Leaving The NHS
By admin
Issued on behalf of Independent General Practice
Doctor Joanna Longstaffe is clinical director of the Independent General Practice (IGP), Wales’ first exclusively private GP Practice. Established in August 2004, the IGP now has circa 1000 regular patients and hosts daily surgeries in Cardiff – city centre and Cyncoed – Newport and Swansea. A new ‘super surgery’ – with 5 consulting rooms, rehabilitation suite and facilities for both minor surgery and laser – is also soon to open at Cardiff Gate.
Dr Longstaffe shares her experiences as both an NHS and private doctor and her thoughts on how far we’ve come in our provision of basic health care for all.
“Prior to setting up the Independent General Practice, I spent 12 years as an NHS GP, working at a practice in Llanrumney – what I would describe as a ‘high demand’ area of Cardiff.
My reasons for becoming a GP were the same as most others – I wanted to help patients get the medical care they require, as and when they need it – and, among others, one of my reasons for leaving was the very fact that I felt I no longer able to provide this to the degree that I wanted to – working under NHS conditions.
I’ll make it clear from the outset that I have absolutely no issue with my NHS colleagues – many of whom I still continue to work with very closely – my problem comes with the system within which they are forced to work.
By the time I left the NHS, I was starting to get increasingly disillusioned by the sheer level of bureaucracy with which I was faced – classic form filling and box ticking as I see it – that simply served to limit actual time with patients and not allow for the skills I’d been trained to use to be put into practice to any real degree. In my opinion, that’s got progressively worse in the last few years.
The government made an absolute mess of the new GP contract – not least by promising that if GPs took a £6000 a year pay cut, they’d be guaranteed a set working week of Monday – Friday between the hours of 8-6pm. GPs of course, took up this offer, before the government then realised that they’d made a huge mistake – out of hours provision is nowhere near an acceptable level and, to compound the problem, hospitals are becoming even more overloaded with cases that don’t actually need to be there – either turning up at A&E departments or being referred by salaried doctors who, under the new conditions, simply don’t know the patients they’re dealing with or their case histories (and are not responsible for their care the following day). NHS GPs have been offered performance related incentives and have mostly already achieved all the targets set for them – because they have been providing this care for many years. The government have massively underestimated both their skills and worth (and they have just made the same error with the new hospital consultants contract).
I see the NHS failing in its duty of care for patients in that GPs and also hospital consultants, are so bogged down with trying to get to grips with the constant introduction of new ‘guidelines’ that it’s simply impossible for them to provide the care and service patients deserve.
I hadn’t intended to necessarily go into practising as a private GP when I decided to leave the NHS – I’d by this point trained in aesthetic medicine and was considering a complete change. It was actually my husband and fellow director of the IGP that suggested we provide a complete GP service. I couldn’t quite believe that nobody else in Wales was offering this but clearly they weren’t and 4 years on, there’s more demand than ever for the services we provide.
On a personal level, I find private practice so much more rewarding and far less stressful – mainly because I’m able to control the time I have with patients and get to know them all individually. We have a system of 20-minute appointments and guarantee a consultation within 24 hours – I know a sore point for many seeking NHS treatment is that they simply can’t get to see their own GP – and we make a point of making this happen.
Speaking to my NHS colleagues, so many are frustrated by the way in which their jobs have become a real juggling act to get patients in, seen and out again – with no time afforded to getting to know patients on a personal level. This is a luxury – or probably best described as a ‘right’ – that I and the patients I treat now have.
There’s absolutely no reason why NHS patients should be denied such a level of care and NHS GP’s are equally qualified to take such a holistic approach – but can’t respond in the same way within the existing framework.
Sadly, with the way things are going, I can’t see the situation improving greatly in the foreseeable future.
The BMA has published research in the past, the basic conclusion of which was that in a GP consultation ‘a minute makes a difference’ – proof that statistically, taking a minute at the end of a consultation to ask if somebody’s managed to give up smoking or what their weekly alcohol consumption is, can make a huge difference to them maintaining a generally healthy lifestyle and, therefore, less likely to be a future drain on limited NHS resources – it’s just not happening.
Personally I think the government has introduced a systematic anti-GP spin that it’s using to undermine the work of the average NHS doctor because they know that it won’t be long before GP’s start to rebel against unreasonable work loads and expectations – and hit back. The problem here of course is that the general public will probably perceive the situation as a case of well-off doctors complaining about their lot and offer little support – leading to increased disillusionment and more and more GPs leaving the NHS for private practice. If the numbers that are now approaching the IGP for employment are anything to go by, this is to become a very real problem -
In terms of our position alongside the NHS, the medicine is slightly different -around 50% of our current workload is standard GP work and the rest is made up of well person medicals, cosmetic treatments, insurance assessments, medico-legal work, travel vaccines, flu vaccines and offering the single MMR, for example. We do write to our NHS colleagues with details of the vaccines so records can be complete and many NHS practices now refer travel, flu and single vaccines to us. With the majority of our registered patients the relationship we have with their existing NHS GP is great – a two way street of information which helps patient management and is mutually beneficial.
We are not able to write FP10 (not even for contraception), which is a situation I have a huge challenge with. The new NHS is about budgets following patients, patient choice etc. However, if a patient chooses to pay for our time (because it is more convenient and accessible), I feel that they should not also have to pay for their medication.
Cervical smears pose a classic example as Cervical Screening Wales continues to maintain that any smears we do are ‘private’, even though the patient presents with a letter to say they are due or often, overdue. Bizarrely, results from our practice are not automatically sent (or credited) to the patient’s NHS GP, nor included in the national audit and patients still get reminder letters – even though results are read by the same laboratory. I am hopeful that such ridiculous bureaucracy won’t last but not overly optimistic.
I was asked recently if I had any regrets about leaving NHS practice – I have none. I worry that the NHS is becoming increasingly destabilised and we’re witnessing the start a slow burning privatisation of GP practices as many of those on board chose to jump what’s increasingly being viewed as a sinking ship. For more information about the IGP, visit www.theigp.co.uk or call 029 2064 7308.
