Are GPs too lazy?

02/06/2013

Two evenings ago, when I arrived home at 9pm for supper, my daughter, with a smile on her face, pointed me to the front cover of the current edition of The Week which asks Are GPs too lazy?’ She and her brother were always clear that they were not going to study medicine because they thought their parents, both GPs, worked too hard.

I wish journalists were more precise in their use of language. Why not ask, ‘Are some GPs too lazy?’ Why not find out what it is like for a significant number of GPs?

It is 9am on Sunday morning and I am at work, trying to catch up on my mountain of work. I arrive at work at 7am weekdays, and leave on an early night at 8, other nights at 9. And I will not have finished. I work at least one day of every weekend. It is unsustainable. I will be 60 years old in 3 weeks. In our practice we try to provide good quality, evidence-based medicine in a respectful and compassionate way. But it is a real struggle. I would like to work on until I am 65. I have a sense of commitment to our population, I am aware that the role that I play is an important one.

Ultimately, there is a real problem with capacity. The demand outstrips the resources.

We have 10 minute consultations. Many of our patients require 15 minutes, some longer. The job I do now is far more complex than it was 15 years ago, it requires more time.

Yes, it is a bit of a slog for some to get appointments at times that suit their schedules. I am not happy about that.

The politicians and Department of Health set us Herculean tasks which undermine quality.

Politicians, journalists, citizens: be careful, if you blame us and ‘shame’ us in a mindless way, a significant number of us will just give up, and leave you to get on with it on your own. Let Jeremy Hunt do it; let the Department of Health spokesperson do it; let Janet Street-Porter do it.

If you want a better system, let people who understand the complexity of primary care design it and cost it. Then resource it.


NHS Choices Website: my attempt to leave a comment regarding ‘Patient Choice Scheme’

14/04/2013

A few weeks ago, I found the NHS Choices page promoting the ‘Patient Choice Scheme’. I registered and left this comment:

I am a GP in Tower Hamlets, one of the sites chosen for this pilot. What the Department of Health is not telling you is that two of the 6 sites above (Tower Hamlets and City and Hackney) have refused to take part in this pilot in order to protect the local health economy and services to our local population.

The proposed policy to abolish GP practice boundaries is deeply flawed, but the Department will not tell you that.

For more information, see www.gpboundaries.org

*

I checked this afternoon, and noticed that my comment (which I thought had been accepted on 31/3/13) was missing. There are in fact no comments to this page. So I have tried again. My Comment on Choices website but somehow feel that it won’t be visible, ever, to anyone else.


My email to seclegscrutiny@parliament.uk

25/02/2013

Dear Sir/Madam,

I am a GP. I am not a member of a political party. I work hard trying to provide a good service to our patients in Tower Hamlets.

I am grateful when policy makers come up with policies which support us in doing a good, sustainable job.

Unfortunately, in recent years this has not been the case. All too often, the politicians and DH have introduced policies and directives which make our job harder.

The Health and Social Care Bill is a prime example. It is difficult not to feel contempt for the political class and for Parliament. Politicians do not seem to understand how the various parts of the NHS work. They have misled each other to pass this Bill.

The NHS Competition regulations (SI 257) made under the Health & Social Care Act 2012 are a case in point. Assurances were made to CCGs (of which I am a member) that we would not be compelled to put out all services to competitive tendering, and now we see that these regulations contradict these assurances. This is an act of deception.

Please ensure that this is debated fully, preferably in both Houses.

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

 


My email to Health Select Committee on GP practice boundaries-Grotesque stupidity or deception?

01/10/2012

Dear Health Select Committee Members,

Brief Summary: I am a GP; there are very significant problems with the policy of abolishing GP practice boundaries. Is this a matter for you; if not, why not, and who should concerns be addressed to? Is this an example of grotesque stupidity or deception? I am writing a series of articles for Pulse on this issue.

I have been a GP in Tower Hamlets for over 20 years. I was the Medical Director of the Tower Hamlets GP out of hours co-op from 1997 until 2004 when the PCT took over responsibility for out of hours cover. I know a fair amount about the practicalities of providing good quality general practice to local population.

Because we are a popular practice, when patients move away they often want to remain registered with us. This has given us, over the years, a lot of experience in looking after patients at a distance from the practice. And it is clear that it does not work: the greater the distance from the practice, the greater the barrier to care; it is inefficient, time consuming, and at times unsafe. That is why we insist that these patients register with a local GP. Here is an example of the problems that  arise.

This is just the tip of a very large iceberg. There are numerous other reasons why this does not work.

So it is very bewildering to us that politicians and (anonymous) policy makers at the DH should be backing this policy. I used to think it was just grotesque stupidity that drove this. But this just does not make sense, it does not add up. A more credible explanation is that there is a hidden agenda: the drive to abolish GP practice boundaries is not about giving patients choice (which it will not in fact do), but about freeing up (‘liberating’ to use Andrew Lansley’s language) English general practice to a different structure which will please Virgin Care and McKinsey but will actually destabilise and undermine good quality general practice, and introduce additional costs.

So either politicians and the DH are remarkably stupid (in which case they should not be in charge of this), or they are carrying out a deception on the English public (which is really quite shocking).

I am writing a series of articles for Pulse, a GP publication. As part of my research I want to find out what the Health Select Committee’s brief is. If what I am claiming has a solid basis (and I have evidence to support my claims), would this be in your remit? If it is not, why not? If it is not your remit, then who should GPs, and patients, address themselves if they find themselves sharing my misgivings?

Best wishes,

George Farrelly

BA, MSc, MBBS, MRCGP
The Tredegar Practice
35 St Stephens Road
London E3 5JD

www.onegpprotest.org

“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Richard Feynman, Physicist

cc to Health Editors at Guardian, Telegraph; Mirror; Daily Mail; Jennifer Dixon, Nuffield Trust; Clare Gerada, RCGP Chair


13. How can they be so stupid? Corporate lobbying?

05/06/2012

I put a question mark after corporate lobbying simply because I have no direct proof myself of this activity. I am close to certain that this activity has taken place over time with respect to the issue of GP practice boundaries, and I think it is likely that this plays a central role in driving this policy. The politicians talk about patient choice, but underneath it all is really an aim to de-regulate English general practice and open it up in quite a new way to for profit companies.

How and why?

At present practices cover a limited geographical area. This limits the number of patients. Remove this factor, make registration free of geography, then it opens up an entirely different model which can be exploited by companies like Virgin Care.

These companies can set up medical centres in major cities, wherever is most profitable. They will attract a clientele of mobile, essentially healthy professional people. They will not have to deal with these patients when they are actually sick because they will be too unwell to travel to their centres; someone else will have to visit them. The elderly, people with chronic diseases, will remain registered with local GPs.

It will be convenient for the mobile and well, and profitable for the firms. But it will not deliver primary care in any real sense, and will in essence be a virtual asset stripping.


East London LMCs advise boycotting ‘Choose Your GP’ pilot

21/04/2012

Pulse has published an article on this, together with the letter.

My comment to the Pulse article:

Congratulations to the East London LMCs for taking this necessary step. Not only will the commuters using local GP practices be using local resources in terms of secondary care, community services, and prescribing costs, but do local practices really have the capacity to look after these additional patients without distracting them from their local registered populations?

PCT clusters throughout England are having to put in place contingency plans to look after patients who register at one of these pilot sites, but who then fall ill at home and need a GP. What is the cost of all of this? Where is this money coming from?

At all sorts of levels this is a crackpot policy. Either Lansley and the secret agents at the Department of Health are remarkably stupid, or, more likely, this policy is actually a smokescreen to de-regulate English general practice. Removing practice boundaries will open up general practice to an entirely different model which will be ‘liberating’ for organisations like Virgin Care, but will undermine British general practice.

They call this a pilot and they say that it will be ‘independently’ evaluated. I predict that as with other piloted policies, that plans to implement the nationwide roll-out will be made before the (sanitised?) evaluation is made public.

I believe it is possible to stop this policy, but this will require persistent clear-headed resistance to the impracticalities & inefficiencies that will inevitably be proposed. A light needs to be shone on this policy: why did none of the 3 political parties carry out a proper risk assessment of this policy? Why did the Department of Health avoid almost any mention of these risks in the so-call ‘Consultation’ two years ago?

It is really just a confidence trick, and the choice it promises is an illusion. The GP you’ve heard such good things about is actually working at full capacity already. The well-functioning practice you may have heard about works well with this population size, within this geographical area. Increase the list size, change the geography, and the system changes.

For more on this, see my blog www.onegpprotest.org


My comment to Tim Montgomerie’s post advising David Cameron to drop the Bill

10/02/2012

Tim Montgomerie, blogger at Conservative Home, advises David Cameron to drop the Health and Social Care Bill: click here.

 

My comment to his post:

I am a GP in Tower Hamlets and therefore one of the many who have to actually deliver the health care. What I want is policies that help me deliver good quality primary care to my patients. Unfortunately, the politicians and Department of Health have for some years dreamt up policies that make my job harder, if not actually impossible. The basic problem seems to be a shocking disconnect between the aspirations (increasing patient ‘choice’, ‘modernisation’, ‘reform’) and the reality on the ground. One particular example is the issue of GP practice boundaries: all 3 parties want to abolish them. At first glance, this seems like a good idea: choice, who does not want choice. But you then need to ask: are there any unintended consequences, are there any risks, how will it work, will it work? These questions are not asked. And yet, abolishing GP practice boundaries will not actually deliver patient choice; it will make provision of good quality primary care more difficult, less efficient, and at times unsafe; it will cost more money. (Of course, there is a hidden agenda in this: it will suit some vested interests to deregulate English general practice.) For more documentation on this, see my blog at http://www.onegpprotest.org
I am perfectly happy to work with others to find ways to reform things (as opposed to sabotaging them), to make things work better. But it must be done honestly, in good faith, and the nuts and bolts of earthly reality must be taken seriously. Otherwise we will view you with contempt. As the late physicist Richard Feynman said in another context, ‘For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.’