your point rests upon a shortage of GPs, then the market solution would be to better the terms of employment. Introducing restrictive practices and ones that that would adversely affect women more than men is unlikely to find favour.

      1. Mark B
        January 8, 2023

        If part-time GP’s choose to work hours that suit them rather than those of their patients then how do we resolve problems with waiting times ans lists ?

        I the sector that I work in there are no part time workers simply because the employer will not employ people on that basis. And since the Government employ these people for and on our behalf, why should we ?

    4. rose
      January 8, 2023

      It is not just that part time married women aren’t available: they also fail to build up the experience and expertise the full time men did. This means three quarters of doctors may not have the necessary knowledge and experience as compared with the very recent past. As with the clergy, the profession is fast becoming female.

      1. Iain gill
        January 9, 2023

        We need proper equality, which takes account of people who are prepared to work longer hours, who are prepared to work away from home more often, prepared to work unsocial hours more, who take on the riskier projects and assignments all of which is what women of their own free will, on average and not always, tend not to do. The problem is men become more skilled by doing all those things more, on average, but the supposed equality agenda does not want to reward them for doing so. That’s the heart of the problem, and it’s not just medicine.

        1. rose
          January 9, 2023

          Worse, how many such men have been actually discarded through discriminating on sexual and racial grounds right at the beginning of the training process?

  4. Ian Wragg
    January 8, 2023

    They’re supposedly self emoyed but contracted specifically to the NHS.
    Any plumber or electrician doing that would be subject to paye
    What’s so different about doctors.
    Same with judges and pensions.

    1. boffin
      January 8, 2023

      Very good point, highlighting the unfairness of the absurd, TUC-driven IR35 ‘guidelines’ which would have been scrapped long ago by a truly conservative administration.

    2. Ex-Tory
      January 8, 2023

      +1

    3. glen cullen
      January 8, 2023

      What’s so different about doctors – the threat of them going on strike, thats why governments can’t reform the NHS

    4. a-tracy
      January 8, 2023

      Perhaps they are subject to IR35?

    5. anon
      January 8, 2023

      Indeed for pension purposes are they employee or contractor/company? Then treatment should be the same as the rest of us in the private sector. (Defined Benefit Pension- equivalent Pot values are massively higher than defined contribution pots). We should cap Public Sector -equivalent values and ensure the private sector cap rules apply to the excess. Or better still end the public sector pension scam on the private sector.

      Entry bars to the profession need to removed as it naturally seeks to reduce the supply available.
      – allow many other qualification routes. But allow the high standards to applied equally.
      – any UK funded training should be e-payable by the individual over the UK residence period , with a min number of hours of contracted work to the NHS written in ie loan payment deducted from expected hours worked.
      – defaulter loans should be sold on or repaid by or recovered from the country of destination.

  5. Anselm
    January 8, 2023

    When the NHS was invented, it was just after the second world war. Good old Nye Bevan! Doctors were all men with families (except for the gynae doctor at Addenbrookes – Miss Bottomley) and they had very few patients. They were important local people. Think James Herriot the Yorkshire Vet.
    Now they are women and men sitting in a cramped office with a computer. Patients come in, present and are dismissed to someone else. And if you get it wrong, the lawyers are there – in force! And then there are the Car Park Tickets which are URGENT! And – oh by the way – two doctors cannot be there today because their children have covid.
    In Abu Dhabi – or even Australia, Doctors are respected, very well paid and free! If your family is of Indian or Pakistani heritage (like my own doctor) the temptation must be enormous.

    1. a-tracy
      January 8, 2023

      Anselm, well a few women got through. My GP was a magnificent female, I‘ve not seen the likes of her since she retired probably at over 70 years of age around 25 years ago, none of the male GPs match her work ethic but then that work ethic has changed for all occupations over time. She would be out visiting your baby at 10pm then opening up her surgery at 8am prompt after doing the on-call herself.

      I greatly respect my two male GP surgery owners, I have watched them grow their practice from buying it out years ago. The practice has several female GPs now not all part-time and I like a mix. They open early which has been a great development for workers as now people don‘t lose a whole day off work, well if you can get one of those popular appointment times. They have a late night clinic another boom for workers especially female workers who need more contraceptive services, 3 year checks.

  6. Iain gill
    January 8, 2023

    John,
    The whole NHS model does not work.
    The complaints system does not work, and never results in any improvement.
    There is no iterative feedback loop from individual patients which can force improvement and optimisation.
    The senior executives and managers are not accountable to anyone, and can corruptly make outrageous decisions behind closed doors with no scrutiny.
    GP service don’t work, especially out of hours service and the incompetent triage done by the 111 service. They spent far too much time with the wrong people, and hardly any with those who could have decades longer life if some simple diagnostics were done far earlier in their life.
    Most life expectancy improvement has come from reductions in smoking, asbestos,etc and introduction of statins which can improve life expectancy with minimal work from healthcare.
    GPs like the rest of the NHS are not responsive to patient needs.
    I would advocate abandoning the NHS model, it doesn’t work. Don’t try to reinvent the wheel. Instead copy a model that works far better like the Australian or New Zealand healthcare models.

    1. PeteB
      January 8, 2023

      Well said Iain. My views align. We’ve tried lots of extra money, management, targets and tokenism. Time to try a different model based on a world wide study of which approach to health care works best.
      It’s not complex to identify the right solution. The tricky bit will be implementing it.

      1. Iain Gill
        January 8, 2023

        thanks

      2. MFD
        January 8, 2023

        Agreed guys, we need a government that is not corrupted by big pharma which is willing change!

    2. David L
      January 8, 2023

      A GP advised me to “get yourself informed about Statins” when I saw them a few years ago. “Are you suggesting I shouldn’t take them?” I asked. “No, I’m not allowed to!” was the reply. The idea that a GP can have their judgement on suitable medication for me overruled by someone who knows nothing about me is worrying. And I question what, precisely, is the reason for this mass medication? The whole saturated fat/cholesterol hypothesis is questioned by many cardiologists now.

      1. Iain gill
        January 8, 2023

        Not really the statistics are there for all to see, they can drop your chances of dying from a cardiovascular events by over ten percent over ten years. There are side affects, but individuals should try different statin types to see which have the least side affects in their case. But really stuff like providing slots when ordinary working men can actually use the local swimming pool etc are just as important, at the moment we have too many women only, or children only slots.

      2. Enigma
        January 8, 2023

        Spot on David L

      3. Donna
        January 8, 2023

        The last time I saw a GP was about 4 years ago for an ear which was badly blocked with wax. I hadn’t been allowed to go straight to the nurse. He looked at my ear; said “it’s blocked with wax, make an appointment to see the nurse;” checked my blood pressure and asked what medications I was taking. I said “none” and his reply was “we’ll get you eventually.”

        So basically, he outed himself as a drug pusher.

        1. Mark B
          January 8, 2023

          The relationship between doctors and the pharmaceutical is one I am not best placed to comment on, but from what little I know your last sentence may have a drain of truth in it.

          😉

        2. Iain Gill
          January 8, 2023

          another thing the NHS does differently to the rest of the planet, where people routinely go to ENT consultant to have dirty wax removed. in my case often the only way to stop the infection underneath, and while I am there in the private waiting room I am often chatting to other patients who are NHS GP’s who are waiting to see the ENT consultant privately cos they simply dont believe in the NHS approach to this when it comes to their own bodies.

    3. a-tracy
      January 8, 2023

      Funny you should say there is no feedback loop, this weekend my parents have received feedback letters from the NHS about their GP and services.
      They were going to put them in the bin, even though they have had some problems getting appointments even though one of them became hard of hearing and had what they thought was tinnitus, it turned out they needed a syringe (I had told them to go to a private shop but they were waiting to see if it was tinnitus!) because they really like their doctor and don‘t want to say anything bad and cause any trouble.

      I have put in a complaint before and you are correct, whether it is the NHS or probation service, or the passport office you try to write a formal complaint about you get fobbed off and nothing is done, complaints departments don‘t give you answers, take action, they are just dismissed.

    4. Jim Whitehead
      January 8, 2023

      I.G., +++++

  7. Iain gill
    January 8, 2023

    The labour idea for patients to self refer to consultants is of course correct. That’s how it works in the entire rest of the developed world. Moles should be checked for cancer regularly by dermatologist, not ignored by GPs who are unable to tell. Persistent skin problems again should be dermatologist so diagnosis is right first time, and not endless loops of GPs guessing. GPs should not be allowed to play for years trying to remove veruccas from diabetics, where risk of amputation is high, and failing, such patients should be seeing a specialist. A lot of GP rationing is wasted resources, they have no clue about eye problems as an easy example, it only makes sense to have direct access to eye specialist or at least optician. The NHS will react badly, but that’s decades of being dulled constantly by exposure to the NHS ways, lack of self awareness, and lack of understanding that the rest of the world does it so much better.

    1. a-tracy
      January 8, 2023

      GP surgeries, especially super surgeries have spare diagnosis rooms, if they were truly a private business they would have specialist days, where for e.g. private dermatologists that rent the room from the GP surgery for the day + a per appointment fee to reception who could book appointments and see you for an extra top up cost (the GP surgery does get some extra payments than the standing £150pa charge per patient on their books) but people don‘t want to pay a 1p extra because they take so much more money, taxes are rising so high to give them more money.

      1. Iain gill
        January 8, 2023

        It’s just as cheap to see a dermatologist as it is a GP in other countries, or here privately. It’s only cos the UK has constrained training of dermatologists, and the NHS being wedded to GP as rationers that things are as they are in NHS.

    2. Jim Whitehead
      January 8, 2023

      I.G., ++++++. again you’ve highlighted an unnecessary bottleneck in provision.

    3. forthurst
      January 8, 2023

      Patients have not had seven years medical training and therefore are not able to identify which specialist
      to visit.

      Advice to expats in Germany: Your initial contact for accessing healthcare in Germany will usually be a General Practitioner (GP) or doctor (Allgemeinarzt or Hausarzt), who can assess your condition, provide treatment or refer you on to a specialist, if necessary.

      They don’t have GPs in the US but that is hardly a recommendation for the worst healthcare system in the Western world.

      1. Iain gill
        January 8, 2023

        In Germany moles are looked at by a dermatologist every 12 months, no GP referral needed, direct relationship between patients and dermatologist. The NHS and it’s hype does not fool me because I know the truth.

      2. Iain gill
        January 8, 2023

        I would not recommend copying the US health care system, I would copy the new Zealand or Australian system, or Belgian. But I have lived in the US and their system is not as bad as the NHS propoganda would have you believe.

  8. Candid Ben
    January 8, 2023

    Labour? Who cares what Labour thinks? You Conservatives have been in power for over TWELVE YEARS, yet you airily pontificate on the mess the country is in as if it is anyone’s fault but your own

    1. Bloke
      January 8, 2023

      Instead of maintaining good health for better life the Govt neglects into death. Then as a rotting corpse it attempts to reincarnate itself by sucking the life out of desperate survivors. Our nation needs a Zelenskyy in action to protect it, not a Zombie feasting at our health’s expense.

    2. Hope
      January 8, 2023

      We read today DEFRA offering more money to farmers for its green agenda on habitat and the likes rather than food production!!! It sounds very EU environment nonsense to me. Tory govt has a mass immigration policy and bribes farmers not to grow food!! Whose fault is this?

      JRM in papers blaming the establishment for not implementing Brexit!! We were told by Clegg in govt there were not many EU laws so presumably easy to scrap!

      1. Gary Megson
        January 8, 2023

        Hope, have you noticed that Brexiters like JRM ALWAYS find someone else to blame for Brexit going so badly? Think about it Hope – the Brexit deal was negotiated by David Frost and Boris (Brexiters), implemented by Boris, Gove and JRM when he was in the Cabinet (Brexiters) and is now in the hands of Rishi Sunak (a long standing Brexiter). And yet it’s all going wrong. Hope, do you think the Brexiters might eventually stop blaming other people and start taking some responsibility?

  9. Cuibono
    January 8, 2023

    Apparently Barclay is drawing up extremely expensive plans to move hospital patients into care homes…to save the ***@#%* NHS!
    What’s this? Ground Hog Day?
    Surely this report can’t be true?

    1. Berkshire Alan
      January 8, 2023

      Cuibono
      May be cheaper in the long run, as I would suggest a care home bed is less expensive than a hospital one, but there is often a waiting list to get into a good care home, perhaps more vacancies in poor ones, hence you may create a solution on the one hand, but create another problem with that solution. !
      We used to have specific wards/hospitals for recovery, treatment, and physio decades ago, like wise for the long term sick elderly, but that was deemed too expensive and inefficient by those in power at the time.
      Lessons learn’t I do not think so !

      1. a-tracy
        January 8, 2023

        Alan, how can it be cheaper in care homes?
        In hospitals people share 4-6 beds per ward.
        In care homes people have individual rooms.
        This whole hospital ward cost needs costing up properly. Surely they could run a ten bed ward for people needing minimal nursing/doctor care. The dividers created for Nightingales could be used to give more individual privacy on those wards. They wouldn‘t need all the medical equipment near the beds. They would however require lots more Healthcare assistants and training staff, people who can look after their grooming needs.
        These hospital wards had room for more beds in time gone by, more patients means better productivity. If people want private individual care then they have to pay for it (because there isn‘t enough money in the NHS) or their families have to provide it and yes my family did provide that care for my Nana after her stroke and incapacity.

        1. Berkshire Alan
          January 8, 2023

          a-tracy
          How much do you really think a hospital bed costs a day, I think you would be amazed ?
          Then work out the answer, clearly the cost will vary from one hospital to another, and from high cost area’s like London to those out in the sticks, but may I suggest well over £1,000 per day for starters !
          Having had a family member in a Nursing Home (more expensive than a Care Home) for 6 year period, I can be absolutely sure a Care home is certainly far less expensive than a Hospital bed..
          Cottage Hospitals used to have geriatric Wards decades ago, staffed with just a few qualified nurses to dress wounds and give out required medication, and a few orderly’s to ensure all was kept spick and span, including the patients, they also used to help residents/patients with eating and drinking.
          Such an environment had open visiting hours with a limit to 2 visitors per bed.
          Such Cottage Hospitals only had basic equipment, did not need expensive consultants to be in attendance, or expensive scanners or x-ray machines and the like, indeed the local General Practice Doctors used to do the rounds each day on a rota basis just as a preventative check, with the Nurses doing the basic blood pressure tests before they arrived.
          This sort of set up with Nightingale type larger Wards, with transparent screens between the beds (to curtail a feeling of isolation) would be far preferable in my view than being suck in a single hospital/care home room on your own.
          Entertainment could be via a small TV screen/Tablet with headphones.
          The above could be provided by the State at a sensible cost to the taxpayer, and if you wanted an upgrade then that could be an option at the residents/patients personal cost. Or for those who wanted the option of a full blown Nursing home then there would always be the Private homes that exist at present.
          The above clearly does not provide all of the answers, but people need to think outside of the existing box (present set up) and lessons should be learn’t from history.

          Sorry for the length of this JR but could not really split it up to make sense and provide a sensible answer.

        2. Berkshire Alan
          January 8, 2023

          a-tracy
          Age concern report in 2021 that the occupation of a hospital bed (without treatment, for an elective patient) is about £400 – £500 per day, which is about five times the cost of a traditional nursing home.
          An ICU bed cost is approximately £5,000 per day with treatment

          1. a-tracy
            January 8, 2023

            Bedblockers as they are rudely called now aren‘t in ICU though.

          2. a-tracy
            January 13, 2023

            If that were true Alan then they could afford to pay the people that look after them properly!

            I would like Age Concern to breakdown that figure.

            6 beds on a ward requiring just basic care and food, Age Concern say is costing £2700 per day! I doubt it.

      2. Cuibono
        January 8, 2023

        +++
        Yes but last time infection was carried into the Care Homes.
        The vulnerable Care Home residents got ill with whatever it was and were put on midazolam and possibly ventilators.
        They had “good deaths”.

      3. Timaction
        January 8, 2023

        Why not put them in 4* Hotels, like they do with the boat people?

    2. Nigo
      January 8, 2023

      Why is not happening already if it’s an acceptable solution?

      And in answer to a comment I made yesterday about nightingale hospitals, I think there were 8, three didn’t take on patient, the rest 280 approx at a cost of 500 million.

      Who pays we do. Bulb energy looks like costing 6 billion, partly because of the governments refusal to take out hedging insurance, normal in the industry, partly through regulatory failure.

      Who pays. Looks like we do with another energy cost, a surcharge. Does anyone believe HMG will get performance improvements from the NHS or train drivers in response to wage increases. No me neither.

      And so the circus rolls on. Indeed looking at the papers, I read the chief clown, Boris is being touted for a comeback.

      1. Nigl
        January 8, 2023

        Sorry typo. Nigl

        1. Bloke
          January 8, 2023

          Nigl:
          Contributors’ names are saved in the Diary. Entering a name with a typo indicates you might have more than one identity, or share your input device with another contributor.

          1. TheComputerWhizKid
            January 11, 2023

            Plain wrong.

      2. turboterrier
        January 8, 2023

        Nigo
        Another who pays.
        On line promotions to companies to buy electric cars for their employees and get tax relief and credits starting from £3k.
        Really exceptional products don’t need subsidies and incentives to sell if they are desirable, effective, and affordable.

    3. glen cullen
      January 8, 2023

      If bed blocking has been an issue over the many years, why have successive governments reduced the number of hospital beds over the decades, surely we need more beds but mainly convalescent /recovery beds /wards ….nursed by non degree auxiliary nurses or indeed student nurses

    4. Medic
      January 8, 2023

      We could call the community units a cottage hospital and arrange for GP supervision. The politicised NHS never learns, it re-invents the wheel every decade or so.

  10. Nottingham Lad Himself
    January 8, 2023

    Thirteen years the Tories have been in, and the NHS has never been in a worse state.

    When Labour left office, satisfaction with it was at an all time high on the other hand.

    I really can’t see what Sir John is hoping to achieve with these sorts of article.

    Reply I want an improved NHS. The NHS in Wales and Scotland under Labour and SNP is worse.

    1. Mickey Taking
      January 8, 2023

      Reply to reply ….relatives in Scotland tell us it is worse in Scotland, and many operations have to get done in England. However confirming the state in Wales and Scotland doesn’t absolve England. Of course you want improvements, most would say they find NHS on its knees – the ‘record’ played every year to raise more money to disappear into the ether. What differs between a precise instatntly available computer diagnostic questioning, and the GP ‘safe’ at home on the telephone – prior booked appontment? A responsive service and a long-winded frustration!

      1. Hope
        January 8, 2023

        Reply to reply. What a very poor reply from JR.

        No English parliament and all devolved nations allowed to vote on every English matter. Your govt failed to deliver Lothian Question, it gave a meagre offering then Gove took it back!! Therefore the other devolved nations can influence anything here but we cannot influence anything there!

        1. Iain Gill
          January 8, 2023

          correct and needs to be fixed far more urgently than any of the political class seem to be caring about

    2. Medic
      January 8, 2023

      Yes the PFI was a great success.

  11. Iain gill
    January 8, 2023

    But the obvious response to labour on anything NHS related is… Why have you not done this in Wales? They have had a long time to show they can run healthcare better in Wales, and the reality is the healthcare in Wales is even worse than the terrible state it is in for the English. The problem all the politicians have is the NHS execs and senior management being useless, and the fundamental structure of the thing which needs constant top down fiddling to even do anything.

    1. rose
      January 8, 2023

      The watchword in the West Country is, whatever you do, don’t have a heart attack in Wales. No-one said that when Sir John was in charge there. Quite the reverse. People went to consultants in the Welsh hospitals by choice.

      1. Bill brown
        January 9, 2023

        Rose

        You constantly contribute with claims that are never backed up by figures, sources or any other proof.
        It makes it unreliable statements

      2. hefner
        January 9, 2023

        ‘Quite the reverse’: Really, anything goes with rose … Sir John was there between May 1993 and June 1995. Can you quote anything related to a drop in heart attacks in Wales during that period?

        1. rose
          January 9, 2023

          The good done by a good administrator can live on. The schools were better then too. Teachers moving to Wales from England attested to that.

    2. a-tracy
      January 8, 2023

      I wonder how many people living in Wales are treated in England, it used to be lots of patients in The Countess of Chester from Wales including maternity services. Yet other nearby English towns couldn‘t use this hospital.

  12. Gary Megson
    January 8, 2023

    If only the country had a governmnet that could address these issues. Do we have a government? Haven’t we had the same political party in power for well over 12 years? Isn’t it time for the Conservatives to stand aside, having failed to do any of what is addressed in this post, excepting only making access to trained health care professionals even harder as a result of the failed Brexit experiment?

  13. Iain gill
    January 8, 2023

    Interesting to see English NHS hospitals currently having wiring and oxygen facilities added to support beds in the corridors. Which at least acknowledges that they have far too few beds. Problem will remain lack of staff and operating theatres and x-ray facilities for more throughput. They should just use private hospitals as a short term measure. Putting beds in corridors will in itself be substandard care in many ways.

    1. Iain gill
      January 8, 2023

      Poor infection control causing more long term patients and adding to the problems being one.

      1. Mickey Taking
        January 8, 2023

        So many urinary infections with the elderly play havoc with diagnosis, create admission issues, the length of stay too long, and the dilemma of how to discharge (sorry!).

    2. formula57
      January 8, 2023

      Re. beds in hospital corridors, I recently saw a cartoon that sums up forcefully and succinctly rather too much about contemporary Britain.

      It showed a somewhat frazzled nurse standing in a corridor full of occupied beds as far as the eye could see saying “I have lost count of how many patients we have lining the corridors”. Next to her is Mr. Sunak whose rejoinder is “Don’t worry – I have a plan to tackle Britain’s numeracy problem!”.

      1. P Heathcote
        January 8, 2023

        Making people not veru interested in maths and probably rather poor at it have to continue up to age 18 is rather unlikely to help with maths. But a bit of basic maths for Sunak would be good though. Teach him about how that printing money debases the currency and causes inflation. Or shutting down a country impoverishes the economy. Or how increasing tax rates beyond a certain point decreases the tax take and kills economic growth. Or how net zero kills economic growth and does nothing positive for the environment all entirely negative. Or perhaps explain the difficulties in storing electricity and how on demand electricity is far more useful and valuable. Perhaps also a bit of stats on winter excess deaths caused by cold or by heat. (almost 600,000 people die globally from heat but 4.5 million from cold). Or why eat out to help out was economic lunacy. But this is perhaps all beyond the PPE globalist dope.

    3. a-tracy
      January 8, 2023

      This is where I‘d start Iain if I were a new Manager. I would look at every ward. How many beds used to be on each ward, how many now. Some corridors are integral to each ward complex and some are outside and are general access. Are the corridors the beds are being left in the walkways or the integral larger wards of the past.

      1. Iain Gill
        January 8, 2023

        if you look at the old “carry on” films set in a hospital… the beds are much further apart than they are in current NHS hospitals where they are squeezed far too close together. every other developed country provides private bedroom per patient, the NHS still builds brand new hospitals with shared wards… again this would change if patients had any buying power.

        1. a-tracy
          January 9, 2023

          Iain that was probably just for the filming. I went into Oldham hospital for a short spell and a hospital in North Manchester overnight over 30 years ago and there were lots of beds on each ward. One ward I think had 30 beds with not much room between them and added to that the bed next to me had about six – eight visitors all around their bed for hours on end.

          In the maternity ward there were so many beds I paid extra for one of the individual rooms after one night as they used to make you stay in five days.

          They had to semi private pods in the Nightingales, its a shame they can’t reuse them in hospitals. There are vast differences between hospitals around England though. VAST.

  14. Cuibono
    January 8, 2023

    We had a very snowy winter 30 odd years ago.
    A young GP ( local lad) took to going out on foot in the snow to VISIT his patients.
    During the plague his surgery doors were firmly shut as were his phone lines.
    Sadly he has since died and patients received no notification.
    What on earth happened?

    1. formula57
      January 8, 2023

      @ Cuibono – he probably succumbed to Covid infection himself?

      1. Cuibono
        January 8, 2023

        +1
        Nobody seems to know.
        No mention of him.
        Wondered if it all just got too much?
        Dreadful times.

  15. Sharon
    January 8, 2023

    I think, that as with everything, too must complicated, bureaucratic, red tape and government interference, results in a poor performing service.

    I think as GP surgeries go, I’m fortunate, that despite everything, they seem to run a reasonable practice; but I know that’s not typical. So, attitudes to work and their patients must make a big difference. Perhaps this confirms that one size doesn’t fit all. Leave surgeries to run their practice the best way they seem fit, but keep an eye on those poorly performing? As I typed that last sentence, I thought… that would give bureaucrats the idea of an Ofsted equivalent for GPs… so perhaps not then. If standards aren’t great, people will go elsewhere?

    1. Iain gill
      January 8, 2023

      Even the best GPs have significant problems due to the poor way that the out of hours GP service is organised and run, which pushes massive extra workload onto daytime GPs.

    2. Jim Whitehead
      January 8, 2023

      Sharon, ++++, quite, especially your last four words.

    3. Iain Gill
      January 8, 2023

      we have the care quality commission supposed to be doing that job, but they are worse than useless too

      1. Jim Whitehead
        January 9, 2023

        CQC, a major irritant and obstacle to the objectives of achieving quality health care.
        If in doubt about that, just ask any health professional, carer, cleaner, porter, etc.

      2. Jim Whitehead
        January 9, 2023

        CQC, a major irritant and obstacle to the objectives of achieving quality health care.
        If in doubt about that, just ask any health professional, carer, cleaner, porter, etc., you’ll soon be informed!

  16. turboterrier
    January 8, 2023

    One thing a number if GPS I knew through a shooting syndicate were totally brassed off with was the hours and the associated paperwork piled upon them by the NHS.
    They get paid by patient numbers and carrying out NHS surveys and government initiatives. If the government instead of throwing millions at the NHS as a organisation set meaningful targets that every GP centre had its own scaled down facilities and the local hospitals provided a visiting service to operate them , that would make their job and purpose in life more interesting. With 2 GPs I helped with internal surveys and 78% of their workload comes from 22% of their patients (their regulars) the majority of which, personal life style choices were the biggest problem. But they have to see them no matter what.

    1. Mickey Taking
      January 8, 2023

      I heard the ‘regulars’ called the ‘silver service’.

    2. Iain gill
      January 8, 2023

      Buying power in the patient’s hands is the only way to fix it.

      1. Jim Whitehead
        January 8, 2023

        ++++, Iain Gill

  17. Lynn Atkinson
    January 8, 2023

    Socialism, delivered by both red and blue governments, has taught the population that they are better off working for the state and building a gold plated pension.
    The concerted attacks on small businesses of every kind, has caused the proprietors of said businesses to advise their offspring to take the state route.
    We are approaching a perfect storm.

    1. Hope
      January 8, 2023

      +1

    2. Iain gill
      January 8, 2023

      Agreed, either that or emigrate.

    3. a-tracy
      January 8, 2023

      Lynn, correct!

    4. Timaction
      January 8, 2023

      Yes we are. We’ve had 25 years of Blairs selection processes going through all our health, Councils, public services, police, Home Office, quangos etc. All the leaders are useless woke/PC left wingers. Clearly agreed by the Consocialists after 12.5 years in office.

  18. Walt
    January 8, 2023

    The fuss about doctors’ pension limits is an odd mix of misunderstanding and greed. It is entirely fitting that the state should restrict the amount that a person can invest with the benefit of tax relief and the limits should apply to well-paid medics as it does to almost everyone else.

    Reply Let’s change tge rules for all

    1. mickc
      January 8, 2023

      And include the Civil Service…at all levels.

      1. Hope
        January 8, 2023

        JR, reply to reply. Change rules for all. How about MPs pensions under RPI! How about pay rise hikes above inflation to stop thieving? A part-time non qualified job on £83,000 plus expenses, office staff to answer all queries while in jungle, holiday or elsewhere! 650 of them. Will this be slashed to 14 when England is Balkanised I to regions?

        Barclay saying not affordable to Abu above inflation but it is okay for MPs! Incredulous!

        Reply 7 day a week on call, email and case responses 7 days a week, evening work in Parliament

        1. Lynn Atkinson
          January 8, 2023

          Reply to reply
          Being an MP is a rubbish job, rather like being a mother. No amount of money can compensate for the dedication demanded. Indeed the job is undertaken for love. When love of country or child is the motivator, high quality people sacrifice themselves and undertake this critical work.
          We need to stop paying MPs so the ‘wide-boys’ look elsewhere for a meal ticket.
          BTW I am in no doubt that in an unpaid House JR would dutifully take his place and give his all.

          1. Cuibono
            January 8, 2023

            +100
            Agree. But MPs do need wages…to guard against corruption ( on balance).
            And let’s face it.
            JR’s accurate description of MP work is exactly what GPs (all Drs) should do and certainly used to do.

          2. Mark B
            January 8, 2023

            When it comes to MP’s, I believe that there is a world of difference between say, Member for Parliament for Wokingham, and the Member for Parliament for Uxbridge and South Ruislip.

            For example :

            https://www.theguardian.com/politics/2022/oct/21/boris-johnson-returning-to-fray-after-three-post-resignation-holidays

            I did not think parliament was in recess ?

    2. agricola
      January 8, 2023

      Part salary invested with tax relief is a winner for the state. No impoverishment benefits claimed from fhe state in later life,
      ability to fund medical needs.Only a problem for socialism. My eldest son, an engineer is forced into retirement at the age of 55 by the same nonsense tax rule. You know more financially than most SJR, why not re-write our insane Tax Book for us to create the ground rules for a successful Conservative society. It would be the anti tax bite serum to our chancellors death wish.

    3. a-tracy
      January 8, 2023

      The lifetime allowance was £1.5 in 2006 when it was introduced by Labour.
      Osborne reduced it to £1.25m and again to £1m in 2015.
      So now ‚real term‘ increase.
      A £100,000 pension pot would buy a 65 year old man (none smoker) with spousal transfer a pension of around £4000 last time I checked. I was told this has recently increased but I haven‘t had a quote and I don‘t know how long they will stay up for.
      How many public sector workers are on pensions over £45,000 pa? Do they pay the extra taxes?

      1. agricola
        January 9, 2023

        Without disclosing individuals personal details perhaps our host could explain the Pension and Tax arrangements for MPs and Senior Civil Servants. Specifically any ways in which they are different from a UK taxpaying member of the electorate.

        Reply MPs obey the same tax and pension arrangements as anyone else. MPs who qualify by virtue of the location of home and constituency can claim expenses for having to stay in London when Parliament requires their presence just as a company pays hotel expenses or property rental for employees working away from home. MPs also claim for and pay no personal tax on the costs of their MP office staff.

  19. Martin Ward
    January 8, 2023

    In most countries (US for example) the doctors pay for their medical training costs (in the UK this is about £200k) with a loan and then their very high salaries allow them to repay the loan.
    Here, for some reason, the hard-pressed taxpayer pays for all their training costs outright and the doctors still get the huge salaries but have no loan to repay. Crazy?

    As more than half the intake has been women, over recent years, seeking a “family-friendly” career most of them choose to go part-time since they can easily afford to work just a few days a week on their inflated salaries.

    The answer is to offer medical training paid with a loan to save burdening the taxpayer. There will still be masses of applicants which will solve the shortage problem at no cost.

    Finally, all public sector pensions must be defined contribution.

    1. Wanderer
      January 8, 2023

      I’m confused. A couple of contributors have said doctors don’t have to pay back their “training cost”.

      A quick Google suggests they do have to pay back their student loan, so are these “training costs” an on-the-job, or postgraduate element of their pre-qualification training?

      1. rose
        January 8, 2023

        It takes seven years to train a doctor.

    2. a-tracy
      January 8, 2023

      English student doctors have to pay £9250 pa (Scottish, N Irish, and Welsh don‘t as you say!), I read there are scholarships and bursaries available. Students can also try to study in the university closest to their parents or grandparents homes so that they don‘t have high living costs in student digs to pay on top.

      A trainee from abroad would pay from £38,000 pa but those from the EU didn‘t pay in Scotland and Wales and in England took English tuition fee loans (which shouldn‘t be allowed) as often they disappeared after graduating without any way of recouping the graduate tax unless they stayed in the UK.

  20. Iain Moore
    January 8, 2023

    Has the GP service been functional ever since Labour ‘improved’ it last time? The contract they gave away to the GPs has been at the heart of many NHS problems.

    1. a-tracy
      January 8, 2023

      That change to the GP contract came in 2004, the effects of which is what we are experiencing all the time now.
      They wrote [The new contract which came into effect on 1 April 2004 was accompanied by substantial uplift in investment of 33% a year over the next three years.] https://www.gponline.com/nhs-70-general-practice-1991-2018/article/1485693. Labour give all the concessions the Tories pay for the downward spiral that was supposed to give us improvements but taking all the obligations away for evenings, nights and weekends for such a low sum I think it was just £1600 pa what did anyone expect, really? So now out of hours you have to try to get yourself to the A&E…

      Some GPs have low numbers of patients, some ridiculously high ratios for the number of patients per GP. See this from Blackpool https://www.blackpoolgazette.co.uk/health/gp-near-me-the-surgeries-with-the-most-patients-per-doctor-in-lytham-poulton-fleetwood-thornton-st-annes-kirkham-and-garstang-3879378

    2. MFD
      January 8, 2023

      Nail- head! Iain. All problems in Britain are caused by our supposedly elected members of Parliament.

      I call that incompetence!

  21. boffin
    January 8, 2023

    The NHS funding model for practices is gravely flawed, being based on number of patients registered rather than clinical needs in the GPs’ particular locality.

    For example, this confronts GPs in ‘retirement’ areas with a painful ethical dilemma – should we do as the beancounters would advise and let our elderly patients die off, concentating our stretched resources on younger, healthier patients with more life ahead of them?

    1. agricola
      January 8, 2023

      This mindset, if real in the UK, requires an adjustment in the service. The business has to respond to the market and euthanasia on behalf of a cash strapped state is not one of its tools. In my contact with the Spanish NHS the absolute opposite was all too obvious.

    2. turboterrier
      January 8, 2023

      boffin
      Your first paragraph highlights the real crux of the problem. Each surgery should be assessed on the underlying health problems especially in poor areas of the communities as it relates to potential work load. The same principles should be applied to every hospital.

    3. a-tracy
      January 8, 2023

      Boffin perhaps the rate per patient should be directly reflective of the increasing needs of the eldest proportion of patients and the patients with big medical needs and the equivalent reductions in the number of male patients they have on their books from childhood right up to about 50.

  22. James Freeman
    January 8, 2023

    John, the problem is that, gradually, GP practices got tied into the NHS bureaucracy over the years. Their contracts were over-specified in how they should do their jobs, pensions and the services offered. It meant opportunity for innovation was lost, and the NHS suffered over time. Doctors no longer find the job rewarding.

    When things went wrong, nobody identified this as the cause of the problem. The answer was always more central control. But the issues you describe were all caused by the rules imposed by the centre.

    A good comparison is with a veterinary practice, where there is less government meddling. I recently took my dog to the vet, and he was scanned and diagnosed, with a treatment plan created within two hours. At the same time, my wife needed a diagnosis by the NHS. We had to go into A&E for this, which took them eleven hours.

    Instead, it would help if you offered GP practices the choice of an alternative ‘free’ contract. This approach will allow them to innovate, expand and take the pressure off the rest of the system.

    1. turboterrier
      January 8, 2023

      James Freeman
      Well said.
      Last paragraph bang on the money.

    2. a-tracy
      January 8, 2023

      James, how much is your veterinany insurance costing + extra charges on average per year.

      1. James Freeman
        January 8, 2023

        Annual pet insurance is £345. Add £100 a year for a couple of appointments including vaccinations.

        1. StephenS
          January 8, 2023

          Not if you have a 13 year old miniature dachsund! We pay £96 per month!

  23. agricola
    January 8, 2023

    Your arguement is a good one. Local medical centres containing Doctors, Nurses, Pharmacists, Radiographers and Paramedics is the way things should go. It would reduce the scramble to A&E leaving them to deal with more serious events. My own GP practice is 2/3rds the way there. In the ideal scenario it needs to be a 24/7 service. Additionally the interface with the patient needs to be medical not administrative. Medics can administer , but administrators cannot medicate or make medical decisions.

    1. IanT
      January 8, 2023

      We had two local GP practices combine and relocate to new, larger premises. All very modern and slick until you actually try to get an appointment. I need regular scans, which for some reason my GP has to authorise (although they are undertaken elsewhere by the NHS) but is apparently unable to automatically schedule. I have to first call and request them (although my Consultant has written to them several times complaining about this). So I call the Surgery (spot on 8.00am), I’m told I am number 63 in the queue, wait for about 45-50 minutes, explain (again) that I don’t need the Doctor to call me back, just for him/her to authorise my scans (please ask them to check my file). The Doctor still calls back, presumably because they’ve hit the phone whilst still digging out my file. Wastes my time, the Receptionists time and the Doctors time. Every Time. And the definition of stupidity is???

      1. a-tracy
        January 9, 2023

        Ian, does your clinic have an e-consult? It is an app. Or you can send an e-mail.

        This is a way that clinics can make things easier for people just trying to get repeat prescriptions or a repeat scan.

    2. graham1946
      January 8, 2023

      We had two ‘walk in’ health centres in our area which were convenient for working people to go and saved GP’s a lot of work but which were closed down to ‘save money’ which is now biting us back. The old adage ‘buy cheap, buy twice’ is one maybe the government could pay heed to. They chuck billions away trying to save money. Osbourne was the great exponent of this idea with his disastrous austerity programme which did no good at all, ruined services such that none now work properly and is now costing billions to put right. Keep amateurs like politicians with their pet theories away from health and education.

    3. Cuibono
      January 8, 2023

      +1
      Agree.
      Basically, as with shops etc. everything needs to be local.
      ( Am I agreeing with 15 min cities? Yikes!)
      But it is all only reversing life to how it used to be.
      In other words..SANE.

  24. turboterrier
    January 8, 2023

    Whatever happened to all the convalescent homes which were used to keep the main hospital beds freed up?
    Ideal place too have part time flexible working for those ex NHS staff.
    Now it’s called care in the community which is very inefficient due to the travelling cost and time ànd restrictions on what one person can do in a short visit. Sometimes the old ways were better value for money in the long term in providing patient after care excellence.

    1. graham1946
      January 8, 2023

      Yet another ‘cost saving exercise’. It’s been going on all my life and things are now worse than I ever remember them. Politicians need to know the value of things, not just the cost. Things are just done short term, never thought through properly, an eye just on the next election which is why we need to keep them away from long term projects such as the NHS. Major and later Brown and the ‘private finance initiative’ has been hog-tying the NHS for years and will for the next 50 years if the government don’t do something intelligent about it. That’s where a lot of the NHS money goes – to the money men, not on health care or nurses wages.

  25. turboterrier
    January 8, 2023

    One of the problems today…….
    As many a younger GP has been heard to say ” this is not what I signed up for, too much administration and today there is no WOW factor into coming to work”

  26. Original Richard
    January 8, 2023

    Perhaps GPs should not be paid by the number of people they have on their list but simply by the amount of work they do and the services hey provide.

    Two questions for the Minister :
    How many GPs are there?
    What is the total number of patients on GPs lists?

  27. Donna
    January 8, 2023

    The three legs of the Westminster Uni-Party are jointly responsible for the chaos in the NHS, including GP provision.

    Making a political weapon of GP provision, which is what Sir John appears to be doing in this article, is an exercise in delusion. Not one of the legs of the Uni-Party is prepared to do ANYTHING to genuinely reform the NHS and deliver a health service designed and fit for the 21st century.

    Meanwhile, 440 hotels across the country are fully occupied by the criminal migrants the Government has ferried in over the past two years. And it has plans for another 200 to be occupied by them. So Sunak’s “promise” to stop the boats was just another soundbite and they are expecting the invasion to continue.

    1. Hope
      January 8, 2023

      Tory party are a bunch of followers not leaders. They only implement what they are told to do. Brainless,Clueless and totally useless.

    2. Hope
      January 8, 2023

      D,
      +1
      Not invasion but encouraged, helped by ferry service with huge rewards on the back of English taxpayer.

    3. Original Richard
      January 8, 2023

      Donna :

      Agreed.

      And these criminal migrants have no problems accessing GP services.

  28. Berkshire Alan
    January 8, 2023

    We have an interesting large notice in our waiting room surgery in Wokingham, a Practice of some 14 doctors.
    At least it was there a couple years ago, the last time I visited.
    It warned patients not to seek Private medical care, because if it all failed, then the NHS may refuse to help even as a last resort, which I can sort of understand but:.
    All a bit ironic really given that the Practice is already a private business, but taking money from the Government/NHS/taxpayer for every Patient registered.

    1. Iain gill
      January 8, 2023

      Healthcare in the UK is the only business that puts up posters telling customers to go away.

    2. mickc
      January 8, 2023

      Yes, quite!

  29. Dave Andrews
    January 8, 2023

    It does seem like an opt out of the NHS would work for many people, and might suit a section of GPs as well. There are 2 problems with this – one is that anyone paying private doesn’t get a tax rebate for relieving NHS pressure and two health insurance opts out of a range of long term medical conditions.

    1. Iain gill
      January 8, 2023

      State backed medical insurance for all, pay according to ability, pay out according to need, what you are entitled to in black and white before you are I’ll, all payments to be given to patients to spend how they choose. Get state out of owning, operating and rationing providers of care. Modest state intervention to ensure provision in rural areas. That’s it. Stop the nonsense.

      1. Iain gill
        January 8, 2023

        ILL not I’ll

    2. a-tracy
      January 8, 2023

      Dave, this has already started recently, private hospitals are now offering private GP appointments in order to bypass local GP practices where people were having problems getting appointments for referrals. £90 for 30 minutes, you fill in a pre-health questionnaire to save time.

  30. The Meissen Bison
    January 8, 2023

    If GPs are remunerated on the basis of the number of patients on their lists, they have no incentive to provide an adequate service and the patient is locked in and has no effective choice of where to go if he is dissatisfied with the practice where he is registered. The last couple of years have shown how doctors can ignore their personal responsibilities to patients and brush aside the requirement for informed consent from those they treat.

  31. Ex-Tory
    January 8, 2023

    “Some GP s argue that the reduction of limits on tax free pension saving stops them working more years to build a better pension pot. Many GP s are also in the pay band above £100,000 where the effective marginal tax rate is 60% , discouraging full time or longer hours working.

    “Government needs to listen to GP s over tax and pensions.”

    Agreed. But this applies to many people of all walks of life, not just GPs. The government should listen to those people as well.

  32. Mike Wilson
    January 8, 2023

    If doctors are self employed, paying for and running their own surgeries etc., why are they in a NHS pension scheme?

    The 3 doctors at my local surgery each work a 3 day week. They are so overworked! And it’s very difficult to get an appointment.

  33. William Long
    January 8, 2023

    We are in the fortunate position of having a really excellent GP practice which makes it possible to see how effective these can be when working properly, and if it can be done by one, it can be done by all. The State should be doing all it can to facilitate this, rather than decrying it.
    On the question of high marginal tax rates though, it would be wrong to give the impression that the medical profession is the only one to suffer from these: they apply across the board, and Doctors must not be made a special category. The rates were put in place by Labour: the Conservatives offered no opposition at the time, and have done nothing to rectify the matter since. Mr Hunt has just made things worse.

    1. Mickey Taking
      January 8, 2023

      I feel really sorry for all those people being paid guaranteed £100k+, and with it a cosy pension whether they ‘retire early’ or not at 50, 55 some work longer than that!

  34. glen cullen
    January 8, 2023

    Open up freedom of choice and remove the archaic prescription authority from doctors …allow patients to buy medication from pharmacies or wherever is safe
    Why do ill people have to wait for a doctors appointment often 1-2 weeks just for antibiotics or inhaler or statins etc, often on a repeat basis
    By allowing people to self medicate we could reduce the need to visit GPs by 3/4s
    The only reason we go to GPs is because we need their signature on a piece of paper …in this day and age that’s pathetic – that arrangement is elite & pleb

  35. Bryan Harris
    January 8, 2023

    <BBlockquote> I see nothing wrong with the idea that GP s form partnerships…. Indeed and they could go a lot further with offering additional services if more doctors had been trained in this country and more were available to become GPs.

    Most of the pressure on GPs is down to a lack of doctors – GPs state this whenever the subject comes up – If more UK doctors were available GP service would improve in leaps and bounds.

    The tax system is broken and beyond being unfit for purpose, and not just for doctors. It needs a total redesign, but that won’t be possible while HMG is determined to squeeze every last penny out of us and throw it down the nearest black hole like Ukraine or White elephants like HS2.

  36. David Cooper
    January 8, 2023

    Admirably put, Sir John, and may I add that another factor driving early retirement is burnout. One reason behind this is daily demand (e.g for unnecessary medication and unmerited sicknotes) from the entitled classes that goes hand in hand with lack of respect for professionals – they are of course a minority but they have a disproportionate effect. Another reason is the attitude of NHS management towards GPs in circumstances where in practice the GPs have all the burdens of employee status (compliance, control etc) without any benefits. NHS management think Big Is Best – they’d be only too happy to see the back of the traditional single handed family doctor.
    I speak as the husband of one of those single handed family doctors who has found herself with no option other than to seek ill health early retirement, at least 5 years earlier than she would have chosen.

  37. Ian B
    January 8, 2023

    “I see nothing wrong with the idea that GP s form partnerships, finance their own surgeries, can run their own pharmacies and have a contract to supply services free to patients paid for out of taxation via the NHS budget.” Agreed. The money should follow the service, no service no money.

    The only caveat being the recent trend is for the GP’s in those self same GP Practices to have walked away from the services they have contracted to supply. My local practice is an amalgam of 2 former Surgeries. Nice new building, new management and the regular GP’s have walked away. We now have no static GP’s, they arrive, if they arrive, from far afield on an ad-hoc basis. As such there is no effective and efficient service. So how do the collate the money flow? I was amused recently when I had to contact a service in Ireland (RoI) to make a regular check up appointment at the local surgery which they had requested. There is no one locally able to take calls or make appointments.

    Roll back a couple of year before the amalgamation we had an exemplary service.

    From an outside observational point, the problem lays with the new tiers of managers they can’t recruit and retain staff at any level yet the want to play manager and build empires.

  38. Bert Young
    January 8, 2023

    Where I live the local GP surgery has closed it doors to new patients for some time ; the area is overcrowded , new building is taking place and over-population has – and will continue , to play havoc . My next door neighbour has tried to get an appointment with his GP for several weeks without success ( he is suffering with a severe skin condition ) . This sort of thing is only the tip of the ice berg ; no solution is in sight . There is no alternative local GP practice and his is not an acceptable condition for an A and E appointment . Our National Health service is a disgrace .

    1. fedupsoutherner
      January 8, 2023

      Bert. And still the numbers of immigrants rise. More people, more houses and more services are required but that doesn’t seem to resonate with those in charge. The South of England is seeing thousands of houses being built but hospital beds reduced. There are no NHS dentists and trying to see a doctor is impossible. I know two people who were around 70 years of age who have been left on the waiting list to see a specialist and both have recently died because they waited too long. I think the elderly are being left so as not to be a burden on society.

    2. Mickey Taking
      January 8, 2023

      not so much a disgrace as an inadequate failure.

  39. Michael Saxton
    January 8, 2023

    You make excellent point Sir John. If every GP worked full time it would make a massive difference to their availability. We have a very substantial local health building but it’s massively under utilised. Yet in the last ten years we’ve seen an increase in local house building and associated population. These health buildings not only need to accommodate full time GP’s they need to be the centre for investigative testing eg MRI, Ultrasound and X-ray as well as bloods and urine. These localised services including minor surgery would relieve the pressure on A&E and other hospital services. However, the coordination between GP’s and Hospitals would need to be hugely improved.

  40. Ian B
    January 8, 2023

    The way GP’s practices seem to be set up now lacks a proper correlation of payments to full time GP’s. If a GP is said to be living 100 or so miles away from the practice and turns up once a week, it begs the question how many other GP’s Practices are claiming the same GP on the other 4 days?

    There needs to be a more formal correlational to the size of the GP’s list and the days available in attendance. At the moment everything suggests management companies of GP’s practices are gaming the system

    Reply GPS have to make accurate reports of their patient lists and services under the NHS contract.

    1. Iain gill
      January 8, 2023

      Ring an out of hours GP where I am, it will take hours to get past the incompetent idiots doing triage following computer scripts for the 111 service, you will then get passed to a nurse on the phone so a little more sensible, if it’s urgent you can expect a call back from a GP in about 4 hours, so 6 to 8 hours from first call to speaking to an actual GP. That’s when it’s fairly urgent. And the GP you speak to will be a hundred miles away with no local knowledge, no idea about pharmacies, hospital depts, etc nearby except a quick sheet with the highlights they have been given. It’s a nonsense.

  41. John McDonald
    January 8, 2023

    Everybody should be subjected to the same Tax rules and likewise private pension rules, no exceptions.
    If there where enough Doctors in General Practice per head of population there would be no need to change the system that was working 50 years ago. should a GP be paid more than a Hospital Doctor ? The Health Care system has lagged behind the population growth over the past 50 years, coupled with the general fall in wages in real terms and ability to pay in one way or other for Health care. Health Care is not free. However I would prefer my Doctor to be independent of the State’s Politics like my Plumber.

  42. XY
    January 8, 2023

    It’s not only GPs, anyone earning a decent amount is seen as a cashppoint, ready to be milked by teh tax bandits using the usual green-eyed excuses.

    Hunt, in his abysmal Budget, claimed that hittingh the self-employed with further taxes was “fair” because “people who do the same work should pay the same taxes”.

    So… by that logic, a plumber who works for Homeserve should pay the same as a plumber who works for himself? But they don’t, the self-employed plumber has all the risks of not having anyone to bill – the same as a self-employed person in engineering, accountancy, IT etc. THat was the reason self-employement was created as a separate status and tax regime.

    But hey, poliicians make it up as they go along these days, hitting “soft targets” (those who will get no public sympathy) at will, on the flimsiest of excuses.

    Doctors get away with it because they believe they can count on public support and an outcry if they withdraw their labour.

  43. a-tracy
    January 8, 2023

    If a GP practice has £17500 people on their books per registered GP does your government just pay up for all those people a flat rate without checking if they get the service they should be getting? Are some GPs just working much longer hours and seeing more people than others?

    1. Mickey Taking
      January 8, 2023

      yes, and yes.

      1. Iain gill
        January 8, 2023

        Some GPs have better local hospitals, better out of hours service, wealthier patients, patients with jobs where it’s easier to stay healthy, demographics with more young people… For those GPs things are different to those that have none of that. The NHS catchment areas make things worse, without that people would see GP closer to work instead of closer to home address etc.

  44. Margaret Campbell-White
    January 8, 2023

    Wes Streeting was right! GP ‘s should be employed directly by the NHS in order for equality of access to facilities. The way the system is working at the moment is failing, unfortunately. GPs are clever people and Nye Bevan was correct saying that the NHS had to fill their pockets with gold. They should be concentrating on medical matters, not running their own businesses. Systems in Europe work very well with an insurance based system which is accepted as the norm. In the UK there is a great divide between private and NHS patients with no transfer being allowed between the two, unless in all the private hospitals where NHS patients are being treated for nothing. The main problem is access to see a GP which is in the hands of receptionists who are paid the basic minimum wage and are taking medical decisions beyond their pay grade, if you can get through on the antequated telephone systems each individual surgery used. This should be nationally efficiently organised so that people do not fall between the rails and then end up costing the NHS more to treat. One has to be feeling very strong to be fit enough to be awkake to ring at 8am precisely to join long queues to then be cut off and have to try again the next morning “as we only accept appointment requests for today”
    The only way to solve this problem is for a crossparty committee to put in place changes which are accepted by all political parties to stop all this time wasting and stop the NHS being the laughing stock of the world

    1. Mickey Taking
      January 8, 2023

      I propose it is renamed WHS (World Health Service).

      1. glen cullen
        January 8, 2023

        Renamed …you’re a bit behind the times; that name change happened three decades ago

  45. Geoffrey Berg
    January 8, 2023

    GP practices are a good example (as are privately run prisons) of the privately run/publicly funded model I am advocating to extend privatisation into core services such as schools and education. GP practices are not perfect but they are a lot better and a lot more cost effective than if they were run by salaried officials. At least people may choose their G.P.s and G.P.s depend on achieving financial viability, a reasonable standard and customer satisfaction relative to nearby G.P. practices. I want a similar system for all publicly funded schools and hospitals etc.,.

    1. Iain gill
      January 8, 2023

      People cannot choose GP that is a nonsense.
      They say you can but in practise you have no choice except by moving home address.

      1. Geoffrey Berg
        January 9, 2023

        I suspect that may depend on where you live – people I know in Greater Manchester have been able to change G.P.practice in the past and anyhow many more of my acquaintances have grumbled about the state run hospital ‘service’ than about their privately operated G.P.practice.

  46. X-Tory
    January 8, 2023

    Sorry to go off-topic today but this is a report of a HUGE mistake that this appalling government is making: https://www.thetimes.co.uk/article/delay-to-small-nuclear-reactors-as-ministers-battle-over-costs-cggmmwpqz

    Apparently the government is now refusing to place an order for the RR SMRs. This is absolutely MENTAL. The government is making TWO major mistakes: (1) They are refusing to place an order before the Office for Nuclear Regulation (ONR) has concluded its review (which will take another two years!). Given RR’s history of making reactors safely for our submarine fleet this is just a formality and should not delay the orders. These can, in any case, have a clause that says that RR will need to incorporate any ONR recommendations into their design at no extra cost. And (2) – the second, even BIGGER mistake – is that the government is now considering whether they should order a FOREIGN design, in case this could be a bit cheaper; (although the government is still comitted to paying for the much MORE expensive foreign Hinkley C and Sizewell C reactors!). This takes no account of the boost to the UK economy that would ensue from making RR our domestic SMR ‘champion’: the self-sufficiency, the energy security, the technology, the jobs, the tax revenues and the exports.

    The stupidity and treason of this government just seems to know no limit. I am FURIOUS with the TRAITORS who are in charge who seem to make every decision based purely on what is the very WORST they can do to HARM THE UK. This is clearly deliberate. We have a government that is damaging the UK on purpose.

    1. hefner
      January 9, 2023

      Maybe the following article (nuclearinfo.org 19/04/2018 ‘Dreadnought prototype review exposes flaws in naval reactor programme’) might explain the delay. PWR3 does not (yet?) seem to be operational on submarines. RR SMRs are supposed to take a lot from PWR3 with an increase output to 470 MW. So there may be very good reasons not to rush like headless chickens and use CAPITAL letters when one does not know the first thing about the topic?

  47. Pauline Baxter
    January 8, 2023

    Yes, Sir John. Today you have told us why GP practices were set up as they are and correctly said, why they are better continuing that way.
    The pensions situation does need to be changed.
    It is usually right to investigate bottom up changes. However, in the case of the NHS this does not apply.
    The major problem causing NHS failures is quite simply that all the money thrown at the NHS is spent paying useless administrators instead of front line staff.
    It just gets worse and worse. For example – Diversity Managers !! For crying out loud! Do patients care what colour or religion doctors and nurses are? Just so long as the patient can understand what they are being told by said doctor or nurse.

  48. Lynn Atkinson
    January 8, 2023

    Private but not independent businesses. My GP surgery dutifully telephoned to invite us for our ‘Covid vaccinations’ but when I politely declined, were almost relieved ‘oh that’s all right – that’s fine!’
    I have recently been to the surgery to meet my GP (first visit in 42 years – dog bite on thumb). I was sitting in the waiting room reading all the ‘2 meter rule’ and ‘wear a mask’ posters, maskless, when this poor man came out of his consulting room, mask in hand, to get me. Seeing I had no mask he thankfully disposed of the one he might have been forced to wear had I been a victim of Boris and his crew.
    If this had been an independent business, this Dr would have advised his patients NOT to take the jab. But he is NOT independent, he need to be independent! Had I an insurance ‘to spend’ where I liked, he would be independent and we might not have an 80% excess deaths spike in millennials end 2021. See Ed Dowd ‘Cause Unknown’ – these are actuaries figures, and governments are uninterested in seeking an explaination, though the deaths exceed the ticker-tape ‘covid’ deaths we were subject to through the terror.

    1. Iain gill
      January 8, 2023

      Independent is the doc in A & E telling you to get a taxi to the hospital in the next town, as you need a heart stent and you will never get one if you are admitted here. Which is what my uncle was told. The doc was whispering and risking his job to save a life. That’s the NHS, duty of candour in truth risks your job.

  49. fedupsoutherner
    January 8, 2023

    Yesterday I received an email from old friends who are British but have lived on Vancouver Island since they were both in their twenties. They are both retired now and this is part of the email they sent. Its as follows without the personal bits.

    Thanks for all your news. Nowhere is the same any more is it ? The England I knew is gone but then things have changed here. Vancouver is now an unaffordable place to live and very overcrowded with bumper to bumper traffic. Many, many retirees from all over Canada have moved to the island and continue to come. We don’t have enough doctors for those who are already here and a four year waiting list for newcomers. Water is another issue. There are water restrictions in place every summer now. Housing is unaffordable for young people and rental units in very short supply which has made them unaffordable too.

    Hospitals are overcrowded with patients lying on gurneys in the halls for days. Nurses are worn out and have left their jobs in droves. I was talking to one recently who said she and another nurse are now left trying to take care of patients who used to have twelve nurses tending them. Long waits for ambulances. I think across Canada the medical system is badly broken. My daughter needs to see a specialist regarding her very unusual allergies. Health is a provincial responsibility in Canada. There isn’t a specialist of the type she needs in Prince Edward Island where she lives so she has been referred to one in Nova Scotia. Could be more than a year before she gets an appointment. My Australian sister in law has similar stories to tell.

    The world is in a horrible mess yet we are continually told the world, or the western world at least, has the most highly educated people ever. If so, what the hell went wrong ? Things are worse than they were forty or fifty years ago. Personally I think those people are schooled, not educated. Common sense has disappeared with the advance of political correctness.

    Food prices have skyrocketed here and many, many people are struggling financially even though they have a job. Consequently shop lifting has increased dramatically along with petty theft.

    As for the war in Ukraine. Well what is there to say ? Anyone who has lived through a war, as I did, knows it is a complete waste. Humans learn nothing from it. They merely repeat it a couple of generations later.

    Greed is topmost today. I just read that the top 100 Canadian CEO’s recently “earned” an average of $14.8 million last year. By the 4th January this year they had earned the average Canadian annual salary. Why is this happening ? Why are we allowing it ? Seems to me like the workers of today are no different from the slaves of yesterday.
    ———————————————————————————————-
    It seems other parts of the world are suffering the same problems as we are. Could it be that governments are following the same narrow paths all led by the same mantra? It feels like a deliberate attempt to fell the Western world.

    1. Iain gill
      January 8, 2023

      Canada has socialist medicine like the UK. But they do a lot of things better than the rest of the world. For instance they actively trace family trees to find people at higher genetic risk of cancers, and aim specific prevention measures at individuals with higher risks. This is life saving stuff. NHS does the opposite as they don’t want the extra workload of having extra cases of cancer detected early, it’s cheaper and easier for them if more of us die decades earlier than needed.

  50. Rhoddas
    January 8, 2023

    12 years of Tory Gov, with 6 different Health Secretaries.
    No obvious long term planning imho, no clear ownership of issues by NHS Executives – in any PLC they would be sacked forthwith.
    No clear use of external private hospitals (BUPA/Spire etc) to help clear the backlog of routine operations.
    Other countries models include for e.g. a 20% patient contribution – why not for private treatment, if NHS waiting times are exceeded?
    I think Margaret allowed anyone to take out private health care insurance, subsidised with tax relief, as an incentive … and it would relieve NHS pressures…

    So Sir John – in summary no ideas, no looking at best practice from overseas models, no transformation, just same old same old. Maybe it’s time Labour had a stab at it in England after 12 years and the Tories have a go in Labour Wales… The incumbents look tired and worn out I’m afraid.

  51. Iain gill
    January 8, 2023

    Followed a rail replacement coach today, felt really sorry for the driver. All the so called traffic calming measures made their job impossible, impossible for him to navigate the road thinning, nutty tiny roundabouts, etc we have allowed councils to engineer roads where there is no ability to use coaches and keep the country running when the trains are not running. It didn’t use to be like this. It’s madness.

    1. glen cullen
      January 8, 2023

      Its never slowed down any speeding driver, and never will
      It just, at great cost, inconveniences the law-abiding citizen

  52. agricola
    January 8, 2023

    I cannot imagine why Labour should find themselves in conflict with GPs combining to create GP centres. Rather, I would prefer to have an open discusion on what a GP centre should comprise and this will vary a bit depending on location. It is also important that it fits in with the local hospitals and if possible relieves the hospitals from some of their pressures. Whatever you end up with should be part of a fully integrated service begining to end of life.

  53. glen cullen
    January 8, 2023

    There you go again banning things, what’s wrong with plastic/paper plates & cutlery ….someone in China is laughing their heads off
    What are you going to ban next, maybe A4 sheets of writing paper?

    1. Iain gill
      January 8, 2023

      Yes agree. Wooden cutlery instead of plastic would make sense, total ban is nonsense.

    2. glen cullen
      January 8, 2023

      I’m still awaiting for the results of the governments ‘plastic bag’ environmental levy tax …was that successful, has it improved the world environment and reduced the armageddon of climate change

  54. StephenS
    January 8, 2023

    My GP surgery was absolutely fine until it was co-opted into tone of these business group GPpractices. Suddenly waiting for an appointment was longer, contacting the surgery in the first place far more difficult with restricted telephone timings of 1hour from 8am for emergencies and no phones answered until 1pm later in the day. This years farce is the text I received at the beginning of December:
    In line with General Practices nationwide due to overwhelming demand on GP services, we have had to restrict our appointments to same day medical emergencies only. If you have an appointment already this will still go ahead. Routine GP appointments will be available after 9th January, please do not contact the surgery before this date if you feel your need can wait. You can request urgent appointments by ringing the practice. Help for minor illnesses is also available at http://www.nhs.uk or via your local pharmacy. Thank you for your understanding currently, HMMG

    So a month if no access unless very ill when you would assume advice on ringing would be go to A&E. The NHS is a shadow of where it was when John Major left office.

    1. glen cullen
      January 9, 2023

      I can’t believe that these new doctors appointment arrangements ie before 8am that day, is written into their NHS contracts ….why isn’t government imposing a UK ‘appointment model’

      1. Lynn Atkinson
        January 9, 2023

        Price Waterhouse is successfully introducing an automated appointment system for some NHS Trusts.

  55. hefner
    January 9, 2023

    To anybody with the mind open enough to accept various sources of information (oops, I must be on the wrong blog) there are some interesting MOOCs offered by the IMF (icdtasaemarketing@imf.org) in particular ‘Macroeconomics of Climate Change: Science, Economics, and Policies (MCCx)’ six modules over six weeks, typically 2-3 hours per week. Free to follow them after registration, £126 if one wants to take the tests and get a certificate of achievement.

    For people with other interests, there are also 33 other courses on various other aspects of finances and macroeconomics.

    Or you might want to stick with what your preferred newspaper/website/blog feeds you …

  56. Iain gill
    January 10, 2023

    It’s pretty obvious nobody at senior levels of the NHS understands queuing theory, constraint modelling, etc. Like all other areas of substance they are completely unaware of how poor their own knowledge is. They push PR agendas telling us how fab the NHS is, cos spinning glossy stories like the political class is what they do.

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