The evening’s light fades into night and a new day is born when the sun creeps over the horizon.
The legacy of the day that is just gone, is carried into the new day; joy, sadness, the footprint of our carbon and the burden of our sins.
What happens to us, when we run out of our allotted days? Who knows?
We can only have faith in what we believe.
Reincarnation, perhaps?
Multiple religions and philosophies have been based on transmigration or metempsychosis, the concept that the soul, or some bit of the soul, that we don’t understand, is reborn into new lives.
Predominantly, Hinduism and Buddhism.
I’m not sure mathematics would stand the idea up… but that’s why we have faith.
Monotheistic religions, like Christianity, Judaism and Islam conceive time as a straight line and there’s no turning back.
I’m not sure where the physics is, for that… but that’s why we have faith.
There are more than a few sneering politicians who smarm… ‘the NHS is a religion’.
If it is, you must have done something really bad, in a previous life, to come back as a GP.
The GP; the tale of two careers. The best of jobs and the worst of jobs.
The best of jobs. A cradle to grave job. A detective job, searching for the tiniest clue. A mesmerist. A people watcher.
The worst of jobs. The bureaucracy. Pointless targets. Criticism and pressure. The dumping ground for political problems.
The latest; prescribing for fuel poverty.
There is something going horribly wrong with primary care. It’s fundamentally a partnership model that, now, few seem to want.
From the desk of HMG, it’s the cheapest way to deliver patient care. GP’s, entrepreneurial, ready to innovate and drive up efficiency, lower costs.
A major funding boost, in 2004, kept the primary-care-show on the road but drove Fleet Street’s finest into hysterics. Since then, governments have been more cautious.
It’s true, GP partners can earn £100,000 a year, plus. But…
...now comes a toxic cocktail of;
- uncapped fuel-costs,
- unfunded wage increases,
- unexpected inflation,
- unworkably long hours,
- unaffordable locums,
- unwarranted inspections and
… unacceptable confrontation over unmet demand.
Practice earnings will fall this year. By how much? Some say £50k, others put it over £80k.
The choice for partners becomes;
Maintain income and reduce services.
Or…
… keep going and take home less money.
Or…
… hand back the contract and earn as much, working as a locum, without all the hassle.
A bad winter will see partners handing back their contracts.
In April 2021 Pulse reported;
‘… in 2020… 96 practices closed their doors…’
Maybe three times that number might fold by 2023.
The signs have been there since 2013.
Following mergers or closures, between 2013-17 over a 1.3m patients had to find a new GP. In 2017-18, just under 460,000 patients had to change surgeries.
NHSE are powerless to stop the slide;
- Almost zero growth in GPs since 2015
- As of June 2022… the equivalent of 1,806 fewer, fully-qualified full-time GPs, compared with September 2015
- During 2021, primary care lost 358 partners, 512 salaried and locum GPs
By contrast, there are 10,000 more people wanting to study Medicine than there were just five years ago.
But…
… because of Covid, last year’s, marked-up, exam results, meant a lot of people had the qualifications to study medicine but there weren’t enough places.
Many, were deferred to this year and they’ve been added to the students qualifying this year.
But…
… there are no extra places. HMG have capped medical school places back to 7,500 in England.
Whilst, medical schools continue to offer 7.5% of their places to international students … coz… they pay higher fees.
By 2033, when this year’s crop of doctors emerge, if we’re lucky, about 20% might want to be GPs. By which time the population will have gone from about 62m to 73m.
If HMG won’t stump-up for more doctors-in-training, NHSE, me, you and our families are merely spectators, as primary care implodes.
Solutions?
Where the partners want to, let them soldier on. Be grateful and get off their backs.
Otherwise, it’s digital first for most of us and primary care becomes a salaried subsidiary of the local hospital.
The NHS; a religion?
Well, keep the faith by all means but presentism might serve you better.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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