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Stress levels rising?


12 January 2011

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Some GPs are complaining that the new changes the UK's coalition government is set on enforcing are "a bridge too far", forcing greater numbers of older GPs to leave the profession early and causing young doctors to avoid it. The family doctors' fears come in the wake of July's white paper, detailing plans for them to be given control of £80bn of NHS expenditure on patient care in the biggest shake up in the NHS's 60-year history.

Some GPs are complaining that the new changes the UK's coalition government is set on enforcing are "a bridge too far", forcing greater numbers of older GPs to leave the profession early and causing young doctors to avoid it. The family doctors' fears come in the wake of July's white paper, detailing plans for them to be given control of £80bn of NHS expenditure on patient care in the biggest shake up in the NHS's 60-year history.
The doctors say that these changes come on top of a health service that has already been turned upside down over Some GPs are complaining that the new changes the UK's coalition government is set on enforcing are "a bridge too far", forcing greater numbers of older GPs to leave the profession early and causing young doctors to avoid it. The family doctors' fears come in the wake of July's white paper, detailing plans for them to be given control of £80bn of NHS expenditure on patient care in the biggest shake up in the NHS's 60-year history.
The doctors say that these changes come on top of a health service that has already been turned upside down over
the past 10 years. They claim that during this period GPs' responsibilities have changed significantly from a clinical focus to the current environment of bureaucratic 'box- ticking' introduced by the 2004 nGMS contract.
Dr John Wynn-Jones, 59, was a GP at Montgomery Surgery in Powys before he retired prematurely after suffering from depression. "The new system doesn't mean a dismantling of the old system, but rather an adding of extra burden … the new process, I fear, may be a bridge too far," he says.
Dr Wynn-Jones says that other doctors are vulnerable to
depression, particularly those who are over 50 and cannot cope with the extra workload. Moreover, he believes that the system has to change, and that education and training be introduced for new doctors to help them to handle the stress of being a GP.
"There is no clearing out of some of the administration and no understanding by authorities of how we protect doctors. You don't get doctors looking after themselves very well," he says. He points to the Australian system, in which the medical curriculum for new doctors includes "built-in stress management", he says.
"There needs to be an understanding that stress is something we all suffer from, but doctors can be very macho and leave things until too late, so you get a significant proportion saying at one time: 'We just can't carry on'."
At the same time, new data indicate that GP vacancies are harder to fill than most other jobs in the NHS. According to NHS Information Centre figures released in late August, long-term vacancy rates for most NHS staff groups, with the exception of GPs and midwives, have fallen. The vacancy rate for GPs is around 2.1 %(125), compared with 1.6% (79) last year, according to the GP Practice Vacancies Survey 2010.
A big factor that may have led to increased stress levels has been what one doctor called a "tick-box mentality" that has meant less time is spent in the clinic. Some GPs believe that the problems must be viewed in the historical context of the massive changes that have happened to the healthcare system by successive governments.
The 'fundholding' system of commissioning for patients' health at the start of the decade, where practices received a fixed budget from which to pay for primary care, drugs, and non-urgent hospital treatment, was deemed to favour bigger practices over smaller ones, leading to the phrase 'postcode lottery'. In response, under New Labour, the Quality and Outcomes Framework was developed, which aimed to reward doctors financially according to their preventative work.
But out of this contract grew animosity because of the mismatch of expectations on both sides, Dr Wynn-Jones believes. "I don't think any of us realised where the new contract would take us," he says. "The government didn't realise it would cost so much and the profession didn't realise the managerial and administrative responsibilities that
would result." Consequently, something of a "public relations war" was waged on the profession, according to some doctors. The government would claim that the doctors were paid too much. Some commentators even believe that the latest salvo from the newly elected coalition government is aimed at capitalising on the perception that GPs are over- compensated, by having them do the work of primary care trusts (PCTs), but for less.
One of GPs' biggest concerns is that, on top of the requirements set out in the 2004 contract, under the new system there will be too little money set aside for the job of commissioning medical care. Health authorities in England have been told that the management fee for GP consortia will
be in the region of £9 to £10 a patient. This is considerably below the £36-a-patient fee that PCTs currently receive to cover the cost of running the commissioning services on behalf of the patient population. In some cases this also involves paying independent companies and consultants, such as Tribal Health in the UK, for support.
"The great concern in GP circles is that the amount of money available in order to administer the whole thing is going to be slashed, making it so much more difficult to do," said a senior partner of a practice in East Anglia that caters for 6,500 patients. "The government thinks we are going to just squeeze it in."
He said that in his area, the commissioning group will presumably involve five to 10 GPs (out of the total of close to 200) being full-time administrators, organising commissioning for a patient population of about 400,000.
"This seems to be part of the government's 'Big Society' philosophy, which is another way of saying that if something is
not working you give it to someone else who is not an expert … essentially the pendulum is swinging too quickly on these reforms and you get the sense that the new government feels that it has to make a big impact," he says.
The GP in East Anglia also thinks that the government's "naivety" will lead to less doctors being interested in becoming GPs because of the amount of bureaucracy that will be placed upon the profession. On top of this, he said, the net increase in income of GPs was not as much as it has been made to appear.
He cited that, for one thing, doctors have to make both the employer and employee contributions for their pension schemes. Another point is that newspaper figures often quoting GP income relate to the income that the practices generate, and do not take into account the costs. Lastly, he says, it should be considered that all GPs are not partners in their practices, and that salaried GPs are not earning exorbitant amounts.
In terms of potential solutions to this mental anguish, Dr Wynn-Jones said that the Australian model, while not perfect, does provide good ideas. "In Australia, GPs tend to work in a different way. They get their Medicare payments and keep 60 per cent, but they don't have to do any management or administration."
Maybe this isn't totally the case, but one does suspect that the coalition government has raced head first into 'reform', without paying too much heed to many of those who will have to implement its ideas. 

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