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International Primary Care Association

from the editor...

The annual winter tempest to hit the NHS is blowing. The Times and Independent newspapers recently carried stories that the service is £2 billion in the red and this is even before the winter pressures have commenced.


The general conclusion was that more financial squeeze can only come with reduction in services and staff. This simply will not equate with the standards of care deemed an absolute after the Staffordshire and other medical scandals, and which identified lack of staff, clinical and nursing, as the core issue leading to unnecessary patient fatalities. The experience of many clinicians is that NHS employers are making unilateral decisions to increase workloads as permissible under the consultant contract and tugging on the usual mantra of, “doom, gloom and services being decimated”. Such scaremongering and crying wolf has become an annual pantomime that staff are simply hardened against, which are viewed as shallow attempts to balance the books. The BMA and the Hospital Specialists and Consultants Association will have to plenty of requests from clinical staff to examine what is legally allowed.


The government has sleep walked into a series of time consuming and bruising battles. The deficit requires a choice between cutting/pruning services or a finesse with the usual accounting procedures, identifying the lie of their commitment to have a world class NHS. Its policies on staffing have given rise to confrontations with consultants, junior doctors and general practitioners. A triple battlefront, something even Napoleon would have thought about and dismissed!


The juniors are at the threshold of a new contract about to be foisted in them, without negotiation and agreement. The mutterings (I am unable to print language that was truly used) simply ask, “Who can be asked to accept additional work and less pay, greater contributions to a pension with a lower final payout and classifying a normal day/working week as way beyond the usual hours and days”?


The consultants’ contract is being altered primarily to include the ability of the employer to enforce weekend working to provide a full 7 day service. No one has seen how this will be funded. The NHS can barely finance the present service. Hundreds of millions are spent on locums as there are too few clinical and nursing staff to deliver the 5 day week. Will staff be forced to work 7 days a week? Where does this leave work/life balance, so important to the well-being of individuals. Burnout will be a major issue and more commonly seen.


General Practitioners will also have a new contract to ensure a 7 day delivery of services. The evidence is that it is not popular with patients with the majority of vanguard practices discontinuing the service. Strangely, even patients do not wish to be sitting for hours on end in a GP surgery at weekends, when they could be with family and friends. The government has once again flexed its power, as a monopoly employer, and this time it may end up not being able to bandage over the consequences. Juniors are looking to overseas opportunities, consultants and GPs are hemorrhaging well before official retirement age and nursing and other staff are opting to work for medical locum agencies. As one of my colleagues observed, “The NHS ship may well sink if 1000 junior staff decide to resign/move on”. Politicians beware!


I hope that you will enjoy this issue with excellent contributions on the theme of supplements in the form of Vitamin D disorders (p.8), in pregnancy (p.16) and joints (p.34). Sexual dysfunction in adults (p.24) will be a common issue seen in primary care and this article provides core knowledge. GPs also have access to blood tests, routine or otherwise, and Dr Allard and her colleagues succinctly embody the management of the common blood disorders which you are likely to encounter (p.42).


Professor Ram Dhillon


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Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: Clinical Focus Primary Care
Read 1098 times Last modified on Tuesday, 03 May 2016 15:37

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