With impending industrial action and the influx of newly qualified GPs into a nearly non-existent job market, Dr Burnt Out discusses the importance of August for the future of general practice
The first two weeks of August are going to be interesting.
Firstly, it is looking like thousands of newly qualified GPs will find that there are no jobs for them. This could, and should, be headline news and, if correctly termed, a ‘scandal.’ If what the BMA predicts in terms of possible GP unemployment is remotely true, then it is a time for some serious soul-searching and apologies by all manner of GP and NHS bodies.
It will be a profound betrayal of young, newly qualified GPs, who have had to train for many years, doing many rigorous and expensive exams – only to find that they are unemployed and have been replaced by cheaper and less qualified non-medical staff. I hear many are already emigrating or leaving the NHS entirely. This situation is, as far as I am aware, unprecedented, so all bets are off as to how it will pan out.
Secondly, early August is the proposed date of BMA led industrial action. But let’s face it; it will be voted through and it will happen, with various selections from the ‘menu’ of options that the BMA has devised (I’ll have the steak please, medium rare, followed by the crème brûlée.)
This step is understandable. The behaviour of primary care leaders at NHS England (GPs themselves mainly) is inexplicable: Why not include GPs in ARRS funding? Why not transfer the ARRS funding into core funding? Why continue to promote and ingrain ARRS staff when clearly most of the public want to see GPs? Why tolerate and not speak out about unemployment amongst your own fellow GP colleagues?
It is almost as if NHSE England has hunkered down into non-listening mode, gone out on the razzle, ended up in a dodgy nightclub, had one too many Carlsberg Special brews, got beaten up (or possibly beaten someone else up) and then come home in the early hours singing My Way (the Sid Vicious version) from the top of the stairs, before slamming the bedroom door shut in a fit of rage. (Incidentally, I would rate the Sid Vicious version of My Way joint best hit single of 1978 along with ABBA’s Take a Chance on Me).
With industrial action, unlike newly qualified GP unemployment, there is both national and international precedent. The junior doctor strikes have been well documented and debated, and still seem far from resolution. The latest round of strikes concluded only this week. Junior doctors are also threatening winter strikes if a new government rejects the 35% pay rise.
Don’t get me wrong – I support the junior doctors bar one thing: Strikes rarely work. And they definitely don’t work if the general public is not on your side. What usually works is skilled and extremely tactical and clever negotiation.
One example of this is the current South Korean Doctors’ Strike. This has been ongoing since February, when doctors expressed dissatisfaction with the announcement of new government policies significantly increasing medical student quotas. The 11,994 striking doctors (who make up 93% of the trainee workforce) claim the recruitment of 2000 extra trainees a year will compromise the quality of services. Instead, they have called for improvements to pay and conditions.
However, the situation has now descended into considerable acrimony. The South Korean government has started taking steps to suspend the medical licences of thousands of the striking doctors. Neither the public nor the media seem to be on the doctors’ side, with an editorial in a national paper saying: ‘People’s patience is wearing thin…the exit from this quagmire must be found between dialogue between the two sides.’
Furthermore, a poll by the Yonhap news agency found that 84% of the public supported the government stance of hiring more doctors, and 43% thought that the striking doctors should receive severe punishments. So, it is safe to say that the strikes in South Korea do not seem to be working.
Back to the first few weeks of August: this could be the start of an especially tumultuous time in general practice. We will see how industrial action pans out. I am, however, more concerned about the future of a profession where huge numbers of newly qualified GPs cannot find a job. It almost seems to call into question the longevity of doctors becoming GPs as a long-term career option: will GPs even exist in a few years? This seems the pertinent and terrifying question that we now have before us.
Good article. As GP principal numbers decline and become a smaller percentage than salaried and sessional GPs, and as the NHS is in the powerful position of being a monopsony employer, and as it seems corporates will be taking over contracts via APMS, then the future is a fully salaried GP service.
GP contractor comments in Pulse over the last 6 months (if they’re representative) and articles re BMA GPCE “strategy” just expose the weakness of GP contractors’ position. The Labour Govt will soon declare a National NHS Emergency following BMA industrial “action” in August, and this’ll allow them to force through a new GP contract, with full public backing, to nationalise general practice (something that wasn’t done in 1948).
Too little, too late – the clueless BMA. Should have rejected the 2004 contract which opened the doors to a salaried service, instead of falling again for being stuffed on temporarily increased profits, and thus prevented the decline and fragmentation followed by 14 years of Tory rule and right-wing press which with intention reduced GPs to weeping and general practice to rubble…sorry for the bleak assessment.
But hopefully, the future will be brighter.
Sorry STBFA it wasn’t “the clueless BMA” that voted through the 2004 contract it was a vote by the whole profession which voted 79% in favour. It’s important not to stand on the sidelines and groan about yesterday but to make your voice heard in the here
and now. And take action for tomorrow not just today.
The 2004 contract opened the door wide open to greed. The then labour government assumed that doctors are good and selfless people….ta daaaaa
FW, you were in the GPC so you should know the BMA, which is supposed to advise and represent us, was clueless in telling us that the 2004 contract was the best we could get, and also that it failed to advise us against it foreseeing its potential to privatise and fragment general practice. Many GPs voted for it under duress. So by being clueless in its role, the BMA is surely partly accountable for the dire state general practice is in. You can’t lay everything at the feet of successive Govts.
And glibly advising “making your voice heard” is like whispering to terrified lambs to bleat away as that’ll keep the ravenous wolf from devouring them this time..
Hot tip, we lose, Govt wins, BMA shrugs and keeps collecting subs. But hopefully, eventually, the public again get a decent GP service.
I’m a GP who worked in NHS as a GP for about 18yrs but now work in Australia but am visiting the uk at the moment and checking out the job market with a view to returning to the NHS in the next few months for family reasons, for a period of time , possibly long term , but it’s pretty clear I am far more in demand in Australia and getting an equivalent job back in the uk is pretty unlikely to say the least! Even the locum agencies are telling me not to risk it ! My family probably can’t quite believe that given the universal frustration out there trying to see a GP that there aren’t 1000’s of GP vacancies out there ! They probably think I just want to make excuses to stay in Australia but it’s looking a lot more tricky than I thought!
I read the final few lines of the article which timidly suggest the future might be one where being a GP simply isn’t a thing, feeling a bit confused. Why so timid? Hell yes this is exactly what is currently happening. Right now. The last few months, the last couple of years. The GP role as something done by a generalist Dr is on its way out..TODAY. Going salaried just makes it all so much easier. A salaried employee is grunt. Fill the posts with associates, Drs with registration and a medical degree. Pay them pea nuts. Get all the super routine stuff done by paramedics. This is the model. This is it. It is here TODAY. It isnt a weird far off possibility. Its the current model being rolled out everywhere the minute your practice goes under and is bought up by the guys offering all the shite jobs nobody wants on BMJ careers ..take a look.
Absolutely AB – it is already here. No future in general practice now – just hope it can last me till retirement. Will be awful loss to the health service and patients alike.
The people who voted in the 2004 contract did very well off it. Now they have left a huge mess behind for someone else to clean up
We are a successful, medium sized training practice. In the past we have had over 100 applicants when we have advertised for the post of salaried doctor. After 3 months of advertising we have had 2 doctors apply. One lives over 100 miles away.
I don’t believe there will be thousands of newly qualified GPs looking for work in General Practice. The work is unappealing. It is a hard and relentless grind. There are rewards-but not enough. I think the generation coming through want to earn as much as they can with the least amount of stress. I don’t blame them. The out of hours providers provide plenty of work (including in hours). General Practice is in decline. The demand is increasing. The resources are dwindling. There is financial risk. The job is exhausting.
I have a few years left. My children have been encouraged to follow a different pathway. I’m puzzled by how many GPs have encouraged their children to pursue a career in medicine.
Today is Tuesday. According to the newspapers and TV I might be going on strike on Thursday.
My staff and patients have asked me what the plan is.
Does anyone have any clue about what is going on?
This is a farce.
Re Yes Man———been saying this for years