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.

OP, I live in a county town. When I moved here 6yrs ago, there were three GP surgeries. Now, there are none.

The nearest is six miles away, which equates to a £35 round trip taxi fare for my neighbour's sister (95), twice a week, because she's unable to physically get on a bus.

I am most definitely not a fan of Labour but I am relieved.

Yes the money needs to come from somewhere and working people are under too much pressure as it is. So I feel Labour have made some good choices with one or two exceptions.

That is rare praise from me. It was never going to be great for everyone!

There’ll be a lot of worried employers this morning, and a lot if jobs, Christmas bonuses, annual pay rises won’t happen this year.

Prices will also go up for routine things though (our cleaners who are contracted, for example we haven’t factored in yet). The firms we buy equipment for will also charge more as their costs will also go up. The £130K is just our NI, NMW and Business rate tax. It doesn’t include the above or increase in our insurance premiums as a practice, the costs of heating/electricity etc.

If it was simply that, we’d only need to charge £10 more and have 13,000 appointments and it would be (possibly) doable as between the two practices we manage just under 800 appointments a week so that would be about 18 weeks (factoring in Christmas closures etc). It’s the whack of everything becoming more expensive and at rates we can’t predict - the most responsible thing to ensure we’re not in a position in five months of needing to make redundancies (and being frank my DP is very soft and would want to give as good a package as possible) is to sell. We might ask some of our older vets or receptionists about retirement - but loath to lose their experience and it’s unfair to ask.

I’ll stop posting now as I’ve totally railroaded OPs thread! But I think the main point its not just the NMW increase people seem to think it is - and the assumption we’re all awful employers - it’s everything. And these are issues every other business will face as well.

I don't see nationalisation of GP helping. If GPs are all simply paid to work sessions, they will see pretty quickly how much extra work the GPs have been doing in addition to these 'sessions'. Who will do all that work now? The service will be far more expensive to run if you don't have GP partners who are invested in the business and salaried GPs who feel some loyalty to said partners. They will also have to pay for managers to manage each practice, something that GP partners do a huge amount of as part of running their business.
This is exactly what happened with the out of hours provision the last time we had a Labour government. They thought that they were paying GPs far too much to provide this and decided to run it separately. It ended up being considerably more expensive.

On the Government who trashed everything before they left office and pickpocketed the public purse?

I don’t agree with everything Labour are doing and OP has highlighted an issue that most of us probably hadn’t thought about. But you can ‘t pin this on a government of only 4 months.

Is it still great for workers if businesses have to reduce staff levels or close entirely?

This is the problem I think. This govt tends to think of business as Starbucks, Tesco etc whereas that’s far far from the truth.

But the NMW increases etc are just inflation. Any business should plan for inflation its not new it happens every year.

I am not surprised, running a pharmacy is so tough now, lots of unavailable medication so companies who can provide this are charging extortionate amounts, these are really important meds too such as anti-psychotics, there is the ability to reclaim some costs but not all. It is Brexit that has caused that though and now with all the increased overheads, Pharmacy staff are working their arses off to get their hands on life saving meds that are no longer readily available.

Entry level pharmacy assistants are on around £12 an hour, so there will increases there plus those above them which will cause more pressure.

People who run small businesses are working aren’t they?

And the OBR have already stated high majority of extra cost will be passed to employees - they are working people I assume

Exactly. Some people seem to be focusing on the fact that GPs earn more than them and just showing their unpleasant jealousy instead of seeing the big picture.
There is a much bigger picture here to the regular NMW rises and NI increases. Lots of people are going to be made redundant just in time for Christmas and ongoing. This will simply escalate already rising unemployment further.

I'm just going to answer a few things and then I'm not going to post anymore.
An quite surprised by how little doctor bashing just the few usual comments.
I don't earn a salary. My profit share varies hugely from year to year. Our accountant tells us repeatedly out income is reducing in real terms and the practice is not really sustainable.
Not every GP is earning loads just cos your mates friends are doesn't mean we all are.
I have some years made a decent income. I believe I deserve it. I'm not justifying that.
If course we have a manager. Honestly I wonder how people think sometimes. He runs the practice. However he is an employee too. He also cant magic money out of his arse. Ultimately it's my responsibility to provide the service and pay my staff. My name is on the contract.
How GP practicee run and how they came about and are funded is a wbole other thread and just too complicated for here IMO. But we have a monopoly contract we can't pass costs on or easily increase income. And the GP contract has had minimal uplifts for many years.
I can and do other things to reduce burnout. I now only work 2 days in the practice. I work in my special interest field employed by the trust. I also work GP OOHs. Both of those jobs are fare more enjoyable, far less stressful and better paid.
I like many many GPs have a ridiculous sense of loyalty to my practice, my partners, my staff and my patients. I could of course just walk away. The thought makes me sick and sad. My young/new partners aren't quite ready. If I resigned they would probably decide to hand the contract back. Our area would really struggle as one practice has already closed in the last few years.
For those of you who think this is down to us just being rubbish, there are many practices in this boat. The days if fat cat partners are long gone. If you truly believe managed practices or private ones will be better , you're in for the surprise of your life.

This happened under a conservative government though.

You have to ask what the BMA are actually doing, what the health secretary has achieved.

We're under labour in Wales, believe me it's no better here. But the Spire have built two new hospitals in three years in my area. They're dealing with NHS overspill as well as private patients.

And GP's are missing the fact that working people can't be available at their convenience. Take a simple phone appointment. I have to be available from 1pm to 6pm. I work full-time in a professional job too and have a diary like jenga. The GP expects to speak to me at their convenience. There is no hope of me seeing them at my convenience. The telephone appointment practice means I cannot access the NHS care for which I have been paid.

What stops a Dr from ring fencing time for telephone appointments as they seem to prefer them? Nothing except the fact they have zero respect for the time of the patient.

After a bit of blustering for their Tory owners most of the these business will be fine.

I'd go private in this instance

Oh come on! I'm not even a Labour supporter and that is just a ridiculous comment.

We won't get anywhere by bashing those who, on the whole, are trying to do a good job in exceptionally difficult circumstances. The fact is that the current model is the same one that was established at the very beginning of the NHS. It has not evolved to flex and meet the challenges of an ageing population. There's a whole raft of policy decisions required to address the issues that GPs, and their patients, face. Yes, a major one is whether NHS Trusts take over the management of GP practices, as has happened already in some cases. Another is the training, recruitment and retention of GPs. Another is how we utilise modern technology to improve patient experience, outcome and satisfaction.

All yesterday's NI and NMW increase has done is highlight that there are businesses that exist that straddle private and public sectors that are in desperate need of reform. I am sure the Government knows this, and given that it has a vested interest in protecting and investing in the NHS, I think reform will happen.

Op, yesterday's news might feel like the final nail in the coffin, but the reality is that you've been treading water for years and change is needed to address it, not a government shying away from NI and NMW increases that may ultimately lead to much better investment in broken public services. In your situation, I would be contacting your MP to highlight how many years of inadequate and ineffective policy has left your surgery at danger of collapse.

You seriously have absolutely no idea do you. I have literally just listed all those costs over the last 4/5 years that have increased way above inflation. I am talking small to medium businesses here, not bloody Amazon. It is impossible and anyone arguing any differently have absolutely no idea of the issues many businesses are facing since lockdown.

OK yeah they can close but then all those people are out of work, plus the huge knock on effect to suppliers etc. They are working their arses off to keep things going. Laying people off is awful.

It certainly isn't the same as being an accountant or solicitor. They have to treat their clients with respect else not get paid. If their staff were rude they would be dismissed. They are also far more accountable to their clients when things go wrong.

To be fair I moved about 18 months ago from a shockingly awful GP practice and the new one seems to operate to much higher standards both clinically and in the context of respect for the patient. Services are pretty inaccessible though.

We need improved productivity & better wages. We’ve had no investment for years, taxes were going to have to rise & they are never going down.

Perhaps you could elaborate on the 'good choices' theyve made ?

Your question was perfectly reasonable. The sneering tone of OP's response was not.

You might not be employed by a business but you must know people who are

OBR have already majority of costs will be passed on to employees