To think this budget will finish us off

[BurnoutGP]

I am a GP Partner of over 20 years. I am now senior partner for the last few years. We have seen year on year below inflation funding increase. With an explosion in demand and massive shift of work from secondary care. We have issues wirh recruitment.
Our partner income is shrinking year on year. We are now always overdrawn and this gets worse every month.
We just cannot soak up the MLW and NI without adequate resource uplift.
I think we will be done. I'm so very tired of the constant battle and the demand and anger while working "part time" 60hr weeks.
We will have to hand back our contract. And we wont be the only one. That will leave one surviving practice in my area.
I'm done.

This awful Government does seem to be a complete nightmare.

The GP practices weren't co plai ing when they were making a surplus from public money and investing it into new buildings etc which were privately owned assets.

The op has said they are 10k overdrawn every month. And the new build they had been promised pre covid did not happen.
This is not.labours doing . They are just trying to sort the mess the torys left

There is no way I want my children to do medicine now and I’m from a medical family. Something has to change.

Our public infrastructure is chronically underinvested. Cutting taxes across the board isn’t going to fix this. Whether there’s a “black hole” or not it’s blatantly obvious to everyone bar the most cosseted that we need money to pay for more houses, healthcare, roads, railways, prisons, state schools, etc, etc.

Tax less and let the private sector provide has been the Tory way since the Eighties. And look where it’s got us. If the private sector can’t - or rather won’t - invest in the vital, yet not naturally profitable, elements of society, then the money has to come from somewhere.

I really don't know why the minimum wage has increased yet again. It increased significantly not too long ago.

Inflation and crap salaries in general. £12.21 next yr is the equivalent to about £9.50 in 2020 and £6.50 in the early 00s. I earned more than £6.50 in my retail job back then.

Are doctors and lawyers good at running businesses? Some are fantastic at it and some are rubbish. There's actually no reason a doctor or lawyer would be bad at running a business - it's a skill set to learn like any other and I'd suggest that people who aren't interested in learning that skill set probably don't become partners in a GP practice (or partners with business responsibilities in a law firm) - it's not like it's a career requirement! For those who are interested and decide to learn how to do it, most will be perfectly capable of learning because we're talking of a group of fairly bright people (particularly doctors). Of course some just won't get it but that applies to a lot of people who are in business management roles generally!

I love the assumption that nationalising would solve the issue when history shows that nationalised companies aren't magically more efficient (if anything the opposite) and the NHS itself is a complete shit show (massively because of funding issues but also because it's an insanely beaurocratic beast that no one can work out how to get to work efficiently). Economies of scale should mean that nationalising would work better than individual GP practices. I have my doubts it would in reality.

So many of the issues GPs face require major investment (particularly the insane IT inefficiencies) and a commitment to have one centralised system so that everything can actually talk to each other. But I also have no faith that in the NHS's ability to implement large scale IT projects (and again - we have history of failure and wasted money on a massive scale here).

I'm sorry OP. I can't really add anything to that. The one thing I'll say is that if you can't make it work, you can't make it work and shouldn't feel guilty. It's not up to you personally to prop things up.

I am flabbergasted that Labour have chosen this policy. Yes they can’t keep taxing workers but honestly why clobber businesses like this?

They shouldn’t have done both. NMW increase and the NI changes together is obviously going to create huge issues.

They needed to increase tax take and this is the more palatable way of doing it.

Yes they can’t keep taxing workers but honestly why clobber businesses like this?

By default it will hit some workers just not obviously so.

Well yes many will lose their jobs, and most of the costs will be passed on somewhere.

We still have considerable labour shortages particularly in health and social care, hospitality, construction. An ageing population is only going to exacerbate this, hopefully people will be able to find other jobs or upskill rather than remain unemployed.

And of course some businesses will fail, many will be able to pass the cost onto their customers and many won’t.

The country voted for Tories and austerity then Brexit.

We voted to make ourselves poorer and reduced economic growth in return for "control".

We made our bed so...

Yes, sorry to hear this OP.

A loss if you quit/retire early.

I’m so sorry OP. I’m also sorry you’ve been forced to show receipts here and are arguing against people who are pushing ideology rather than sense. This isn’t labour vs Tory, as some are making it out. It’s a gp, who helps people for a living,worried and stressed. It’s another business which might shut down, which serves the community and has employees with families to feed who may lose their job. ignore the ideological zealots and the armchair know it all here in MN.

I do think a lot of businesses are going to really struggle.

Thing is OP is probably paying herself a salary (with the personal allowance it wouldn’t make sense not to, I’ve know business owners who’s salary is exactly the personal allowance which tbf you can’t live on) , the profits from ownership will be taxed as dividends so not income tax levels.

OP are you saying your business is making going to make a loss this year? Dipping into overdraft doesn’t mean making zero. Or that you are going to make less profit?

Also I’m not a left wing, this isn’t a political point.

Exactly!! It’s hardly groundbreaking! My husband was a hospital consultant for many years, don’t remember anyone hanging out the bunting when he diagnosed their cancer!

Thing is about economic growth - it also won’t happen if we have an uneducated, sick population where regions are poorly connected.

The UK has experienced poor growth and productivity for somethings like 40 years, under both Labour and Conservative governments. A single budget assessed over only 4-5 years won’t give a U-turn in growth or be able to be delivered by ANY party.

Plus you have to look at the global situation and how it impacts our economy.

I made this point yesterday about my DPs practice (vet). He needs to find £130K and I was told ‘just have him take home less.’ Then I was called greedy and wealthy. His salary is well below what he’d earn if he didn’t own his practices.

Ultimately, we’ve spent all night discussing what to do - because we can’t just find £130K, after he’s been paid and we’ve reinvested in new equipment, insurance etc, we about break even (and he doesn’t even take home the salary he’s worth) - and decided we’ll likely sell out to big corporation and if that doesn’t work, redundancies.

Ultimately, customers will find their vet bills sky rocket - a lot. But it was a choice between that or laying off two vet nurses/ two junior vets and some of our receptionists OR raising prices ourselves but the money flow from that would take time to help balance the books (time we don’t have).

It’s not just about increase in minimum wage or increase in NI - business rates are also going up, so that’s going to hammer everyone (including your local independent shops etc). People who think this is a good idea have no idea the implications for this on small high stress shops. It’s going to be bad.

By all means, raise taxes from businesses. But do it to multi-million pound profit companies like Next, John Lewis etc - not your local shops

You’re flabbergasted that a labour government have increased minimum wage?

We are living well beyond our means, and have done for decades, and no one is able to face up to it…

I can't speak to NI specifically but the NHS model for general practice has been under such stress that the tipping point is surely near, and a decision about how to create a sustainable primary care service has been punted. If NI doesn't do it, something else will.

Plenty of countries have privately operated GP surgeries operating under different health service models. In some countries they are paid fee for service (you bill per visit). The NHS pays on capitation; each patient is worth a fixed amount of money for the year. Some doctors want the autonomy of being a GP partner; others want the stress of running a practice off their back. The issue for the NHS specifically is that there's increased demand for primary care services and decreased funding. The result is that GPs get expected to do ever more for the same money. The result of THAT is that fewer GPs want to work full time (since "part time" is really full time) and fewer want to be partners. That can't be fixed easily by changing who manages the practice. Nationalising them may become inevitable if more and more surgeries can't find partners, but it won't fix the fundamental issues, and it will install a new and less flexible management layer.

As an aside, in the USA, Centene is notorious for its bad practices. They specialise in sectors with poor finance and then figure out how to turn a profit on the backs of people's health.

However the NHS as a whole needs a massive re-organisation,

https://giphy.com/gifs/bbc-one-uk-uFiaMyDjtxoE6Q1gCU