It is wrong to prop up GPs with huge pots of tax­pay­ers’ money

The Herald - - OPINION - ● Have your say: The Edi­tor, The Her­ald, 200 Ren­field Street, Glas­gow G2 3QB; e-mail: let­ters@the­

I NOTE with in­ter­est your lead story to­day (“Unions fury at ‘scan­dalous’ £10k wind­fall for doc­tors” (The Her­ald, Jan­uary 12). I am a mem­ber of one of the two He­lens­burgh GP prac­tices. There are five GPs in my prac­tice who have an av­er­age of 14 hours and 30 min­utes of pa­tient con­tact time per week. In Scot­land, GP re­mu­ner­a­tion av­er­ages £90,000 per year or for the doc­tors who treat me £119 per hour.

How can this be jus­ti­fied in a world of aus­ter­ity and a liv­ing wage of £8.45 per hour?

Dr Peter Bennie, the chair­man of the Bri­tish Med­i­cal As­so­ci­a­tion (BMA) – the doc­tors’ trade union – has given his view: “We have seen staff in NHS Scot­land work­ing in­cred­i­bly hard in ex­tremely dif­fi­cult cir­cum­stances over re­cent days to de­liver the care that peo­ple need.

“I’d like to add my grat­i­tude to the many ex­pres­sions of thanks that teams across the coun­try have re­ceived. But to be hon­est, it is not thanks that doc­tors and their col­leagues want.

“In­stead of grat­i­tude, we need a long term, sus­tain­able plan that closes the grow­ing gap be­tween re­sources – in par­tic­u­lar fi­nances – and the de­mand for ser­vices.”

A Gov­ern­ment spokesman says “nec­es­sary pro­fes­sion­als are in scarce sup­ply”. GPs are in short sup­ply be­cause the Scot­tish Gov­ern­ment did not in­crease places in Scot­tish med­i­cal schools af­ter the Euro­pean Work­ing Time Di­rec­tive was passed in 1998. If a doc­tor can’t work as many hours, ei­ther you need more doc­tors or you have to im­prove the ef­fi­ciency of those al­ready in post.

I was a pro­fes­sor at Ore­gon Health Sciences Univer­sity, Port­land, Ore­gon, United States. There are 110 places avail­able each year in the med­i­cal school class. There are around 2,000 ap­pli­ca­tions for the 110 places, all from qual­i­fied stu­dents. The Amer­i­can Med­i­cal As­so­ci­a­tion, the equiv­a­lent of the BMA, re­stricts the num­ber of med­i­cal school places to main­tain the salaries of prac­tis­ing doc­tors. It is not in the in­ter­ests of the BMA or its mem­bers to have too many doc­tors in Scot­land.

Scot­tish GPs are paid a high salary in part to com­pen­sate for the fi­nan­cial risk as­so­ci­ated with part­ner­ship and pro­vid­ing premises. The new con­tract will re­move these fi­nan­cial risks. The new higher salaries will be guar­an­teed and “out of hours, premises in­come, com­mu­nity hospi­tal work, en­hanced ser­vices and other NHS-re­lated work will be in ad­di­tion to this scale”.

In the brave new BMA world,

GPs will have time to take on a sec­ond, third or fourth job to make ends meet. We al­ready have banks and bankers who are too big to fail. It seems that we will now have GPs who are too im­por­tant to fail and must be propped up with huge pots of tax­payer money.

John Black,

6 Wood­hol­low House, He­lens­burgh.

PRO­FES­SOR Mike Lean (Let­ters, Jan­uary 11) help­fully lays out the so­phis­ti­cated 1-9 se­quence of ac­tions which pa­tients should ex­pect within a four-hour pe­riod or some­times longer on en­ter­ing emer­gency de­part­ments. The pop­u­la­tion should be re­as­sured by that. While re­ports of­ten sug­gest that pa­tients at­tend with flu, ac­tu­ally most at­tend with symp­toms which are wor­ry­ing them or their part­ner or carer. Typ­i­cally, apart from in­juries and burns, these are pro­longed pain, high fever, rig­ors, breath­less­ness, blood ap­pear­ing from an ori­fice, faint­ness and col­lapse or a com­bi­na­tion of those. Es­pe­cially in older pa­tients, these symp­toms and signs may rep­re­sent vi­ral ill­ness, flu be­ing at the more se­vere end, or from some other dis­ease al­ready known about or pre­sent­ing for the first time.

From 8am till 6pm week­days, gen­eral prac­ti­tion­ers have a re­spon­si­bil­ity to or­gan­ise their prac­tices to be able to re­spond timeously by phone or ap­point­ment to con­cerns and wor­ries about such symp­toms. Nurse or doc­tor phone ap­point­ments mid-morn­ing and there­after or one GP act­ing as “on-call doc­tor” for the day should gen­er­ally meet that need. Un­nec­es­sary de­lay should be avoided as gen­er­at­ing worry. Of course re­cep­tion­ists need to be trained and su­per­vised to pass on more se­ri­ous symp­toms im­me­di­ately or sug­gest a 999 call ap­pro­pri­ately. Con­fi­dence in this pri­mary care ser­vice is key to avoid­ing that un­nec­es­sary trip to the hospi­tal.

The ac­cess equiv­a­lent af­ter hours and at week­ends is the an­swer­ing time for as­sess­ment and ad­vice pro­vided by the NHS24 teams. Key clin­i­cal in­di­ca­tors are mea­sured against stan­dards of re­spond­ing within 20, 60 or 90 min­utes de­pend­ing on the ur­gency de­ter­mined by the ini­tial ques­tions asked.

Phar­ma­cists can re­spond to con­cerns, pre­sum­ably across the counter, rather than by phone. That will mainly as­sist those whose prob­lem has not ren­dered them bedrid­den or house­bound.

Best use of the good menu of ser­vices can mit­i­gate the pres­sures fully de­scribed re­cently. Each health board plans for the win­ter pe­riod and should now in­di­cate whether they were able put all that they thought nec­es­sary in place. Did they ex­pect un­met need? Dis­cus­sion about all-year-round safe bed oc­cu­pancy lev­els and win­ter staffing plan­ning across health and so­cial work are re­quired to in­form man­agers and politi­cians what may be re­quired in fu­ture.

So­cial care re­mains a ma­jor con­cern and the re­ported Scot­tish Care sur­vey show­ing that more than 80 per cent of com­mu­nity care provider firms feel in­se­cure about their sus­tain­abil­ity adds to that. I be­lieve main­tain­ing and en­hanc­ing care pro­vided in peo­ples’ home and in care homes is our Achilles heel along with the steadily shrink­ing num­ber of hospi­tal beds.

Philip Gaskell, GP,

Wood­lands Lodge, Buchanan Cas­tle Es­tate, Dry­men.

WITH the Scot­tish Gov­ern­ment ex­pect­ing NHS Scot­land to en­sure 95 per cent of pa­tients are seen within the four-hour time frame, it’s hardly sur­pris­ing that just 78 per cent were seen dur­ing the fes­tive pe­riod. The Gov­ern­ment’s un­re­al­is­tic ex­pec­ta­tions, com­bined with un­der­fund­ing, makes its time frame highly un­sus­tain­able. There­fore we must en­sure we give praise and en­cour­age­ment to our hard-work­ing, over­stretched, ded­i­cated health ser­vice staff. On com­pli­ment­ing a nurse in a su­per­mar­ket, I was told her or­thopaedic ward at Glas­gow’s Queen El­iz­a­beth Univer­sity Hospi­tal has now been turned into a med­i­cal ward, to cope with the ex­cess num­bers of flu pa­tients, and the med­i­cal com­pli­ca­tions. This in turn has a knock-on ef­fect of or­thopaedic surgery cases be­ing de­layed or post­poned. Please be aware it’s our over­paid politi­cians who are to blame here, not our ex­cel­lent front­line hospi­tal staff. Jill Fer­gu­son,

Crow Road, Thorn­wood, Glas­gow.

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