We’re publishing an original essay by Jon Garvey, a doctor who retired from General Practice in 2008 for the reasons he sets out here. He thinks the bureaucratisation of General Practitioners spearheaded by New Labour account in large part for the current failures of the health service.
The 2004 GP contract is a handy hook on which to hang the decline of British General Practice into the calamitous state in which we would now find it, if we could ever get an appointment. The usual accusation is that it made GPs overpaid and underworked and enabled them to spend all day on the golf course, but we should know by now that scapegoats are products of propaganda.
I was senior partner of a large General Practice at the time of the contract, and since it led directly to my taking early retirement four years later, certain aspects stick in my memory. One is that it was Gordon Brown (then Chancellor of the Exchequer and in overall charge of the negotiations) whose erroneous belief that GPs already did spend all day on the golf course led to some of its worst outcomes.
In truth, the rot had set in long before, following the same trajectory that some U.S. front-line Covid doctors have identified over there. A profession of inquisitive minds, gaining expertise from seeing patients and from peer-to-peer discussion, gradually shifted towards a top-down model of centrally planned protocols and ‘best practice’, executed by technical operatives and, increasingly, controlled by Big Pharma and government PR.
I came into General Practice at its possible zenith, when it had ceased to be a bolt-hole for people falling off the hospital consultant ladder, and had become a skilled speciality in its own right. It had inherited the early-NHS model of independent practices contracted to the NHS, which once wedded to high professional standards served to put the doctor-patient relationship centre-stage, rather than the relationship between doctors and their managers.
Moreover, recruits came from hospital jobs with insane hours, in my case 112 hours a week on call for my pre-registration house jobs, and then around 85 hours as a Senior House Officer on a General Practice rotation. That made the 65 hours required in my practice to cover 14,000 patients 24/7 seem a perk. Missing one’s family growing up was par for the course, and the pay was pretty reasonable.
Over the years, though, workload increased both through the devolution of increasingly complex chronic disease management from hospital clinics to GPs to save money, and from each new government deciding, without evidence, that obligatory ‘patient checks’ would prevent disease rather than merely wasting valuable appointments. This led to the increasing use of cheaper nurses and other non-medical staff for ‘routine’ work, necessitating rigid protocol-driven care, a trend one of my colleagues dubbed “getting a nurse out of the drawer”.
Now, intelligent nurses, pharmacists or even receptionists can acquire professional ‘nous’ by hands-on experience, at which point they become in effect underpaid doctors. But they lack the authority to step outside the protocols, and so their wisdom usually turns to frustration.
Latterly, Tony Blair had set up the algorithm-driven NHS Direct to virtue-signal that the NHS was open-all-hours. This undid years of training patients in demand-management at a stroke: workload increased both for GPs and A&E departments as non-medical staff referred trivial problems on as emergencies. It is no fun being phoned at 3am because NHS Direct told your patient that her genital finger wart might be cancer and so was urgent.
At the same time, every pay-review body recommendation, apart from whenever a new Conservative Government wanted to reward doctors for voting them in, was decreased for ‘affordability’. The combination of more work for less pay, in real terms, made General Practice a decreasingly popular career choice.
Nevertheless, the majority of decent practices were doing all the extra clinics, if only to get the item-of-service payments to keep their income up. But in 2003 Gordon Brown refused to believe GPs weren’t all playing golf, much as he believed that any member of the public questioning immigration policy was a bigot. The proposed contract would dramatically increase such payments, but Brown simply wouldn’t credit that most GPs were already doing the work, even though the doctors’ negotiators themselves warned him that because of this error the remuneration package would become unaffordable. Perhaps he saw himself as the heir of Aneurin Bevan, “stuffing their mouths with gold”.
The immediate result for me was the best pay rise I ever had, for a while fooling me that at last our hard work was properly valued. That didn’t last long, because Brown, irate that he’d been wrong, started a press vilification campaign to claim that GPs should have spent their pay rise on patient services, although he didn’t say what. Because press propaganda was almost as effective then as now, patients easily forgot half a century of sometimes sacrificial care from my surgery, and started passing snide remarks about golf courses. At some stage I came to the conclusion that it wasn’t worth the hassle for another decade.
Here another anomaly of the contract kicked in. Our negotiators managed to get a reasonable pension deal, given how pension funds overall had been shafted over the years. But it wasn’t as good as the existing arrangement, and that meant that if older GPs were still working when the new scheme kicked in, they’d be paying more for a smaller pension for the rest of their careers. Retirement was a no-brainer.
The new contract offered an opt-out from unsocial hours in return for a reduction in pay. But because of the unrealistic level of this reduction, probably to disguise years of under-remuneration for the work, I calculated that I would actually earn £1K less from co-operative payments if I continued working unsocial hours than if I opted-out. What would you have chosen?
It has been said that the Labour Government’s unstated aim in this contract was to destroy the awkward independence of GPs, and I can well believe it. Even before this, the NHS had tried to get us to display its corporate logo on the building we paid for to do work which in our case was founded on the Christian values of a retiring medical missionary, not on government policies, years before the NHS was invented. We refused to display the logo.
Because most GPs opted out of unsocial hours work, most co-operatives folded for lack of doctors, and these services became the domain of private companies employing salaried staff.
The gradual feminization of General Practice had for some time been raising the proportion of part-time salaried doctors. Many women saw General Practice as a family-friendly part-time career, without the financial risk of premises ownership or unsocial hours. The new contract made this an increasingly attractive lifestyle for men too, and it became harder to find traditional GP partners to replace those retiring.
So what do you do when you are the last property-owning partner standing? You may have to dissolve the practice, sending several thousand patients to join the lists of other oversubscribed GPs. Alternatively, an NHS trust takes over, and the state is then fully in control; or you sell out to a company employing salaried staff for the bottom line alone, adding corporate policy (perhaps financially linked to Big Pharma policy) to State-prescribed ‘best practice’.
Increased patient load on the remaining practices led to increasing shortages of appointments on the patient side, and professional burn-out on the other, so that more doctors retired or moved to part-time work, thus accelerating the spiral of decline. Over time this resulted in a different kind of doctor, both by inclination and by training. What was now required was someone ready to implement protocols and policies during contracted hours for a senior administrator, a corporation and the NHS, and to manage a range of non-medical staff. What was not needed was an independent thinker prepared to use his or her initiative when faced with unfamiliar clinical situations (which, to be honest, is what every sick patient is).
The increasing problems with such a system encouraged increasingly complex bureaucratic solutions, and simultaneously institutionalised obedience to the god NHS amidst the remains of what had once been autonomous professional partnerships. In 2019 the latest fix was the ‘Primary Care Network’, by which groups of practices would share increasingly scarce resources, and this was what made the Covid vaccine rollout – a mere logistical exercise – so efficient. But like any such reorganisation, PCNs depend on tight top-down control in practice, which means extra layers of bureaucracy and inflexibility.
Perhaps it is no surprise that between June 2020 and April 2021 the number of GPs considering early retirement rose from 14% to 32%. Since 2016, when the government promised 6,000 new GPs, the number has actually dropped by 1,800 – a full 10% of the number of GP partners.
The response to this crisis has been more centralized bureaucracy: from July 2022 the NHS intends to combine all health services across areas in Integrated Care Systems, and you can bet the GP representative on the boards of these will be more like Anthony Fauci than Jay Bhattacharya.
Nothing in such a system encourages questioning the norm. Add Covid totalitarianism, and you have the perfect environment for Faucian group-think. Doctors jump to whatever tune the Secretary of State for Health decrees under his chronic emergency powers, or find themselves unemployed or, worse, hauled up before the GMC for heresy.
The NHS, now an entirely top-down institution with the apparent co-operation of a British Medical Association in lockstep with it, rose to the challenge of Covid by working on the ‘temporary’ repeal of the service frameworks by which GPs were required to care for patients with diabetes and the other major chronic conditions that have now been thrown under the bus by Public Health policy. This is in order that GPs, trained for so many years to identify and manage whatever patients come in off the street, can devote their full attention to injecting every man, woman and child with endless boosters of the mRNA modifiers we all know and love. I would like to ask my own GP, professional to professional, how this is working out for him, but routine medication reviews no longer exist, so I can’t, and he didn’t respond to my e-mail.
There is no sign of anything like a return to traditional General Practice. Rather, the future seems to hold even more of the same. Massive bureaucracies lend themselves to control by large corporations, and it appears that the Health and Social Care Bill currently going rather unnoticed through parliament will facilitate this, morphing the NHS into a system more like that in America. As Dr Bob Gill explains:
The model is endemically fraudulent, has massive overheads in terms of cost of administration, extracting shareholder value and paying CEOs. The public will end up paying twice, either through taxation or individually through top-up insurance.
The idea (going back to Hippocrates, I suppose) of an enterprising doctor buying a stake in their local community and tailoring their practice of medicine to it will be completely gone: the doctor will be paid a salary by a distant corporation, no doubt finally owned by Black Rock or the Gates Foundation, and the patients will simply be the source of revenue for that entity, while it remains profitable.
The best hope for us all is that a new breed of enterprising doctors will manage to get trained, somehow, in the old way (only perhaps freed from the expensive Rockefeller model of molecular medicine and patent drugs), and will band together to bypass the state system altogether and offer basic scientific medicine to an inflation-impoverished public at a reasonable cost.
I am not optimistic.
Jon Garvey retired from General Practice in 2008, and has since concentrated on writing, being the author of two published books on science and faith, one samizdat book on our propaganda society, and (since 2011) the blog The Hump of the Camel.
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Good article. In summary, if you let morons formulate policy which they are then allowed to enact, don’t be surprised at the almighty cluster**** that inevitably ensues.
Excellent article. Progress reflects human resolve and ingenuity prevailing over risks to life and limb.
Health, wellbeing and life expectancy correlate with sanitation, running water, mains electricity, supplies of gas and nuclear power, the Haber-Bosch process and overall economic prosperity. Likewise the clean environment green zealots bang on about ad nauseam.
The Politburo doesn’t get the basics of how hundreds of years of social, technical and industrial progress lifted the developed world out of the squalor and tyranny of feudalism. Reliable, affordable and unbounded energy supply was, and still is, fundamental to progress.
The Student Union Government is instead fixated on the ramblings of those ne’er do wells, Marx and Engels, that may have had some 19th century relevance, but are now ancient doctrine gone rancid and sour.
Predicated on climate claptrap and energy folly, a Great Leap Backwards beckons. Witness Western European economic mass insanity.
The Kommissars Must Fall.
All true, but…
“The Politburo doesn’t get the basics of how hundreds of years of social, technical and industrial progress lifted the developed world out of the squalor…”
The lions share of human advances took place in just the last 200 years. Please see Buckminster Fullers chronology of the Industrial Revolution below using the Periodic Table as a key reference. Notice also the number of inventions. The abolition of slavery was in 1830 around the same time as the Factory Act 1832. Notice also the change in transportation across the top. My Father was born 12 years after the Wright Brothers first flight and before he retired Humans had been to the Moon.
Agreed, progress really took off in the last two hundred years. With a bit of imagination. I can just about relate to the world of 1854 (year of one of my great grandmothers’ birth), but not to the world of a century earlier than that. Great Grandma’s life likely began in the era of wells and middens, and ended in 1937 in a house with mains electricity.
I’d argue, however, that the seeds of the 1830s onwards were set by the advances in scientific thinking of Boyle, Hooke, Newton et al, that began around the 1660s. Foundational era of the empirical scientific method. Let there be Light, let there be Enlightenment.
True. We should also include Magna Carta, the Lollards, the English Bible, the Reformation and I think the pivotal English Civil War. The change from an Autocratic monarchy as well as the affects on working practices caused by the plague took the brakes off. Cromwell had already started the agricultural revolution with the draining of the Fens. When King Charles II was restored to the thrown he tried to restore the authority of the Monarch and get us back into Europe, or rather the Roman Catholic Church, and failed on both counts. He tried to shut down the coffee houses in London where all could meet, talk and trade without regard to status, or even gender and he failed on that too. Monarchy and to a large extent the aristocracy became irrelevant. The first commercial steam engine was in 1710, a mere 50 years after the Restoration, and 17 BEFORE the last women was burned as a witch. All nations up to this point were powered by men, horses, and sail. The steam engine was a multiplier and it is significant that engine power is still measured in horses.
“The Kommissars Must Fall” oh they will just a matter of when and how much devastation they cause in the meantime.
Purely using common sense it would seem the lower end of the variables more likely when it comes to deaths caused
The amount of land effected and its effects on humans living on it afterwards is almost impossible to calculate
I would say nuclear is nowhere near as dangerous as is proposed by the green blob and I would certainly prefer it to acres of wind turbines and solar panels
Nuclear waste, which is partly recyclable, is another conversation that needs being opened up to public debate instead of being instantly used as a big stick by the blob
We really do need grown ups in power at the moment, like never before!
Unfortunately the grownups are sadly lacking or swiftly put to the sword – metaphorically speaking.
The world needs energy. We always hear of the risks of using certain fuels but NEVER about the risks of NOT USING THEM—–Without coal gas oil or Nuclear we are back in the middle ages and going to work on a horse, dying young of preventable disease and of injuries caused by back breaking labour. —–There are forces to day trying to control energy use, and infact almost everything else human beings do as well. —-GREEN = RED.
Presumably judging by your last comment you have read James Delingpole’s Watermelons (or perhaps you ARE James Delingpole
).
There has been no shortage of anti-nuclear output about the Chernobyl disaster, but it appears that the design of the particular type of reactor had a built in risk, and they fell foul of it during it’s operation, or maintenance thereof. Not all of the stations in the ex-USSR are the same.
Historically, the old USSR was quite keen on the use of electric traction on it’s railways. Back in 1996, I travelled from Beijing via Mongolia then into Russia and all the way as far as London by train, and once we were on the Siberian route after the Mongolia/Russia border, it was all overhead electric (via Moscow, Warsaw, Berlin, Köln, Brussels). You can travel all the way from the Pacific across the continent that way. You can’t do that across the pond!
That sounds fantastic – a trip of a lifetime!
Central planning is lethal.
45 million people died as a result of Mao Zedong’s Great Leap Forward – perhaps the greatest number of deaths attributable to the folly of a single man (or small group of people.) To be clear, those were unintended, accidental deaths.
For comparison, 36 million died in WWII and 13 million in WWI.
Allowing a few people to exert immense power and influence over many others is just really dangerous and should not be allowed. It almost always goes wrong at some point. That is the single most compelling argument for small government, in my opinion.
Central Planning is fab, or so i heard on the BBC the other day. People don’t want EVs, so sales are only 21K monthly as opposed to the 28K mandate. Manufacturers can’t manufacture them profitably, and have thrown over £4bn trying to shift the ones they can’t sell.
So, said the man on the news, if the motor manufacturers can’t make them affordable, “the government will have to step up to the plate.” Meaning, of course, that because the public can’t afford them, they’ll have to pay for them anyway through taxation.
So if we are to lead the way to saving the planet, central planning is the sine qua non.
In passing, I heard a story via a friend of someone trying to buy a normal white diesel van for his business (still going). The dealer couldn’t let him have one until he had managed to sell a quota of Electric vans – so over a year he was able to ‘release/sell’ only 3 ‘normal’ vans as EVs don’t sell very well. How on earth have we managed to achieve this?
Everyone seems very keen on Latin today.
It’s yer actual classical education innit? Courtesy of J. Caesar you get to learn how to make accurate measurements with a water-clock without a Lithium battery in sight. Noli illegitimi carborundum.
On the upside he’s also the greatest drug reformer in history. Prior to his coming to power there were millions of opium addicts in China. By executing dealers AND those caught using it there were very few opium users left by the time he died.
Yesterday’s Reform Press Conference on the subject of “renewable energy” and the Net Zero scam is worth watching.
https://www.youtube.com/watch?v=WxTrWTWBoM4
Thanks. I will try to work my way through it, though so far disappointed that they are using the term “renewable” without qualification as I think it’s misleading. But perhaps they cover that later.
In the surrounding forests around Chernobyl there are no 2 headed wolves or five legged dear or deformed trees, or any deformed life. This also means It is also not a desolate wasteland devoid of life.
Not far above Las Vegas is Area 51, and a couple of valleys to the West is one of the United State’s nuclear test ground. I’ve attached below a Google Earth screen grab of this area. Each crater is from a nuclear test. It is possible for people to visit.
Didn’t Clarkson visit Chernobyl on one of his Top Gear tours? They all seemed to have survived.
Absolutely first class. So much information packed in to this article. It’s like a Roman banquet.
Thank you.
We owe the “linear, no threshold” model to Hermann Muller, who knew it was false as he collected his Nobel Prize from research by his own team members. It has somehow become an axiom in many sciences, even though in fact it has never been demonstrated scientifically because it is, indeed, false.
It’s not only irrational fear of radioactivity that has been fostered by this (in that case, directly by Muller’s advice to the US government). Muller used it first to make the case that, since heavy radiation causes genetic mutations (hence the Incredible Hulk!), Darwinian evolution would easily work by stray radiation causing tiny, selectable, mutations.
That forms the basic assumption of modern evolutionary theory, but is as untrue as the death estimates from nuclear accidents.
But consider also PM2.5 particles in diesel and other air pollution – ALL the supposed deaths are based on linear no threshold.
On the other side, how do you think proponents of fossil fuels in developing countries estimate the deaths caused by cooking over open fires? Do they count respiratory illnesses or bodies? No, more estimates of toxicity based on linear no threshold.
Likewise when the EU and other regulators ban fertilizers or other chemicals… same reasoning.
I remain convinced that one of the central aims of Nut Zero is depopulation.
‘there is no such thing as a safe dose of radiation’.
The curse of safetyism writ large for the purposes of control.
According to Wikipedia:
Oh dear, even living isn’t ‘safe’.
Maybe that’s why the eugenicists want to kill us all.
Excellent article – the only point I would take (minor) issue with is “And that’s before we’ve even considered the further consequences of rising energy prices, such as unemployment, living in a cold home, reduced levels of public services and so on.” Doesn’t the previously quoted £238 per year income/month of life expectancy ratio already explain/account for that?
“Greens get very worried about the risk of nuclear accidents. But have they considered that the economic devastation of Net Zero will cause far more deaths than were ever suffered by Ukraine after Chernobyl, asks Ben Pile.”
And I ask Ben Pile have you considered economic devastation and many deaths is exactly what Greens want?
Ben Pile is a constant voice of reason. I do hope that his lucid, referenced pieces resonate far more widely than merely in the (inevitable) echo chamber of this forum.
A good read, thank you.
Excellent article and a very useful statistic to counter the “you can’t put a value on granny’s life” covid claptrap from the so called conservatives. Arguably you confuse annual and capital spending but it’s a great point nevertheless!
The photo in this article says it all. This part of the world is dead.
I’m all for nuclear, but the article really cannot make its claims without looking at the history of nuclear accidents in Britain (and their coverups), particularly the Windscale event.
I keep writing to the RSPB about the carnage being brought to bird life in name of Green energy and all i get back are “party line” replies, and now they are saying that solar farms will actually enhance birdlife..! So why not glass over the whole country and see how that goes!. Please can folks here write to the RSPB in hope that its not just me saying this to them, as they probably regard me as some sort of annoying crank.