BACK TO HEADLINES
29 March, 2003
After another week of crisis to the GP contract bmanews once again almost, but not quite, manages to forget to mention the issue. Four half-columns on the front page, and the equivalent of two columns on page 3 and that's your lot, as they say. Far from being "The voice of doctors" bmanews manages once again to be the sycophantic mouthpiece of BMA House.
Having cocked the matter up Dr Chisholm is now having to spend even more members' subscriptions sending out 43,000 letters of "apology". At a GPC meeting he continued to express his support for the Carr-Hill ("Benny-Hill") formula at the root of the problem. Also at the special GPC meeting, but not reported in bmanews Dr Chisholm laid the entire blame at the feet of the DoH. Not a mention did he make about the collossal misjudgement, to say the very least, in trusting Milburn's minions and not checking the figures they presented to him. The bmanews report failed to mention any adverse comments at that meeting.
Readers would like to know if the editor in chief, BMA Chairman and ex-GMSC chairman Dr Ian Bogle has exercised any editorial control in this or whether it is just bad reporting, or even reporting in fear of their jobs.
Scots CCSC has come to an agreement north of the border about job-planning and the appeals mechanism.
Politics and cardiothoracic surgery do not mix, says the BMA, as ministers refuse to rationalise paediatric cardiothoracic surgery units possibly for fear of upsetting the voters. All the expert groups, including the government's own Bristol Enquiry, have advocated larger but fewer units. Another instance to support the Tory proposals of keeping politics out of the NHS.
Another government blunder, or was it deliberate policy? Impoverished health-care students, that is nurses, pharmacists, physiotherapists, you name them, all have access to a financial hardship fund - but not medical students. It is to be corrected.
Those, now proven to be, infamous doctors' leaders are spouting again. This time one of their number, Dr Chisholm, has been granted space to list the major faults which had been found in the contract to which he and his committee had only recently given their blessing. He explained that they did not realise the scale of the problems because "modelling the impact of the formaula had taken longer than anticipated".
So, we have here, a major trade union leader, responsible for the pay and conditions of some of the larger earners in society, who preferred to gamble on the correctness of the employers' calculations and formulae rather than spend time checking them. And all this to save time and his own face, having delayed the introduction of the contract more than once before.
Remembering the consultants' fiasco, what on earth does that say about the standard of the BMA as a trade union? This editor, speaking as a BMA Council member, has to say that it makes it look like naive fools. It was difficult to treat them seriously in Council before. Now it will be bloody impossible.
The final GP contract contribution comes from Dr Brian Keighley. His is a piece which, rumour has it, was spiked by another magazine, and as it was reprinted in its entirety on DNUK, where it was liberally shot down by numerous angry contributors, it will be ignored. Suffice to say that it was very supportive of GPC. Dr Keighley is Treasurer of the organisation which funds all GP committee members' expenses and he would be expected to support colleagues. Judging by DNUK he failed, spectacularly. Those who can should scroll down the pages of New Contract on DNUK until they see his name.
National Clinical Assessment Authority has been attacked by Tory peer, Baroness Knight who said that despite spending £2.5million in 2 years its reports were frequently biased and wrong and it was of poor value. This quango of self-important, empire-building, government sycophants was set up by the arch-spawner of quango's Alan Milburn when in yet another of his doctor-bashing tempers. The vengeful, compensation seeking public and others have referred 500 doctors to it but the NCAA has managed to deal with just 18. But, never mind, Alan, there's always the GMC and 30 other groups only too pleased to have a go at doctors, so you'll still have your fun.
Our TA colleagues in the Gulf rightfully get a mention. They have the complete support of countrydoctor. It takes a special type of doctor to volunteer for hazardous duties.
Government machinations or squirms to get over the A & E waiting time crisis is discussed together with the manipulations they must adopt to keep the figures low so that failure Milburn can say what a damn good job he's doing. Such tricks as keeping patients in ambulances outside A & E, transferring them to corridor "observation wards", permitting direct nurses admissions. Consultants quite correctly condemn such tactics and the politics behind them. Once again, Tory Liam Fox is right.
A & E consultant Charles Lamb pens a splendid jibe at conference organisers who charge far too much for too little just because folk have to have brownie points. Well said, sir.
The demise of the clinical team in hospitals is mourned, leading, as it will, to less well-trained doctors. As "Dr O'Pinion" says, juniors are now around for fewer hours and rotate at 3-4 monthly intervals and there is no staff increase to replace the 9-5 houseman. As O'Pinion rightly says, there is no substitute for experience and, to paraphrase him, a doctor who ain't there ain't getting experience. To make matters worse, far from lengthening the medical course to compensate, it's being shortened at both undergraduate and post-graduate levels. But that doesn't bother politicians like Milburn who can punish erring doctors whenever they like for not acquiring knowledge they have denied them achieving.
Head to Head focusses on medical school teaching. A 4th year student says that the message of what's needed is unclear and teachers must get their acts together because there's too much anyway. Whereas an ex-GP academic is very suspicious of Milburn's political interference in medical education. She feels he is dumbing it down for the sake of increasing the supply of doctors for political expediency. Reading not very far between the lines Dr Gordhandas believes that the new, young deans are government sycophants more interested in pleasing Alan than in training good doctors.
More political manipulation is mentioned in a piece which seems to believe that just because a student comes from a sink-school he will have "the traits that will make them potentially better physicians, GPs or surgeons than more conventionally qualified straight A-level students". The trendy Dean for admissions of Glasgow medical school seems hell-bent on this and on psychometrically testing and telling children at age 14 that they will make super doctors. Quite where this enthusiast has got this information we are not told but she has persuaded all the other Scots medical schools that she's right - God help us. Sadly, there is a following for psychometric testing. Except, of course, for politicians.
22 March, 2003
Following the week when the general practitioners' negotiating committee committee made the biggest blunder in medico-political history, it was to be expected that the chairman of that committee would at least give an explanation and an apology, no such thing. BMAnews has implicitly expressed its solidarity with those negotiators by virtually ignoring the GP contract. In fact the edition is hardly worth reading let alone commenting upon.
The lead article briefly mentions the matter but reports that two supporters will continue to support the contract whilst making little mention of the thousands who have filled other media with their protests. As disgraceful an example of reporting as ever there was. Could the editor-in-chief have had a hand in this?
Even the Letter Page does not reflect the anger within the profession as BMAnews gives a good imitation of Pravda.
Readers who want to see what else is within this week's edition are referred to the BMA.
15 March, 2003
All trace of the contracts has disappeared from this edition. The lead article discusses the current shambles about revalidation. How many GPs will, in their secret thoughts, be really and deeply concerned about its delay?
The anonymous "doctors leaders" are once again quoted although being anonymous their mouthings should not necessarily be taken with any seriousness.
Maybe the political wind is changing within BMA House but the Tory website is given on the front page.
"Doctors leaders" get some prominence on the second page. In this case it's the consultants and one of the leaders is quoted (I assume), JCC Chairman, James Johnson. As I recall it from Council he was, to say the least, very unhappy about the government's latest wheeze. This involves shortening the training time for consultants, creating a sub-group of general consultants and a longer trained specialist group. All this has, of course, nothing to do with fooling the public by spuriously increasing the number of consultants according to stupid promises in The NHS Plan.
Surprisingly few candidates have put their names down for the GMC elections except in the North and the South East. The Midlands only has 5 candidates for 3 seats.
Hopping mad consultants are pushing CCSC towards "industrial action" of one sort or another. The new CCSC, they feel, appears to be dragging its feet in time honoured fashion. There may be some truth in that. Is the new CCSC chairman going native?
The Small Practices Association seems to be swimming against the contract tide by saying that few small practices will have a problem with it. What about the "economics of scale" which Milburn has refused to allow. You know, it takes just as many staff to service a small practice as a large one.
Milburn says the contract is a turning point in primary care. He's right at that. The point is, where does the turning lead, except to disaster and government control of the "job" general practice will become.
That honourable man, John Chisholm, is a true politician. Sure, he's not overtly commending the contract for fear of a consultant-style bloody nose but he does everything but that. He declares its virtues and how fantastic an improvement it is and attempts to scare colleagues into a YES vote with doom prophesies of the future after a NO vote. Simon Fradd and Mary Church are carrying out those policies at their roadshows, too. John, you assured people that the roadshows would simply answer questions rather than be discreditable promotional charades.
Weapons of mass destruction, terrorism and the country's state of preparedness are discussed.
A roadshow is described as having standing room only yet bmanews' straw poll at the end found 6 GPs in favour of the contract, , one going to ask a friend and one against. What happened to all the rest or was the meeting held in a broom cupboard? The upshot of the meeting was that the negotiators who didn't set out to sell the contract had sold it to at least six GPs. Mary Church's photograph shows her looking very dismal and gloomy as she thinks of the future, no doubt.
Second Opinion this week is written by a 2nd year medical student on the subject of student fees. He is not optimistic for the future of medicine in the UK if the government's proposals actually come to pass. The answer is in the ballot box.
The Antarctic sounds an interesting place to practice. Apparently past employees of the British Antarctic Survey have little problem in getting a job when they return. After all, these courageous doctors work far from help. Remember the case of an American doctor who operated on her own, newly diagnosed breast cancer with the electronic help of colleagues back in the States and lay colleagues on site. If you think you have that degree of confidence, go for it.
In summary this was a not very political issue but, Iraq war permitting, we are in for more stirring medico-political times over the ensuing few weeks.
8 March, 2003
For this week, at least, GPs have been eased off the pole position by extremely angry consultants faced by a Milburn who, at this stage refuses to renegotiate. Knowing that they have the advantage CCSC is very much in a mood to use it. For the time being consultants are being advised to use to present contract and extract everything from it they can. This should consist of demanding a job plan to remove their long, unpaid working hours and reduce their week to the 35 hour minimum the BMA believes that their present contract represents. Maybe appropriately considering their ire, topics relating to the consultant contract are flagged in red.
For some very odd reason items relating to the GP contract are flagged up in green. Is this meant to symbolize the BMA negotiators' opinion of their colleagues, one wonders or just that the negotiators are going to green light it through? One of the roadshows is mentioned on the front page and, to bmanews' credit it does mention that more than one GP had reservations about the contract. In fact, careful reading showed none of the reported doctors unreservedly favoured what they are being presented with.
Errors are still causing a problem as doctors of all kinds fear the climate of punishment and compensation which has grown by such enormous proportions under the Milburn regime. Until this is finally removed (with Milburn?) there is likely to be little progress.
Student fees are another problem causing anger invented by this government. If the nation really wants more doctors from lower economic classes then it will have to pay for them. The BMA students' representative spoke eloquently and passionately in Council last week.
The GP contract is still not priced two weeks after its unveiling. This, despite assurances from the GPC chairman John Chisholm. This means that roadshows will discuss an unpriced contract. never fear, GPC is at hand. It will be sending out tailored figures to individual practices of what they could earn in the global sum, calculated against that wonderful Carr-Hill Formula which looks as though it came from a Christmas cracker joke book. For future reference the Carr-Hill formula upon which 2/3 of a GP's income depends is as follows:
Practice list adjusted for list inflation * ((48.1198 + (0.26115 * SLII) + ().23676 * SIR <65)) scaled back to the UK population
This insane gibbering originates from that mad-house of anti-GP academics, York University. In these days of evidence based medicine doctors would like to see the evidence for it.
Rather quaintly GPC is telling practices not to worry if they believe they will lose out under the formula because it will all work out in the end due to "transitional arrangements". By definition transitional means temporary. So GPs should think about the future rather than the immediate pieces of silver designed to get them into the system
The points system for quality and outcomes will lead to GPs chasing up to 1000 points for four areas Clinical (550), Organisational (184), Additional Services (36) and Patient Experience (100). It has been described as rather like collecting Green Shield stamps for your own funeral. The harder the GP works the more points he will get and the sooner burn out will appear. Whatever else the negotiators may say, GPs will have to flog themselves to get that extra cash promised. Some partners will be able to do it and will be angry with others who don't. The system is grossly flawed and not in the interest of GPs and, let us face it, the BMA negotiators were instructed to look after GPs.
An overall discussion of the contract is set out on pages 6-7 and it is interesting that one supporter says that it will fail to "impact" on recruitment. As one who deliberately left Milburn's NHS I can vouch for that. I will not be returning to the mad-house. Another erstwhile supporter, Brummy LMC Chairman, Charles Zuckerman believes it won't help recruitment also. The negs have failed GPs over forced allocations and pensions. To which may be added 48-hour access. To bmanews' credit it does mention those who will reject the contract, leaving only one GP, London GP Sam Everington, a past or even present advisor to the Labour Party, broadly in favour of it.
Welsh GPs interviewed seem not to be very much in favour although one does say she likes it because it should reduce paperwork. What, by having to record and chase of all those Green Shield points? She should remember, even with IT, computers only spew out what they have ingested and even that has to be checked. Unless the GP is content to gamble 2/3 of his pay. Breaking the solemn promise of the GP negotiators not to recommend the contract, negotiator Andrew Dearden could not resist "looking forward to the new contract". He also displays a remarkable naivete in believing promises made by the Welsh Social Services secretary. It's easy to promise but difficult to deliver - as he should know, being one of the group who promised and failed to deliver pensions, forced allocations assurances etc.
Scottish GPs don't seem to know yet how the contract will affect them as they still do not have the figures. There are several pious "hopes" from the Scottish GPs chairman, Dr Love but Dr Sutherland, a Midlothian GP, expects to "be hammered" by the contract.
Northern Ireland is in its customary turmoil and nobody knows what is happening because nobody is speaking to anybody else.
Medical training is featured as the government seeks, with the peculiar help of the Royal Colleges, to fulfil ludicrously unrealistic election promises one way or another by shortening consultant training to boost the numbers of people called consultants. If Milburn has his way there will be generalist consultants after 5 years PG and specialist consultants after several more years. Fast-track indeed. Another spinning lie from Blair's regime.
More red flagging picks out more consultant anger expressed by their new-style, determined leader, the un-by-lined, Paul Miller on Page 10. I do advise him not to believe government and GPC propaganda that GPs will earn 50% more than consultants. Come on, Paul, we too are working under Milburn and we, too, have a leader trying to sell the contract. Remember that guy called Hawker?
The BMA Poll shows that 77% of the chosen panel believe that losing out of hours will increase retention and recruitment. Maybe it would if it were simply a case of that and nothing else but it ain't! When asked whether it would reduce GP workload the panel is much more unconvinced. 52% saying NO and a further 26% don't know. Pardon me, John Chisholm, but wasn't that one of your main tasks? Even when asked the vital question "Do you think the contract will benefit the profession as a whole?" only 32% thought it would whilst 30% thought not and the final 38% were don't knows. Hardly a ringing endorsement. Let us hope that GPs follow that up by voting NO.
Ian Bogle's missus, Julie Coulsdon is continuing the family business with her on-going efforts, under the skilful guidance of Russell Walshaw, to rejig the BMA. This writer still has very strong reservations that the BMA Chairman's wife should be, in any way, connected with so important a topic. Nevertheless, the topic is important so members should read, digest and respond to what may appear to be some original and not very sensible ideas as they emerge. It's down to you, doctor.
In summary, bmanews has resisted the temptation, as a house magazine, to publish biased GPC opinion about the GP contract. They must have learned bitter lessons from Dr Hawker's experience. Well done. Keep it up. countrydoctor will be watching.
1 March, 2003
As anticipated, this edition is overwhelmed by BMA spin on the new contract. Within the more than usual number of pages the discussion, such as it is, seems to be weighted about 95% in favour, with 5% neutral and none against. However, it is repeated a number of times that the negotiators do not "commend" the contract, they just speak strongly in favour of it. A very nice play on words, worthy of Alan Milburn. This edition of countrydoctor may go some way to redress the balance.
It is difficult this week to comment on each piece, item by item as very many are devoted in one way or another to the new contract but page references may be included for those who wish to return to source.
The lead article urges GPs to judge the contract on its merit and I am sure that they will. Despite promises the contract was not presented last Friday yet the GPC chose to break assurances and to go ahead with its press conferences and LMC conference with an unpriced contract. A propaganda victory was thus handed on a plate to Milburn and he used it well. It appeared as though rather than upset Milburn by cancelling the conference and putting blame where blame lies, the negotiators chose to break promises to 43,000 GPs. There is no shred of an apology for this enormously resented gaffe. Instead the lead chooses to have Chisholm telling GPs and the world "There's a great deal here that is positive". Whilst not commending the contract, of course, or telling of the negative.
What the Lead misses (as it would) is that this contract is not about paying GPs more, not even about improving patient care. They are red herrings. Remember that Milburn has delved minutely into the working of general practice and through this contract made each GP accountable in every aspect if he is to be paid. Remember also that we have a prime minister with a reputation and a secretary of state with an ambition. This contract is about breaking and controlling the profession. All the rest is decoration. It is deeply offensive that the negotiators could not see this before presenting the proscription contract.
A more miserable bunch of toads could not be imagined than the negotiating group heading page 2. And rightly, too, considering how their much vaunted contract and their handling of its revelation has been greeted. The caption says "on the table" but "on the rack" might be more appropriate.
The brief which GPs gave their negotiators was to enhance pay and control work-load and, thus, to aid retention and recruitment. It appears that the new contract may well enhance pay but only if the workload is increased and thus it is likely to fail on the recruitment stakes. As the item on page 2 indicates there has truly been a shake up of the family doctor role. Indeed, so violent a shake-up that it may even be that the family doctor has been liquidised.
If accepted (God help us) the GP's work and pay will be divided into "Normal" services - subdivided into "essential" and "additional"; "Enhanced" services, subdivided into "directed national enhanced", "national enhanced" and "local enhanced"; together with "Quality services" for jumping through a large number of NHS political hoops. Still with me? Well, each of these will account for one third of the GPs pay.
So, all practices will get 1/3 of the notional figure but by working extra hard and not opting out of the few £enhanced" services he is allowed to, he will get another third. The lucky few who have all the staff needed to aid them to jump through the hoops, will be the ones to reach the headline figures mentioned in the press. How much they have achieved will be marked in "points" up to a maximum of 1000 in a year. Verification would be by an annual report scrutinised by a visit from the PCO.
Now this is the really intelligent bit - for Milburn's side - GPs will only get the first third at the beginning of each year but will have to manage to run their practice without it as they wait until the end of the year to get their proportion of the other 2 thirds. And the GP negotiators agreed to that as an improvement for doctors?
It will come as little surprise to some colleagues that Professor Alan Maynard (York University) and his team are deeply involved in deciding the equity of GP work load. Maynard is on record as saying that GPs are workshy and overpaid. Despite this the negotiators accepted the biased wisdom from this source.
An interesting comment on pay rises is given in another piece (page 11) where it is reported that "there are already a number of £100,000 a year GPs - and the rest should not get their hopes up".
On page 3, however, the commentary still focusses on the good bits such as that some GPs will have a pay rise of 50% (if they jump through all the hoops). Some of this income should be put aside for early funeral expenses. Another supposed good bit is that the resources to primary care will/may rise by 33% over 3 years. That includes GP pay and all the additional expenses of staff etc needed to jump the hoops, so how much will be left for the GP pocket?
Failures are mentioned briefly. The most notable of these is on pensions. There was a promise from the negotiators that without a satisfactory agreement on pensions there would be no contract. They have avoided that one by caving in and agreeing to the government's position, so they cannot be said to have broken their word.
Small practices are left out in the cold because government failed to accept the reality that a small practice takes proportionately more resources to run it than a large one. The result will be that small practices cannot expect to achieve much from the contract.
On page 4, Dr Chisholm assures readers that there will be a boost for patients. Not if GPs continue to retire early and this contract may do little to prevent that. However, superficially it is a contract for patients and for a few doctors in large practices.
Dissenting GPs have been given a preview of how GPC will seek to get of the hook of a NO vote. The typical, well-rehearsed, gutless, spineless and contemptible BMA/GPC excuse will be along the lines given on page 6:
"A NO vote from GPs to put alongside the consultants' rejection of their contract last year and it would not be such a hard task to blame NHS collapse on the medics"
It was voiced at last week's LMC Conference and you can bet your boots that it will be well used in the future before voting is over..
These people should realise that they are the doctors' trade union not the NHS or the patients' trade union and if they don't like they should get out. Indeed, many medical commentators have suggested that already. This is a bad contract, a controlling contract and gives little in exchange for GP freedom. countrydoctor urges colleagues to reject it and Vote NO.
But watch the roadshows. Dr Fradd promises, once again, in bmanews that they will "present" not "sell" the contract. There is a narrow line. Let them not cross it.
countrydoctor regrets the need to concentrate on the important issue of the GP contract exclusively. There were a number of other meaty subjects discussed in a very fat 24 page issue. If you have a copy, you will find some interesting, according to your taste.
The contract, in full, is on the BMA website.