Will you miss me when I'm gone? Photo: Getty Images
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Without anyone noticing, doctors are leaving the NHS in droves

Increased paperwork, increased hours, and ever more pressure are forcing GPs out of the NHS - either to the private sector, or abroad.  

George Osborne quietly slipped into his budget some news that the medical staff perhaps dreaded, perhaps didn’t even imagine was possible: the public sector pay freeze will continue. For another four years.

I’ll just let that sink in. For months, doctors and nurses have been begging the public and the government to take notice: pressure on the wards is building to dangerous levels. Medical staff are overworked, under-appreciated and underpaid, and now there’s this insult to injury – a further slap in the face from a Chancellor unwilling to reward their graft with a share of the recovery, for which they have already sacrificed so much.

It’s so far from justice, such a total misdirection of priorities, it’s taken this long to process.

The Conservatives are on such a high at the moment that judgement seems to be on hold. Back in April at the health election debate, Jeremy Hunt barely managed to defend the Health and Social Care Act, on which the Conservative government’s entire health record will be judged. But last week he unveiled a policy that could only have made it into the X-rated version of the Health and Social Care Act.

And his explanation for why printing the cost of a prescription, with the words ‘Funded by the taxpayer’ on the box would help patients and not just leave them guilt-ridden as well as sick, was so unconvincingly delivered on Question Time that I doubt it would have had much sway in a sixth-form debating society.

But the really galling moment in the show came when a GP in the audience, flushed with anger, attacked his new deal for General Practice, and pointed out what she and all of her colleagues know: it’s a complete departure from reality.

“It’s just not viable,” she said. “It’s just not common sense. You’re driving us all out of the country Mr Hunt. The day you announced your new deal, many many GPs across this country handed in their notice that day. Do you know that?”

It’s a very good question. I have a feeling there’s a lot Hunt doesn’t know, or want to know. I wonder, if I could carry on the GP’s line of inquiry, whether he knows that in a survey of 15,000 GPs by the BMA’s General Practitioners Committee (GPC), carried out earlier this year, 90% said that unmanageable workloads are damaging the quality of patient care.

In its official response to the New Deal announcement, the BMA said: “Health Secretary's workforce commitments are unlikely to be deliverable in isolation from broader changes in general practice. Unmanageable workloads in the face of increasing patient demand are acting as catalysts for early departure from general practice, and deterring new graduates from entering”.

Hunt dismissed the GP who tried to tell him this truth last night, pointing to his desire to appoint 5,000 more GPs by 2020, rounded off by the put-down, “I thought as a GP you should welcome that”. That’s hardly a surprise – most of the government’s rhetoric on the NHS relies on no awkward interventions from doctors or nurses.

But the facts are on her side. A recent survey carried out by the BMA revealed that one in three GPs is planning to retire in the next five years, and that one in five trainee GPs intends to work abroad when they qualify. All this amid a gruelling period when £22bn worth of cuts have been ordered, a figure Hunt’s former coalition partner Norman Lamb now admits is fantasy.

The New Deal he’s proposing isn’t new, nor does it deal with the workforce crisis. I’m sure Hunt read the transcript of a scathing attack by the chief executive of the BMA, Dr Mark Porter, who branded the New Deal solution as showing “little grasp of reality”.

Speaking at the BMA’s annual representative meeting in Liverpool, Porter said: “How are they even going to recruit more GP trainees when hundreds of existing training posts are still unfilled? They don’t say. When will they provide substance over rhetoric and recycled ideas, to focus on the detail of how they will support GPs already burnt out from overwork, in a service where more than 10,000 GPs are predicted to leave in the next five years? They don’t say."

With recruitment and retention woefully weak, talk of hiring 5,000 more GPs when the existing, maligned workforce is now bracing for four more years of austerity is being seen for what it is: the “pursuit of easy headlines” that Porter slammed in Liverpool.

Only last week I described the split between the reality of what’s going on in nurse staffing, and the government’s own line. I’m afraid Hunt’s New Deal for General Practice, topped off with Osborne’s financial slap-in-the-face, is yet more of the same make-believe.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.

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People are not prepared to see innovation at any price - we need to take care of our digital health

Correcting the course of technology in Britain does not need to mean taking backwards steps and becoming an anti-innovation zone.

As individuals, we have never been better connected. As a society, we are being driven further apart.

Doteveryone’s People Power and Technology report, released this week, found that half of the 2,500 British people we surveyed said the internet had made life a lot better for people like them - but only 12 per cent saw a very positive impact on society.

These findings won’t be news to most people living in Brexit Britain - or to anyone who’s been involved in a spat on Twitter. The fact that we’re constantly connected to our smartphones has not necessarily improved our communities or our understanding of one other, and the trails of data we’re leaving behind are not turning into closer social bonds.

Many of the positives we experience are for ourselves as individuals.

Lots of consumer tech puts simple self-sufficiency first - one-click to buy, swipe right to date - giving us a feeling of cosy isolation and making one little phone an everywhere. This powerful individualism is a feature of all of the big platforms - and even social networks like Facebook and Twitter, that are meant bring us together, do so in the context of personalised recommendations and algorithmically ordered timelines.

We are all the centre of our own digital worlds. So it is no surprise that when we do look up from our phones, we feel concerned about the impact on society. Our research findings articulate the dilemma we face: do we do the thing that is easiest for us, or the one that is better for society?

For instance, 78 per cent of people see the Internet as helping us to communicate better, but 68 per cent also feel it makes us less likely to speak to each other face-to-face. 69per cent think the internet helps businesses to sell their products and services, while 53 per cent think it forces local shops to compete against larger companies online.

It’s often hard to see the causality in these trade-offs. At what point does my online shopping tip my high street into decline? When do I notice that I’ve joined another WhatsApp group but haven’t said hello to my neighbour?

When given clear choices, the public was clear in its response.  

We asked how they would feel if an online retailer offered free one-day delivery for lower income families, but this resulted in local shops closing down - 69 per cent found this unacceptable. Or if their bank invested more in combating fraud and cyber crime, but closed their local branch - 61 per cent said it was unacceptable. Or if their council made savings by putting services online and cut council tax as a result, but some people would find it hard to access these services - 56 per cent found it unacceptable.

It seems people are not prepared to see innovation at any price - and not at the expense of their local communities. The poorest find these trade offs least acceptable.

Correcting the course of technology in Britain does not need to mean taking backwards steps and becoming an anti-innovation zone.

A clearer regulatory environment would support positive, responsible change that supports our society, not just the ambition of a few corporations.

Some clarity about our relationship with web services would be a good start. 60 per cent of people Doteveryone spoke to believed there should be an independent body they can turn to when things go wrong online; 89 per cent would like terms and conditions to be clearer, and 47% feel they have no choice but to sign up to services, even when they have concerns.

Technology regulation is complicated and fragmentary. Ofcom and the under-resourced Information Commissioner’s Office, provide some answers,but they are not sufficient to regulate the myriad effects of social media, let alone the changes that new technologies like self-driving cars will bring. There needs to be a revolution in government, but at present as consumers and citizens we can’t advocate for that. We need a body that represents us, listens to our concern and gives us a voice.

And the British public also needs to feel empowered, so we can all make better choices - adults and children alike need different kinds of understanding and capability to navigate the digital world. It is not about being able to code: it is about being able to cope.

Public Health England exists to protect and improve the nation’s health and well-being, and reduce health inequalities. Perhaps we need a digital equivalent, to protect and improve our digital health and well-being, and reduce digital inequalities.

As a society, we should not have to continually respond and adapt to the demands of the big corporations: we should also make demands of them - and we need confidence, a voice, and representation to begin to do that.

Rachel Coldicutt is chief executive of Doteveryone.