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Post by gwynthegriff on Apr 14, 2021 21:46:12 GMT
But many patients really don't like these larger practices where they end up seeing a different doctor every time. And if they have ended up there by default it's going to cause some irritation We have used a large practice for 20 years or more and have (until recently) had no great difficulty in seeing "our" doctor on most occasions.
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Post by gwynthegriff on Apr 14, 2021 22:00:31 GMT
Consumer preference can sometimes be suboptimal, and is susceptible to influence by often invented "tradition", in this case nostalgia for the friendly neighbourhood GP with the personal touch, who would pay a house call at the drop of a hat and prescribe aspirin for everything. Thanks, but I'll have my local health centre-based doctors anytime. Both models have their advantages and disadvantages. But the crux is that, for all sorts of reasons, the old-style small practice is not going to return.
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Eastwood
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Post by Eastwood on Apr 14, 2021 23:39:16 GMT
Ultimately the problem is that not enough doctors wish to become GPs, and that those who do do not particular want to be partners in a practice. It doesn't matter if there's a demand for traditional GP practices if the supply isn't there. Well that's part of it. The fact there is a shortage of GPs means that those who are coming through can choose what model they prefer. But the evidence is not entirely against a desire for partnerships (although more do want salaried positions these days). Things newly qualified GPs don't want: - High buy in fees
- Insecurity in future of practice (i.e. don't want to join a partnership with lots of ageing partners)
- Difficulty securing holiday cover (easier if holidays covered within practice than by hiring in locums)
- Dealing with HR / Admin excessively (GPs in smaller practices tend to have less admin / Practice manager support)
- Time spent in non clinical commitments (GPs in smaller practices will have to shoulder more of the non clinical burden).
Succession planning for successful GP partnerships needs to actively address these issues by: - Disposing of buildings. Either moving into shared facilities or by actively selling their existing building and leasing back. This reduces buy in fees dramatically
- Mentoring GP Trainees to keep young blood in the practice and help recruitment
- Merging practices / expanding in growing areas. 5-6 FTE GPs is the minimum I'd want for a sustainable practice allowing for Holidays / Sick Leave / Maternity / Retirement etc
- Good practice manager and allied professions presence in surgery
- Expert GP Business Planning advice
And they need to start doing those things 10 years in advance of any retirement bulges. Practices who just coast along assuming they'll recruit when the current partners retire end up in the classic cycle of locums and handing back services as happened in this case. The time to save the practice was probably 10 years prior to it closing.
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Post by Daft H'a'porth A'peth A'pith on Apr 15, 2021 5:29:58 GMT
I think people with long term heath conditions probably do benefit from seeing the same doctor. If you have a complex medical history, seeing someone who is used to you and you are used to probably helps. Similarly for people who have difficulties communicating for one reason or another.
Exactly.
Unfortunately the fact that doctors prime customer is now Covid not people, means that even such customers have been deprioritised.
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Post by Daft H'a'porth A'peth A'pith on Apr 15, 2021 5:33:05 GMT
Ultimately the problem is that not enough doctors wish to become GPs, and that those who do do not particular want to be partners in a practice. It doesn't matter if there's a demand for traditional GP practices if the supply isn't there. Well that's part of it. The fact there is a shortage of GPs means that those who are coming through can choose what model they prefer. But the evidence is not entirely against a desire for partnerships (although more do want salaried positions these days). Things newly qualified GPs don't want: - High buy in fees
- Insecurity in future of practice (i.e. don't want to join a partnership with lots of ageing partners)
- Difficulty securing holiday cover (easier if holidays covered within practice than by hiring in locums)
- Dealing with HR / Admin excessively (GPs in smaller practices tend to have less admin / Practice manager support)
- Time spent in non clinical commitments (GPs in smaller practices will have to shoulder more of the non clinical burden).
Succession planning for successful GP partnerships needs to actively address these issues by: - Disposing of buildings. Either moving into shared facilities or by actively selling their existing building and leasing back. This reduces buy in fees dramatically
- Mentoring GP Trainees to keep young blood in the practice and help recruitment
- Merging practices / expanding in growing areas. 5-6 FTE GPs is the minimum I'd want for a sustainable practice allowing for Holidays / Sick Leave / Maternity / Retirement etc
- Good practice manager and allied professions presence in surgery
- Expert GP Business Planning advice
And they need to start doing those things 10 years in advance of any retirement bulges. Practices who just coast along assuming they'll recruit when the current partners retire end up in the classic cycle of locums and handing back services as happened in this case. The time to save the practice was probably 10 years prior to it closing.
In other words despite what we are taught at school, health was never nationlised in the UK in the 1940s, just changed to being run as a private concern on national basis.
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Post by Daft H'a'porth A'peth A'pith on Apr 15, 2021 5:34:53 GMT
I think the core point you make is 'what consumers prefer is irrelevant'. Is that 'progress'? What consumers prefer is irrelevant if no producer is willing or able to deliver it. You might want to plant your roses in Unicorn dung but you'll just have to make do with horse shit!
So why is there a limit to medical places at university if the demand for more GPs is there?
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timmullen1
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Post by timmullen1 on Apr 15, 2021 7:19:06 GMT
What consumers prefer is irrelevant if no producer is willing or able to deliver it. You might want to plant your roses in Unicorn dung but you'll just have to make do with horse shit!
So why is there a limit to medical places at university if the demand for more GPs is there?
Because you don’t choose a speciality until your second or third year at Med School, and other areas of medicine, what my cousin, who’s supposed to be a lecturer at Leeds Med School but has spent most of last year on the Covid unit at Leeds Royal, calls the “glamour specialities” of oncology and cardiology are packed to the gunnels. He only has twelve students on his dentistry course, ten of whom are overseas students who don’t have any intention to practice in the UK after graduation. For the last half dozen years the government have been actively trying to persuading people to switch to other specialities, including General Practice.
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Eastwood
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Post by Eastwood on Apr 15, 2021 7:20:58 GMT
What consumers prefer is irrelevant if no producer is willing or able to deliver it. You might want to plant your roses in Unicorn dung but you'll just have to make do with horse shit!
So why is there a limit to medical places at university if the demand for more GPs is there?
It’s expensive to train Doctors at University and you need to predict your workforce requirement 10-15 years in advance by the time you factor in postgraduate training. More spaces at UK medical schools would be a sensible but expensive policy intervention but it doesn’t pay off for 10-15 years. This was actually one thing the Blair government did well - Brighton, UEA, Hull, Keele, Lancaster, Warwick, York, Exeter, Swansea - all established new medical schools 2000-2004. But those doctors don’t feed into the GP workforce until 2010-2019 long after those spending decisions are made. Medicine like other high skill, high demand professions also has a global employee marketplace. So training enough doctors in the UK is not enough to guarantee they will all work in the UK post graduation. Sometimes people propose enforcing a work in the NHS clause (indentured labour?) but even if this is for 5-10 years that mainly covers the training years and isn’t going to make a substantive difference as it would just breed resentment and see people leave at the end of their lock-in. Pay and conditions need to be right to balance the offers available elsewhere in the world. Doctors I knew at University work all over the world from USA, NZ, Malawi, Italy, Sweden, Australia, Hong Kong, Qatar etc etc. The Cameron government in particular made big efforts to piss off doctors. Brexit isn’t helpful in the short term though points based immigration can be a lever in future. There is no simple answer!
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Post by East Anglian Lefty on Apr 15, 2021 9:12:00 GMT
Legally I can't see how you'd impose a requirement to work for the NHS. You can't stop people from moving abroad, or from deciding they want to change career, or from having a medical issue that means they can't work any more.
There's a similar issue but more severe issue with retention of newly qualified teachers, which I'm always surprised doesn't get more attention given the cost of training. But ultimately the way you solve that issue is to make sure people do not want to leave the profession - reaching for coercive measures just suggests you don't have any ideas about how to persuade them.
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mboy
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Post by mboy on Apr 15, 2021 9:16:28 GMT
How about cancelling outstanding tuition fees for all (UK) students who stay in medicine in the UK for a decade after qualifying?
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Khunanup
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Portsmouth Liberal Democrats
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Post by Khunanup on Apr 15, 2021 10:29:59 GMT
How about cancelling outstanding tuition fees for all (UK) students who stay in medicine in the UK for a decade after qualifying? It's no incentive though seeing as it's essentially a graduate tax anyway that on a doctor's salary is still hardly anything a month. More to the point, where's the fairness? Most people who graduate from British universities work most, if not all their working lives in the UK, many of which in jobs of great social value. Why should relatively well paid doctors get let off their fees while relatively poor paid social workers (for which recruitment is very hard) or charity workers etc have to pay off all their fees, including graduate fees in many cases (necessary for some jobs) that are uncapped? Incentivise people for doing the job, not retrospectively discriminate against other groups for not doing them. It ultimately doesn't deal with the problem, it promotes gaming the system and neglects the fundamental underpinning of why we have the recruitment and retention problem in the first place.
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mboy
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Post by mboy on Apr 15, 2021 10:52:40 GMT
Those are fair points, but really the only way to incentivise the job more is to pay it *even* more money than now, which yet again just rewards already "well paid doctors".
I know more doctors are going part-time to try to deal with the ridiculous hours they already work. Perhaps formalising that is an option.
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J.G.Harston
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Post by J.G.Harston on Apr 15, 2021 11:54:34 GMT
What consumers prefer is irrelevant if no producer is willing or able to deliver it. You might want to plant your roses in Unicorn dung but you'll just have to make do with horse shit!
So why is there a limit to medical places at university if the demand for more GPs is there?
The "pool of labour" issue I mentioned in the social care/shelf stacking thread. By limiting the pool of labour, the workers control the conditions. "Pay us what we want, or we'll walk, there's nobody to replace us." Increase the pool of labour and the employers control the conditions. "Bugger off then, there's a queue of replacements."
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Post by 🏴☠️ Neath West 🏴☠️ on Apr 15, 2021 12:09:50 GMT
Legally I can't see how you'd impose a requirement to work for the NHS. You can't stop people from moving abroad, or from deciding they want to change career, or from having a medical issue that means they can't work any more. There's a similar issue but more severe issue with retention of newly qualified teachers, which I'm always surprised doesn't get more attention given the cost of training. But ultimately the way you solve that issue is to make sure people do not want to leave the profession - reaching for coercive measures just suggests you don't have any ideas about how to persuade them. It's been done by your comrades in Wales. How they structured it was as a bursary that you would have to pay back if you did not work in NHS Wales for two years after qualifying. They then set up a scheme called "Streamlining" to appoint graduands to vacancies. I don't know how they deal with people who are medically incapacitated, but if you choose to emigrate or change career, you get landed with a huge bill.
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Merseymike
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Post by Merseymike on Apr 15, 2021 12:33:27 GMT
Legally I can't see how you'd impose a requirement to work for the NHS. You can't stop people from moving abroad, or from deciding they want to change career, or from having a medical issue that means they can't work any more. There's a similar issue but more severe issue with retention of newly qualified teachers, which I'm always surprised doesn't get more attention given the cost of training. But ultimately the way you solve that issue is to make sure people do not want to leave the profession - reaching for coercive measures just suggests you don't have any ideas about how to persuade them. Easy. They have to pay back the full rates of all tuition and as medicine and dentistry does have connections between countries in terms of professional registration monies owing can be pursued in terms of their ability to practice. That would be my solution - 5 years in the NHS or if you wish to opt out of that you are responsible for the full whack of course fees.
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Post by Daft H'a'porth A'peth A'pith on Apr 15, 2021 15:07:48 GMT
If there is a shortage of GPs how come the saleries are not higher than in more competative areas, as a true market of supply and demand should dictate.
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Post by East Anglian Lefty on Apr 15, 2021 16:56:02 GMT
Legally I can't see how you'd impose a requirement to work for the NHS. You can't stop people from moving abroad, or from deciding they want to change career, or from having a medical issue that means they can't work any more. There's a similar issue but more severe issue with retention of newly qualified teachers, which I'm always surprised doesn't get more attention given the cost of training. But ultimately the way you solve that issue is to make sure people do not want to leave the profession - reaching for coercive measures just suggests you don't have any ideas about how to persuade them. It's been done by your comrades in Wales. How they structured it was as a bursary that you would have to pay back if you did not work in NHS Wales for two years after qualifying. They then set up a scheme called "Streamlining" to appoint graduands to vacancies. I don't know how they deal with people who are medically incapacitated, but if you choose to emigrate or change career, you get landed with a huge bill. Yes, but that only keeps them there for as long as the repayment terms are (and whilst you could manage longer than 2 years, there are realistically limits on what's feasible.) And with doctors such measures are less effective anyway, as their earning potential is much higher.
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Merseymike
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Post by Merseymike on Apr 15, 2021 17:03:25 GMT
It's been done by your comrades in Wales. How they structured it was as a bursary that you would have to pay back if you did not work in NHS Wales for two years after qualifying. They then set up a scheme called "Streamlining" to appoint graduands to vacancies. I don't know how they deal with people who are medically incapacitated, but if you choose to emigrate or change career, you get landed with a huge bill. Yes, but that only keeps them there for as long as the repayment terms are (and whilst you could manage longer than 2 years, there are realistically limits on what's feasible.) And with doctors such measures are less effective anyway, as their earning potential is much higher. It's the principle of those who aren't prepared to put something back being expected to pay the full cost of their training.
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European Lefty
Labour
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Post by European Lefty on Apr 15, 2021 18:58:05 GMT
Legally I can't see how you'd impose a requirement to work for the NHS. You can't stop people from moving abroad, or from deciding they want to change career, or from having a medical issue that means they can't work any more. There's a similar issue but more severe issue with retention of newly qualified teachers, which I'm always surprised doesn't get more attention given the cost of training. But ultimately the way you solve that issue is to make sure people do not want to leave the profession - reaching for coercive measures just suggests you don't have any ideas about how to persuade them. Paying people properly always helps
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timmullen1
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Post by timmullen1 on Apr 15, 2021 19:24:50 GMT
If there is a shortage of GPs how come the saleries are not higher than in more competative areas, as a true market of supply and demand should dictate. Most are self employed, or employed by the practice, which is a standalone business that bids for NHS work from its local Commissioning Care Group, and so sets its own pay levels, but the basics are: “There are two contractual options for GPs. They can be: 1) independent contractors who are in charge of running their own practices as business either alone or in partnerships. They have autonomy in how services are delivered according to their contract with the Clinical Commissioning Group. In England, these GPs have increasing responsibility for the commissioning of hospital services for the community 2) salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2020, the pay range for salaried GPs is £60,455 to £91,228.”
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