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Why GPs are leaving the NHS

For the last few years the medical profession have been the main opposition to NHS privatisation - b

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.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.

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“The guards WANT you to mess up”: meet the prison wives of Instagram

How memes featuring Disney Princesses, Spongebob Squarepants, and saggy jeans have empowered women with incarcerated partners.

During a recent trip to visit her boyfriend in federal prison, 27-year-old Makenzie wore a floor-length black skirt and a grey shirt that completely covered the top half of her body. After a brief inspection, the guard on duty deemed her outfit appropriate and waved her through, and she was able to spend a happy eight hours with her incarcerated boyfriend and her six-year-old daughter. The next day, she came back to visit again.

“I wore the exact same outfit the second day of visitation because I didn’t want to fight with the guards about any other clothing,” says Makenzie, who had to drive five hours out of her home state, Texas, in order to visit her partner. “I was sent away by a guard who had seen me the day before.”

Makenzie felt “belittled and humiliated” by the guard, who forced her to go to the nearest shop to buy a new shirt. “I wore the exact same outfit down to my shoes and earrings,” she explains. When she confronted the guard, Makenzie says he said: “I honestly don’t care.

“All I’m telling you today is you’re not going in there dressed like that.”

Being a “prison wife” can be isolating and confusing. When wives and girlfriends first go to visit their newly-incarcerated partners, the rules and regulations can be overwhelming. When visiting her boyfriend, Makenzie has to place her money in a clear plastic bag, go through a metal detector before a smaller metal detector is used on her feet, and be patted down by guards. If her clothing is too loose or too tight, she is sent home.

“The guards WANT you to mess up,” Makenzie tells me over email, emphasis hers. “They want to make you mad, make you get in trouble.” For wives and girlfriends isolated by these experiences, the internet has become a haven.

***

Makenzie’s Instagram account has 1,123 followers. Under the handle “Texas Prison Wives”, she has been posting memes, photographs, and advice posts for five years. After incidents like the one above, Makenzie can use her account to vent or warn other wives about changes in clothing rules. Followers can also submit text posts to her that she screenshots, overlays on scenic pictures, and publishes anonymously.

One, imposed on a city skyline, asks if anyone wants to carpool to a prison. Another, overlaying a picture of a nude woman, reads: “I’m wondering if I can get some ideas on sexy pics I can take for my man. I’m about 85lbs heavier than I was the last time he saw me naked.”

The prison wives of Instagram recently went viral – but not on their own posts. A Twitter user discovered the community and tweeted out screenshots of prison wife memes – which are formatted with an image and caption like all relatable memes, with the crucial difference being that not many of us can actually relate.

“The life that we live is not widely accepted by families, friends, and the general outside world because people hear ‘inmate’ and automatically assume the worst,” says Makenzie, whose boyfriend was sentenced to two fifteen year sentences for drug possession.

“This account has given women a safe space and anonymity to seek personal advice, ask questions, and seek other women within their area if they want to reach out.” Her account, Makenzie says, also allows prison wives to laugh during tough times. She both makes her own memes and shares those from similar accounts. One, from May 2016, features a collage of four celebrities rolling their eyes. The caption reads: “When you hear ‘Babe, we are going on lock down again…’”

To outside eyes, some prison wife memes can seem flippant or – to those who retweeted the viral tweet – laughable. “My Life As A Prison Wife” is an account with over 12,000 followers that posts a wide array of memes, often using stills from Disney movies to portray emotions. A post featuring an image of a crying Belle – from Beauty and the Beast –  is captioned “that feeling when… when your visits get suspended”. Yet though many online criticise what they see as the glorification or normalisation of a life choice they don’t agree with, Makenzie emphasises that memes – especially funny ones – are important.

“I think it’s fun to have so many people relate to funny memes even though the direct meaning behind it is about being lonely or the hard things we go through to make this relationship work,” she explains. “It’s a reminder we aren’t alone in our struggle and we can laugh through the pain.”

Jemma, a 22-year-old from London who runs an account called “Doing time too”, concurs. Her profile – which has 1,369 followers – showcases memes featuring puppies, Disney princesses, and stills from Spongebob Squarepants.“I'm sure ordinary members of the public would disagree with our light-hearted way of looking at our loved ones being in prison and I would totally understand that,” she says – also over email.

 

HAPPY VALENTINE'S DAY LADIES  #prisonwife #prisonwifelife #doingtimetoo #inmatelove

A post shared by doing time too (@doingtimetoo) on

“Before I was in the situation myself, I would have probably reacted in the same way to an account like the one I now own. But sometimes you end up in situations you never expected to and you deal with things in a way that others won’t understand.”

***

Prison wives don’t use Instagram just for memes. Makenzie’s account helps women in need in an array of ways: they can find out if there have been riots in their partner’s prison; get advice on gifts to send a loved one; and even find out how to appeal sentences. Alongside her Instagram, Jemma also runs a website called www.doingtimetoo.co.uk

Via @TexasPrisonWives

“I started the website because I was in a relationship with someone a couple of years ago who ended up going to prison. It was totally out of the blue for me and something neither of us saw coming,” she says. “I had no idea how to deal with it.” Her site provides information about individual prisons, what to expect from a prison visit, and what to do after release. She also provides tips on how to send creative gifts made out of paper to incarcerated loved ones.

“I believe the internet has been a massive help in supporting prison wives,” says Jemma, who finds most people don’t understand or relate to her situation. Her boyfriend was charged with GBH (grievous bodily harm) and sentenced to two years in prison, after getting into a fight.

Jemma also feels that Instagram can provide prison wives with information that the prisons themselves withhold. “I can't speak for everyone but in my experience, prisons and the visit centres are far from helpful in providing any information, support or advice,” she says. “Sometimes people won’t hear from their husband when they expect to but through interacting with other ‘prison wives’ they may find out that that particular prison is currently on lock down, providing an explanation and reassurance as to why they hadn’t heard from their husband. Without the internet, this wouldn't happen.”

 

Advice! @mothafukn.irvin

A post shared by OFFICIAL N. CALI SUPPORT (@north_cali_prisonwives) on

When Jemma reached out to prison visitor centres in the UK to promote her website to those in need, she never heard back. When she emailed her boyfriend’s visitor centre prior to her first visit to ask what to do, what to wear, and what to expect, she also never received a reply. “There is no communication with family and no support offered… It’s important to remember that the families themselves did nothing wrong or illegal and so don’t deserved to be punished or treated like criminals themselves.” In such circumstances, information shared online is crucial.

Makenzie also believes that the US prison system has it faults when it comes to visitors. “While I know and understand that inmates are being punished for a crime they committed, the guards treat their families disrespectfully and unfairly almost as if we are being punished as well,” she says. “Being a larger woman, I have gotten in trouble for my clothes being too tight AND for my clothes being too loose. It’s a lose-lose situation.”

Makenzie explains that sometimes visitors are forced to wear gowns similar to those worn in hospitals if their clothes are deemed unsuitable. In the past, she has even been sent away to buy a new bra after she wore one without underwire in order to get through the metal detector. In one prison her boyfriend was incarcerated in, visitors had to wait outside to be signed in, one-by-one, regardless of the weather. “We had to wait two hours several times, sweating, drenched in rain, they don’t care…

“The guards degrade your loved ones right in front of your face, they are mean, hateful, and over the top rude, even to the inmates who are the most well behaved and respectful.”

For these women, Instagram has become an invaluable network of support.

***

There are hundreds of Instagram accounts just like Jemma and Makenzie’s. Many often take memes from each other, but Jemma explains there is no competition. In fact, she says, the network is incredibly supportive. “I spoke to one lady regularly about her situation and I remember counting down to her boyfriend’s release date with her,” she says. Jemma and Makenzie also use their accounts to help lonely prisoners find pen pals.

Instagram allows prison wives to find likeminded people, free from judgement. Yet the accounts can also be incredibly informative to outsiders. By using the “When…” format, memes provide a detailed insight into the lives of prison wives. “When you’re kissing baby towards the beginning/end of the visit and the CO yells ‘enough’,” reads one. “When you check your phone and see… not only did you miss 1 call, you missed two,” is the caption on an image of a crying child.

 

A post shared by doing time too (@doingtimetoo) on

“Nobody understands this long distance, no physical intimacy, and then the added stresses of dealing with prison politics, corrupt guards, and the worry of riots, lock downs, and retaliation like women who are living through the same thing,” says Makenzie. Yet thanks to these Instagram accounts, outsiders do have an opportunity to understand.

For prison wives, memes are an easy and fast way to talk about a topic that many deem taboo. The fact that Jemma and Makenzie wished to communicate with me over email, and the fact many more prison wives didn’t want to speak to me at all, shows how difficult it can be to talk about these issues. For many, memes are just a bit of fun. For prison wives, they can be a lifeline.

 

A post shared by doing time too (@doingtimetoo) on

 “None of us enjoy prison visits or being treated like we are criminals ourselves. We don't enjoy waiting for phone calls that never arrive or having to deal with situations all on our own but if we can laugh about it, that’s something,” explains Jemma.

“Memes allow us all to laugh at the situations we are in, rather than cry.”

Amelia Tait is a technology and digital culture writer at the New Statesman.