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General Practice Facing Austerity Measures in Britain

Special Reports

Dr Bashir Qureshi

FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG,

Hon MAPHA – USA, Hon FRSPH

• Expert Witness in Cultural, Religious & Ethnic issues in Litigation.

• Expert Witness in GP Clinical Negligence.

• Author, Transcultural Medicine; Dealing with patients from different Cultures, Religions & Ethnicities.

• Former GP & Paediatrics Clinical Public Health Medical Officer, London, UK.



According to the theory of “double doctrine” in philosophy, it is justified to do a bad thing to achieve good results; for example, to kill four hijackers to save 40 hostages. It is also possible to do a good thing to achieve bad results; which may be intended, for example, to close an expensive service or agency. In Britain, most things are achieved by evolution than by revolution. The aims and objectives to get results are usually planned one year, five years or 20 years ahead. The British politicians are clever and often trained in Oxford, Cambridge, Edinburgh and London Universities. They are mostly of real British origins and very loyal to the British flag. Money makes the world go round. Today, Britain is facing shortage of money and austerity measures, in good faith, are essential. Let us look at five actions which look very good for patients and General Practitioners (GPs) but are amicably reducing the number of GPs, their services, cost of medications and referral to hospitals, as intended, while making patients feel powerful, happy and supportive.

Patient Power and Patient Associations

A patient can complain against a doctor but a doctor cannot complain against a patient. Every doctor is believed to have taken “Hippocrates Oath” but no one has ever done so because it involves a student to give money to the teacher’s family for lifetime. Similarly, a diagnosis is mostly based on symptoms and signs which suggest a number of different diagnoses and the doctor chooses one that is most possible. Medicine is a science but a diagnosis is an informed guess, except in a few cases such as a fracture of a bone. No diagnosis can always be right but the patients are encouraged to expect it to be always right. This expectation is the basis of increasing complaints against doctors, who indeed experience stress which if repeated makes them leave the practice or licence to practice.
Patients Associations are being used by the Government to monitor GPs performances and General Practice facilities. They are also being used by Doctors’ Royal Colleges and Trade Unions as an umbrella. Patients are making demands and complaints to Employing Authorities, General Medical Council and Courts. It is now an irreversible and manmade situation

Care Quality Commission visits General Practices

The patients’ feedback, often less complements and more complaints, is a compulsory requirement by the Care Quality Commission of the NHS. Every GP Practice is forced display a poster in their waiting room, for patients, how to complain and to whom. Surprised and planned visits take place by trained medical and non-medical inspectors skilled in finding faults in every surgery where possible. They question every member of the Practice staff rigorously. Practice instruments and oxygen cylinders are checked. The premises must be very clean all the time. These adjustments need more staff, time and funding. There is no extra funding or manpower given by the CQC or Employer Authorities to these Practices. The findings of good and bad grades, after inspections, are displayed on the internet for the whole world to see and assess the competency of GPs.

Annual Appraisal and five yearly Revalidation of every GP

No one but no one can pass examinations or appraisals for Revalidation at all times. There are instinctive personal reservations as well, based on factors such as age, gender, social class, culture, religion, ethnicity, university or medical college. If an examiner likes an appraisee for any reason, he/she may move goal post towards the candidate but if there is a dislike, the appraiser would move the goal post away from the appraisee and keep moving. For example; patients’ feedback survey and patients’ audits were not essential for self-employed Locum GPs as they were not employed by any practice which can let them access patients’ notes after consultations were over. Now, it has been made compulsory for Locum GPs who have to leave practice or licence to practice, as a result. The agencies who support them have limited influences. These GPs cannot help themselves. Even God helps those who help themselves.

The current situation is similar to what happens to overseas doctors who wish to practice in the UK. In 1960s, when junior doctors were needed to look after war wounded survivors, about 18000 South Asian Doctors were trained abroad by the British and they were all given work permits, by the Ministry of Labour, to work in the NHS hospitals. They were given Certificates of Acquired Rights to practice in the NHs as General Medical Practitioners. The MRCGP became compulsory only when they were all over 70 years of age. When there was no further need, the PLAB test by the General Medical Council was introduced. I am not sure whether the pass rate depends on the posts available in the NHS but I feel that it may be a possibility. We can be proud of our politicians for their skills.

Computer control of Prescribing by GPs

If a GP decides to prescribe a medication, a statement appears on the computer to either change the prescription to a cheaper drug or to give NICE (National Institute of Clinical Excellence) guidelines to forbid prescribing. For example; no prescribing of bonjela; oromucosal gel, for mouth ulcers. No more any prescriptions for Ibuprofen tablets or gel allowed for osteoarthritis pain. No antibiotics prescriptions unless a condition of infection gets worse; sometimes, it may be too late. Some patients, especially with pain or infection, become very angry with the GP as they have waited a long time to get an appointment and now no pain or infection reliever given. Patients’ feedback survey, which is mandatory for a GP’s Annual Appraisal and five yearly Revalidation, becomes very negative. Patients may use the information, provided on the Practice Notice Board, about how and whom to complain against the GP and the Practice. Patients put negative comments on the Practice page on the internet. The GP remains helpless and distressed.

Control of GPs referral of patients to hospitals

A Locum GP saw and examined a woman patient with pain and tenderness in right lower abdomen and gastric region for 3 days, getting worse, and suspected “acute appendicitis”. He rang a surgical registrar of the local hospital. It was usual that such an emergency was investigated and treated at hospital, where investigation staff, time, skills and admission facilities were available. This was particularly relevant when an operation was needed. The surgical registrar advised the Locum GP firmly that he should do an ECG and a pregnancy test, and then ring him. It was an evening surgery with 10 minute per patient appointments. Only one receptionist was helping patients. There was no ECG machine and no pregnancy test kit was available and it would have taken a long time. The waiting room was full of patients waiting anxiously for their turn. The locum GP had to write a letter and send the patient to A&E Department to save the patient’s life. I hope that it happened. Currently, these hospital doctors on call are advised to insist that GPs should manage emergencies in their GPs surgeries. This is a Pandora’s Box opened to risk patients’ lives and litigation against GPs.

Moreover, GPs’ non-emergency referrals are firmly scrutinised by a team of referral controlling trained doctors in local CCGs. Many referrals are sent back to the GP. This reduces referrals to hospitals which can remain open only to treat patients referred by local GPs. These austerity measures would reduce the number GPs and increase risks to patients’ lives. There is a case for the Private NHS today. The patient power and British politicians would soon decrease doctors’ orders or disorders in a NICE way to save money.

Dr Bashir Qureshi

FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG,

Hon MAPHA – USA, Hon FRSPH

• Expert Witness in Cultural, Religious & Ethnic issues in Litigation.

• Expert Witness in GP Clinical Negligence.

• Author, Transcultural Medicine; Dealing with patients from different Cultures, Religions & Ethnicities.

• Former GP & Paediatrics Clinical Public Health Medical Officer, London, UK.

Dr Bashir Qureshi

FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG,

Hon MAPHA – USA, Hon FRSPH

• Expert Witness in Cultural, Religious & Ethnic issues in Litigation.

• Expert Witness in GP Clinical Negligence.

• Author, Transcultural Medicine; Dealing with patients from different Cultures, Religions & Ethnicities.

• Former GP & Paediatrics Clinical Public Health Medical Officer, London, UK.

Page 2


According to the theory of “double doctrine” in philosophy, it is justified to do a bad thing to achieve good results; for example, to kill four hijackers to save 40 hostages. It is also possible to do a good thing to achieve bad results; which may be intended, for example, to close an expensive service or agency. In Britain, most things are achieved by evolution than by revolution. The aims and objectives to get results are usually planned one year, five years or 20 years ahead. The British politicians are clever and often trained in Oxford, Cambridge, Edinburgh and London Universities. They are mostly of real British origins and very loyal to the British flag. Money makes the world go round. Today, Britain is facing shortage of money and austerity measures, in good faith, are essential. Let us look at five actions which look very good for patients and General Practitioners (GPs) but are amicably reducing the number of GPs, their services, cost of medications and referral to hospitals, as intended, while making patients feel powerful, happy and supportive.

Patient Power and Patient Associations

A patient can complain against a doctor but a doctor cannot complain against a patient. Every doctor is believed to have taken “Hippocrates Oath” but no one has ever done so because it involves a student to give money to the teacher’s family for lifetime. Similarly, a diagnosis is mostly based on symptoms and signs which suggest a number of different diagnoses and the doctor chooses one that is most possible. Medicine is a science but a diagnosis is an informed guess, except in a few cases such as a fracture of a bone. No diagnosis can always be right but the patients are encouraged to expect it to be always right. This expectation is the basis of increasing complaints against doctors, who indeed experience stress which if repeated makes them leave the practice or licence to practice.
Patients Associations are being used by the Government to monitor GPs performances and General Practice facilities. They are also being used by Doctors’ Royal Colleges and Trade Unions as an umbrella. Patients are making demands and complaints to Employing Authorities, General Medical Council and Courts. It is now an irreversible and manmade situation

Care Quality Commission visits General Practices

The patients’ feedback, often less complements and more complaints, is a compulsory requirement by the Care Quality Commission of the NHS. Every GP Practice is forced display a poster in their waiting room, for patients, how to complain and to whom. Surprised and planned visits take place by trained medical and non-medical inspectors skilled in finding faults in every surgery where possible. They question every member of the Practice staff rigorously. Practice instruments and oxygen cylinders are checked. The premises must be very clean all the time. These adjustments need more staff, time and funding. There is no extra funding or manpower given by the CQC or Employer Authorities to these Practices. The findings of good and bad grades, after inspections, are displayed on the internet for the whole world to see and assess the competency of GPs.

Annual Appraisal and five yearly Revalidation of every GP

No one but no one can pass examinations or appraisals for Revalidation at all times. There are instinctive personal reservations as well, based on factors such as age, gender, social class, culture, religion, ethnicity, university or medical college. If an examiner likes an appraisee for any reason, he/she may move goal post towards the candidate but if there is a dislike, the appraiser would move the goal post away from the appraisee and keep moving. For example; patients’ feedback survey and patients’ audits were not essential for self-employed Locum GPs as they were not employed by any practice which can let them access patients’ notes after consultations were over. Now, it has been made compulsory for Locum GPs who have to leave practice or licence to practice, as a result. The agencies who support them have limited influences. These GPs cannot help themselves. Even God helps those who help themselves.

The current situation is similar to what happens to overseas doctors who wish to practice in the UK. In 1960s, when junior doctors were needed to look after war wounded survivors, about 18000 South Asian Doctors were trained abroad by the British and they were all given work permits, by the Ministry of Labour, to work in the NHS hospitals. They were given Certificates of Acquired Rights to practice in the NHs as General Medical Practitioners. The MRCGP became compulsory only when they were all over 70 years of age. When there was no further need, the PLAB test by the General Medical Council was introduced. I am not sure whether the pass rate depends on the posts available in the NHS but I feel that it may be a possibility. We can be proud of our politicians for their skills.

Computer control of Prescribing by GPs

If a GP decides to prescribe a medication, a statement appears on the computer to either change the prescription to a cheaper drug or to give NICE (National Institute of Clinical Excellence) guidelines to forbid prescribing. For example; no prescribing of bonjela; oromucosal gel, for mouth ulcers. No more any prescriptions for Ibuprofen tablets or gel allowed for osteoarthritis pain. No antibiotics prescriptions unless a condition of infection gets worse; sometimes, it may be too late. Some patients, especially with pain or infection, become very angry with the GP as they have waited a long time to get an appointment and now no pain or infection reliever given. Patients’ feedback survey, which is mandatory for a GP’s Annual Appraisal and five yearly Revalidation, becomes very negative. Patients may use the information, provided on the Practice Notice Board, about how and whom to complain against the GP and the Practice. Patients put negative comments on the Practice page on the internet. The GP remains helpless and distressed.

Control of GPs referral of patients to hospitals

A Locum GP saw and examined a woman patient with pain and tenderness in right lower abdomen and gastric region for 3 days, getting worse, and suspected “acute appendicitis”. He rang a surgical registrar of the local hospital. It was usual that such an emergency was investigated and treated at hospital, where investigation staff, time, skills and admission facilities were available. This was particularly relevant when an operation was needed. The surgical registrar advised the Locum GP firmly that he should do an ECG and a pregnancy test, and then ring him. It was an evening surgery with 10 minute per patient appointments. Only one receptionist was helping patients. There was no ECG machine and no pregnancy test kit was available and it would have taken a long time. The waiting room was full of patients waiting anxiously for their turn. The locum GP had to write a letter and send the patient to A&E Department to save the patient’s life. I hope that it happened. Currently, these hospital doctors on call are advised to insist that GPs should manage emergencies in their GPs surgeries. This is a Pandora’s Box opened to risk patients’ lives and litigation against GPs.

Moreover, GPs’ non-emergency referrals are firmly scrutinised by a team of referral controlling trained doctors in local CCGs. Many referrals are sent back to the GP. This reduces referrals to hospitals which can remain open only to treat patients referred by local GPs. These austerity measures would reduce the number GPs and increase risks to patients’ lives. There is a case for the Private NHS today. The patient power and British politicians would soon decrease doctors’ orders or disorders in a NICE way to save money.

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