Why GPs are leaving the NHS
For the last few years the medical profession have been the main opposition to NHS privatisation - b
By Jonn Elledge Published 18 November 2008
Last summer, after nearly a decade of training, Dr Jayne Graham qualified as a GP. She's spent the last three years at an NHS practice in a deprived part of South London, and had planned to stay there. Today, however, she's working for a private clinic in affluent Kent.
Dr Graham - not her real name - hasn't joined the dark side because of some damascene conversion to the superiority of private medicine. Instead, like hundreds of her colleagues, she simply found that the NHS didn’t have enough jobs to go round.
"This isn't at all why I wanted to be a GP, but I’ve got to pay my mortgage," she says. "I believe patients should be treated based on need. But I’m giving out private treatment because I have no other option."
She's not alone. Nationwide, the number of advertised vacancies for GPs has dropped by as much as 70 per cent in the last year. The BMA estimates that 1,000 of this year's crop of graduates – around a third - will struggle to find work.
As a result, young doctors are grabbing any work that's going. Some are working part-time; others as locums, doing the medical equivalent of temping. At least one is driving a London taxi. Others still, with £60k of debt and a quarter of a million pounds worth of training behind them, are doing precisely nothing.
The most worrying contingent, though, are those like Dr Graham who have left the NHS altogether. Several of her colleagues have already made the move ("Where else are they going to go?" she asks, pointedly).
Plenty more are considering it. In 2006, a survey by medical newspaper GP found that less than a third of young doctors would work in the private sector. Last July, when it repeated the exercise, that number was more than half. One of the younger BMA reps says that many of her colleagues are setting up private pensions, "because they don't think the NHS is even going to be their main employer any more."
Comments like this may surprise those who still tremble with rage over six figure pay packets for doctors.
In fact, those are a big part of the problem. The contract that created them works on the basis that the partners in each GP practice split its profits. This, it turns out, is a big incentive not to bring in any more partners. The GPs, of course, place the blame squarely on the government’s refusal to increase funding for the last three years, in an attempt to claw back the embarrassingly huge pay rise of 2004.
But while the BMA and the government have been busy blaming each other, the private sector’s been cashing in. For the last few years the medical profession have been the main opposition to NHS privatisation, leaving business to grumble about medical protectionism. Now, though, companies are scheming to bring doctors on board with cushy pay and conditions. US giant UnitedHealth Europe is offering terms so generous they get praised to the heavens at conferences. Virgin Healthcare is going one better, allowing GPs to keep their NHS status, but co-opting them to the Branson brand so that it can flog private health and dental services to those with spare cash and no patience.
The doomsday scenario here is that general practice could go the way of dentistry, where it’s now all but impossible to get NHS treatment in some parts of the country. Dr Alex Smallwood, who represents GP trainees at the BMA, warns that, if the situation isn’t resolved soon, we’ll "hit a bubble down the line when GPs have all gone private, and there aren't enough to staff the NHS."
That’s unlikely. What’s more probable is that one of the last barriers to the commercialisation of the NHS will start to break down. The more GPs who take private jobs, and discover they aren’t so bad, the more likely the profession will be to rethink its stance on private healthcare.
It's unclear how to solve this mess. The BMA, which has spent much of the last year denying there's a problem, now says it's working on proposals to encourage practices to create jobs. But while its head GP, Dr Laurence Buckman, admits it’s "a very dangerous situation," he adds, "We can't take any concrete steps because GPs are independent contractors". Meanwhile the government gets what it wanted all along: a more competitive NHS, and a way of putting downward pressure on GP salaries.
Whatever happens, things will likely get worse before they get better: the number of GPs being trained up is increasing by 400 next year. Dr Graham won’t be the last doctor who goes private.
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6 comments
It is a very sad situation, these doctors study for years to do something they are passionate about. Then they can't find jobs in that field. The NHS is slowly becoming worse by the day. It will be sad to loose all the great UK doctors to overseas countrys, the goverment need to do something about it.
As a newly qualified GP I agree with the themes
contained in this article. Opportunities for young GP's
are quite limited at present. A search of the journals
reveals that most vacancies are salaried posts as
opposed to lucrative partnerships. Within my recently
qualified training scheme only 2 out of 20 trainees
have secured full time employment. Locuming may be
lucrative but is not a viable long term prospect.
Unfortunately at present, GP partners do not have an
incentive to expand list sizes and to bring in equity
partners. The situation will only worsen as there are
now a glut of doctors entering general practice
because of the recent modernising medical careers
fiasco. I have a number of colleagues who wished to
pursue careers in surgery and medicine who were
unable to do so due to decreasing numbers of training
posts. These doctors have now entered general
practice because of low moral in secondary care. I
wonder what they will think when they qualify as GP;s
in the current climate? A number of my peers are
seriously considering moving abroad to Australia or
New Zealand where are qualifications are recognised
and we are able to work pretty much straightaway. It
seems a shame that those who wish to work here are
now migrating to the private sector, which goes
against the very ethos of the NHS we wish to work for.
Tam Tam: "The NHS is slowly becoming worse by the day. It will be sad to loose all the great UK doctors to overseas country..."
There are plenty of jobs in countries like Australia which have managed to manufacture a doctor shortage for themselves through their own version of short-sightedness and government incompetence. The only thing is that they have some other serious problems there too.
From the AMA - "Victoria’s health system is in crisis, with major and ongoing challenges to recruit and retain a medical workforce. We need more doctors..." but there is a problem - no-one is happy working there! http://doctors4hospitals.com.au/
One of the reasons was that former AMA president Indian doctor Mukesh Haikerwal was recently attacked in the street and now has serious head injuries. There have been a number of attacks on South Asian and East Asian tourists and students at night http://www.theage.com.au/national/bashed-doctors-prognosis-positive-2008...
But perhaps the real problem in Britain has been the preoccupation with some in the medical profession desperately attacking other NHS-funded health modalities such as chiropractic and homeopathy but failing to address putting their own house in order? And are patients really happy with what GP's and their health system have to offer these days anyway?
Freedom Land- I can give you unquestionable proof
that the fast majority of people are happy with the
services that there GP surgeries offer, Have you ever
heard of patient satisfaction surveys? Well they exist
and a practices performance links directly with its
funding. A survey earlier this year showed that over 80
per cent of people were happy with their practice.
There was also recently a well promoted "save our
surgeries" campaign which attracted over 1million
signatures in barely a few weeks. I think that the
recent attacks on the profession of general practice
through a coordinated media frenzy have lowered
moral considerably and have irreversibly damaged
GP trust in the government. As far as I am aware also
chiropractic and homeopathy are for the most part
unavailable on the NHS ( certainly this has to be self
funded in my area). The reason for this is based upon
evidence and cost implications ( although I personally
have found chiropractic to be very effective and would
not hesitate to offer this to a patient of mine with lower
back pains). I think you have missed the point of the
article and of Tams Tams claim that the nhs is
worsening by the day. There are many causes that
people recognise as being responsible for a poorer
NHS, such as car park charges for the sick, massively
indebted PFI projects that our children will pay for, the
fact that under this government there are "more
beurocrats than beds". However, let us also remember
the achievements for which we can be proud, such in
most cases the selfless dedication of our frontline
health workers, whose goodwill is slowly being
undermined by the centralisation of management
structure and ethos of private sector. It is not only GP's
who are leaving the NHS in droves, I know of many
nurses, radiographers, physiotherapists , chiropodists,
dentists, dieticians and even consultants in hospitals
who have left to work privately or emigrated. What a
waste of resources, when we pay to train them.
"...I think you have missed the point..."
A Billon, I think the point is to add to this rather short topic piece. You are doing that quite well yourself but you seem distracted with one of my statements.
My main point was that the administrative incompetence and short-sightedness is as widespread as the current economic/financial crisis. That is, there is hardly anywhere in the world one can go to escape it, especially in the English-speaking world. I also mentioned other hazards overseas to be wary of in white racist communities.
Thus the problem has't really anything to do with "private medicine" as practiced by GP's. They shouldn't feel guilty about having to retreat to private practice and the patients they see there are as deserving of their care anyway. But the medical system itself has certain shortcomings that it will not survive. One is its expense as a "Rolls Royce" model and its failures in addressing functional conditions before they lead on to chronic illnesses.
And, of course, as long as doctors are in denial of their own stressful workloads, they will also tend to ignore such symptoms in their patients or fail to address them adequately. This, too, is part of the overall agenda which now MUST be finally addressed by practitioners of all disciplines or they will see an endless continuation of doctor suicides and, as we know, especially amongst women practitioners. So kindly give up hiding behind the naivety of patient surveys and accept that stress kills. So also does the consequent depression.
this is too good
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Smith
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