GPs want to care for patients not run businesses

http://www.theguardian.com/society/2015/may/21/gps-want-care-patients-not-run-businesses

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Whatever his values and assertions (Cameron’s diagnosis might sound plausible, but he offers no coherent prescription at all, Editorial, 19 May), the prime minister will not be able to deliver any sort of future health service unless the existing and upcoming GP shortage crisis is addressed. From entering medical school to qualification as a GP takes a minimum of 10 years. According to the Royal College of GPs, we will be short of 8,000 of them by 2020, without seven days a week availability – for which many more will be needed.

Under the cloak of academic independence, UK medical schools give scant attention to the needs of the health service workforce, receiving no redress if, say, they recruit and train few students becoming GPs and lots interested in neurosurgery. Largely run by clinical scientists and specialists, medical schools recruit with images of high technology and scientific research (just look at their websites), with the result that, frighteningly, only 10-12% of entering medical students see general practice as their preferred career.

So if the nation is to find and train medical students who are likely to become GPs, medical schools need to change their recruitment tunes immediately. Experience suggests that without financial encouragement or sanctions from the funding bodies or the NHS this is unlikely. But the medical schools will even now be designing their recruitment schemes and websites for the 2016 intake, who if they opt for a career in general practice won’t arrive in the consulting rooms until 2026. The need for arm-twisting action is clear and urgent.Richard WakefordHughes Hall, University of Cambridge

• Even Jeremy Hunt accepts that more GPs are needed but the reasons why doctors do not want to go into primary care are less well understood. A succession of contract changes and government initiatives have, over the years, turned general practice from a system that, though with independent contractor status, was essentially aimed at caring for patients to one that is based on a small business model. Because of a misguided belief in market-based competition and profit motivation, GPs now live in a world in which practice profit is in conflict with patient care and the annual meeting with the accountant is one of the most important of the year.

Difficult choices about budget allocation are experienced by every nationalised healthcare system across the world

Juggling the requirements of running a small business and meeting targets that are often of dubious clinical value means the job has lost its focus. Young doctors want to care for patients, not run businesses. If that isn’t enough to put them off, they have also been given the role of running a really big business – keeping the NHS solvent through the management of clinical commissioning group budgets.

If I were 40 years younger, would I be a GP? No way.Martin HimeRetired GP, Clevedon, North Somerset

• Gosh – whatever will David Cameron promise next? Hospital emergency rooms staying open 24/7? Surgeons who have operated on a Thursday or Friday coming in to see their patients on a Sunday? Patients with malignant disease being moved to the top of the list for surgery while bumping elective or non-urgent surgeries down the queue? Transplant surgeons operating in the middle of the night? Junior doctors working for 24 hours without sleep and a proper food break?

Or might he promise an honest communication as to the finite amount a health service can deliver within a finite budget and finite resources? Might he acknowledge the difficulty and cost of providing a 24-hour emergency cover service alongside elective and screening services in hospitals?

Difficult choices about resource and budget allocation are experienced by every nationalised healthcare system across the world.Alison HackettDun Laoghaire, County Dublin

• Cameron’s NHS plan is devoid of logic, writes Colin Leys of the Centre for Health and the Public Interest (Opinion, 19 May) – and so it is to a decent human being like Colin. However, there is a sinister logic to Cameron and the Tories, wonderfully summed up by Noam Chomsky: “That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.”

This logic takes no notice of the report produced by the Centre for Health and the Public Interest, which showed that there are now some 53,000 contracts between the NHS and private healthcare companies, which need 25,000 staff at a cost of £1.5bn a year paid for from the NHS budget. The lunatics have truly taken over the asylum.Michael Gold @radicalmicLondon

• What a splendid idea of David Cameron to suggest that the NHS should be open for business seven days a week. I can’t wait for him to expand his ideas to Westminster, where people work four days a week, enjoy regular pay increases and have the longest holidays of any profession.Brian TaylorKnutsford, Cheshire