[Cut to the chase: for those wanting an overview of the GP practice boundary issue, see my Submission to the Health Select Committee.
For my emails to Jeremy Hunt and the ‘non-replies’ from the Department of Health, click here.
For items related to The Patients Association, click here
For my Posts for January 2015, the start of the policy, click here]
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I am a GP in Tower Hamlets. My name is George Farrelly. My wife and I have been the GPs in a small practice called the Tredegar Practice for 23 years. We have two part time GP colleagues working with us. We are very grateful for their contribution.
This blog aims to protest and to inform. My main point is this: the politicians and planners are making promises to you which are unrealistic and unworkable; & they are making demands of us which we cannot meet without going crazy. I am protesting against some policies. Not all of them are mad, but some are. The problem is that the whole system gets subverted by these few policies. I am protesting mainly about two policies; no doubt there are other mad policies, but I leave it to others to highlight these.
Mad policy No. 1: In 2010, in the run up to the general election, the three main political parties all declared that they were in favour of abolishing GP practice boundaries, allowing patients to register with the practice of their choice, anywhere. This sounds like a good idea, and most people would welcome such a scheme. But as someone who has worked as a GP attempting to provide good quality general practice for 25 years I can tell you that it is quite mad. Click here for further information.
Mad policy No. 2: The 2004 GP contract introduced a number of changes. One was to pay practices for providing evidence-based pro-active care for a number of conditions. On the whole we welcomed this as we were already trying to provide this, but were not given extra resource for doing so. I thought we could look after a smaller number of patients well, and maintain our income (we had to pay our mortgage and utility bills). But they also stipulated that we could not limit the number of patients who wanted to join us: we had to take all comers. This meant that we found ourselves looking after more patients than we could cope with, so the quality of our service (access, time spent with individual patients, ability to cope with workload safely, staff morale) declined.
The Department of Health do not seem to understand the issue of capacity. It is not on their radar; the area of the organisational brain that might deal with this is shut down. They think the overriding issue is CHOICE. Choice trumps everything else. If you want to look at this issue, then click here.
One GP's Protest 
your blog reflects the views and feelings of many of us working as GPs in Tower Hamlets and further afield i’m sure. your email exchange with andrew lansley speaks volumes in that there is clearly no evidence for these suggested reforms and there is no useful explanation in these emails just more promises that we all want what’s ‘best for the nhs’. obviously. sad that your energies are directed to writing a blog in order to get your voice heard and air your views.
keep it up.
Dear George,
Thanks very much for posting this. I’m sure the majority of GPs agree with you. I’m a GP at the Lawson Practice and have been campaigning and writing about these issue for years, and would be happy to share resources, Jonathon
http://abetternhs.wordpress.com/2010/12/12/what-is-the-point-of-practice-boundaries/
Thank you for doing this. I am telling everyone I know to protest to their MP’s and to sign up to everything possible.
I have been married to my husband, a GP for 15 years. We live in Cambridgeshire with our three children. I cannot believe the way in which the profession is being treated, its terrible. I have watched a dedicated, excellent doctor slowly become more pressured, stressed and withdrawn due to the hassle that is being created by this government and their reforms. The hours are increasing to sometimes 90 hours per week, the nature of the job is changing and the finances are being withdrawn. I lecture and work in America at times and see the difficulties with the medical system there. The poor are discriminated against and now due to the recession even the more affluent of folk have stopped paying into health plans as they cannot afford it. They pray that they do not become sick! Is this what we want here in the UK because this is where we are heading. We have become so fed up with the NHS that we have decided to move to Canada in November. We have had enough of the battles and the stress. The NHS is losing a fantastic doctor in the prime of his career. We are one of many! You need to keep shouting and protesting because this government does not have a clue about the implications. Tracey Bennett
Dear Dr Farley
I will admit you have changed my mind on the subject of the need to register locally. I specifically think the examples you give bring home the reality of boundary changes in many situations
If the boundary registration was removed, does the new system say you must accept all who try to register with you? Or can you refuse applicants on the basis of there distance from your surgery? I would guess that you must be able to say no to some patients in the new system otherwise you could end up with all of London registered with one GP service that has a “good” reputation (hypothetically)
Also if the new system was introduced and G.Ps had the option of refusing certain patients would this lead to private providers “cherry picking” patients. For example only registering young working professions leaving you with the more complicated and expensive patients such as haemophiliacs etc.
I ask as I travel within the UK I was originally drawn to the idea of open boundaries and the virgin assura system of connected health centres across the UK but I am now concerned that such an action may be of mild benefit to me but lead to a great dis-benefit for the majority of patients.
Anyway thank you for a informative website
D McCormick
Thank you for your thoughtful and generous comment. Will we be forced to accept all comers if boundaries are abolished? Clearly, this would be a recipe for disaster. And yet, if people are not able to register with the GP practice of their choice, ‘anywhere in England’, they will rightly feel aggrieved, having been promised this. The practicalities have not appeared in public; I imagine there are a number of middle-ranking people at the DoH sweating to somehow square the circle. Cherry picking: yes, this will appear in different ways. You are, I think, right that people like you will benefit but many others will not, and English (not Scottish or Welsh for the moment) general practice will suffer.
Watch this space. The anomalies and absurdities will emerge in time. This is a scandal in search of an audience.
Good luck with the protest; it has my support. You are right; it is not about competition, it’s about allowing cherry picking either deliberately or by default to create a bonus for shareholders by taking advantage of the fact that funding mechanisms do not match clinical need at the practice level.
See my article BMJ 2009; 339:b4188
Dear George,
I agree with you entirely. I’m sure our safeguarding children and vulnerable adults teams will also share our concerns. It will be far easier for an abuser to move on to another practice away from local services to avoid detection. I doubt that policy makers have even thought of this issue.
I agree with Dr George Farrelly.
Having been a GP for over 20 years, I applaud changes which will genuinely improve patient care.
This change is not motivated by a desire to do that (Along with Darzi centres etc. it is motivated by improving opportunities for private investment in primary care)
Those of us who know general practice are aware that this will be to the detriment of continuity and quality of primary care.
It is not a logical way of dealing with “practices that are difficult to access”. There are other ways
of doing that. The “choice” issue is disingenuous(-just as it was when applied to schools)
Community health services,Social Services, Childrens’ Centres and schools etc. are all locality based and we have built relationships over years.
I share the concerns of Dr Spraggins about Safeguarding Children, but this change risks the health and well-being of all of our patients.
As a former professional system engineer, I like your respect for nature. But as an amateur moral philosopher, I suggest that politicians seek support by offering people what they want and expect. Presently, nature and culture have combined to make people selfish and short sighted. So do not be too surprised when your reasoned explanations fall on stony ground!
I have spent a year challenging Lansley’s reforms and wonder if support for introducing policies based on free market ideology into the naturally socialist NHS is a unconscious defence of denial that deregulation of finance and the economy have failed. I am prejudiced here as I having being warning this would happen since the early 1980s. And my advices have been ignored!
However, I gather opposition to the reforms is being expressed more openly and hope your efforts contribute to getting politicians to see sense.
dear dr farley
nice site. i am impressed that you arent being reported to the gmc by someone in authority. I put some mildly adverse comments about nhs policy, the reforms etc., poor information for patients about health screening. I was told to remove it and threatened with being reported to the GMC. Do you have any advice for me?
If the people in authority wish to take issue with what I say, they are welcome to do so in public. I have published the responses the DoH have made so far to my protests.
What I am trying to do is protect good quality general practice. If this is reportable to the GMC, then so be it.
I feel on pretty solid ground, so I do not worry.
I feel so angry about GPs getting an average of £106k salary. It makes me want to cry for this country. Secondary school teachers are flogging their guts out for £35k. MPs are far more talented, work to get thousands of votes, have their private lives raked-through by newspapers and get £60k. Engineers average £50k. Police officers £39k. Paramedics £36k. Architects £36k. Why the hell should we pay the family doctor any more than all of these by far? Why should we have any sympathy now their phenomenal pensions are being trimmed?
I’m a school governor and the last time I looked at the figures, our head teacher was getting a hell of a lot more than £35k. There are plenty of head teachers out there on over £100k. Meanwhile, a GP partner/sole practitioner is like a head teacher – he runs the show as well as doing the hands-on job. Salaried GPs are like the classroom teachers and earn nearer what they earn.
Don’t forget, salary figures for GPs don’t include the period in a doctor’s career where he is a junior doctor in a hospital whereas the salaries of the other professions you cite include the early part of their careers.
I find what my local GPs earn makes my eyes boggle but they don’t half put in the effort for it and I trust my GP with my life, literally.
BTW, where I live, the plumbers charge £70/hour or part thereof. The electricians aren’t significantly cheaper.
In a town of 60,000 people, you might have a couple of secondary schools each with a headteacher on £80k-£90k. I don’t see why that town should support 20 GPs on £106k. It is nothing to do with unions and nothing to do with their value to society. We are quackers to put up with this.
Please see my post which is in part a reply to your reply
Couldn’t agree more. These guys are bleeding this country dry. Half their salary and employ twice as many. My gp only attends his own surgery on tuesdays. Locum doctors the remainder of the week. Crazy.
Ah- when there are no boundaries there need be no GPs or GP surgeries as all necessary provision will be available at the corporate super centres staffed by nurses on £50k a year, owned by the people who will also own the taxi firms which patients will have to use to get there to avoid astronomical parking fees and train/ bus fares- all because the politicians used PFI to help their friends?
For a gp to say he had to change his plans to take an afternoon off because it was his birthday is nothing short of rediculous. How out of touch with the real world of fiscal limitations and a healthy perspective of earning ones salary can you be ! I am a chartered structural engineer (aircraft stress analysis). An intellectually challenging and responsible occupation. My yearly salary is half that of a gp starting out (I have carefully checked the numbers). Gp’s do not clock in and out each day, are not bound rigidly to the confines of a commercial premises, do not adhere to anything like a 47 week year, nor a 45 hour week. I do not understand how these people are above criticsm.
I work for the DoH. I have to say that the daily mail has done a great job ruining the reputation of GPs (much to my bosses jubilation!- primary care undertakes 90% NHS workload for <9% budget it is the Most cost effective area and most lucrative for future private buisness)
Most GPs easily work 15+ hour days. They will see 50-60 people/day. Each person comes with paperwork, results, investigations,prescriptions, correspondence, referrals. On top a GP partner is a small buisness owner. This alone is a full time job! Mistakes by GPs cost lives. They deal with enormous uncertainty. It can take a week to get results back. The DoH agenda is to add more and more work into GP because they deal with it in the most cost effective manor. Most GPs earn far less that 106k it amazes me that people can't understand the difference between gross and net profit. A GP may get 100-150k gross but they must pay their staff from this. Some months a GP may take home no money. It depends on the financial health of the Practice.
The funny thing is that the Americans and Australians are crying out to steal our GPs. I have no idea why most of them don't just go, they are treated terribly in this country. The whole NHS literally depends on GPs to work!
In the uk there is a media and political fear of offending gps. Health service managers take all the heat when the budget runs into difficulty. Realistic salaries and proper working hours need to be enforced. Any disgruntled gps, like any employee, are free to leave. Remember they are civil servants and we the british tax payer foot the bill.
Crazy comment! GPs get constantly berated by the press.
Working hours= 60 hrs per week
Salary most often approx 60k
At LEAST 10 years training, mostly much more.
Position of enormous responsibility.
Market forces dictate salary in most sectors. In the UK there are too few GPs junior drs don’t want to do the ridiculously long hours for poor pay. Many GPs are leaving. If you have a in demand but scarce resource you have to pay them More not less!
basic economics!
If the job is so amazing and great then why does no one want to do it?