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.

The historic reason behind GPs’ perfectly reasonable decision to avoid becoming public sector employees was the wish to maintain medicine as a liberal, academic profession - like barristers.

The consultants were bought off; it was they who had their mouths stuffed with gold, to abandon professional freedom, not the GPs.

I think it would be a terrible shame to lose that important status for GPs.

https://theconversation.com/the-vast-majority-of-gps-resisted-the-founding-of-the-nhs-heres-why-226445#:~:text=GPs%20wanted%20improved%20pay%2C%20which,opposed%20to%20the%20salaried%20service.

Absolutely not my experience after over two decades in core NHS roles. Receptionists are band two, maybe band three if - as you say - they have significant additional duties.

It's not just me saying it; the NHS careers website agrees https://www.healthcareers.nhs.uk/explore-roles/wider-healthcare-team/roles-wider-healthcare-team/administration/receptionist And a search on NHS jobs reveals precisely 5 with the keyword 'receptionist' in band 4 or 5 (and only one of those is actually a receptionist role).

Whilst this is very admirable and kind - you're running a business, and with the economy the way it is, if you want to last you have to raise your prices. There is an in-between, somewhere more than undervaluing your business and its services to such a degree, and less than charging over the odds like Vets Now.

Does your practice employ other vets that perform OOH duties? I'm assuming their salary reflects that, if they're paid fairly? So, you should not be charging absolutely 'nothing' for an OOH service. I'm confused why you aren't already charging extra, if even this was a nominal amount compared to the Vets Now that you reference.

I've not seen a consultation charge of £15, ever in my life, and let's just say that I'm older than 30. I've used chains, I've used independent practices, alike. Independent do tend to be cheaper, but again, I've never paid £15 for a consult in my entire life, it's always, always been more.

Again, it's very admirable that you are trying to keep costs low for the customer, and I assume you have a very large customer base as a result. However, the brutal fact is that this is why your business is failing - not because of NMW cost increase and NI. You don't have to be Vets Now - you just have to change with the times and increase the fee for your services.

Have you seen the yields blowing out?

In part it’s because the markets are pricing higher for longer.

Do you ever entertain a counter-Labour narrative?

"Would have helped if the NHS weren’t still paying off the £80bn debt Labour incurred last time for an investment of just £13bn. Yesterday’s announcement is only a portion of that."

Are you talking about PFI?

Because that started with the Tories. I'm not saying that they didn't take off under a Labour government, but they started with the Tories. A third of PFI contracts can be attributed by the last Labour government, a third to the Coalition government and a Third to the Tories.

Headlines reflecting this today. Most will notice that

I wonder how much this will impact Reeves’ tax and spending plans, I’m assuming the reaction wasn’t factored in

It wasn’t failing until this budget and still isn’t - we’ve had companies approaching for years to sell because we have such a large base (well over 800 routine appointments a week + at least two dozen operations a day across the two sites). We found a good gap in the market. We provide a good service and we did well out of it and were a a v. Good employer (most of our colleagues have been here 15+ years - if they weren’t happy they’d have left given how easy it is to find work as a vet). But finding £130K (bare minimum) before April will be impossible. Most posters on similar positions have to find less and won’t be able to.

My DP (and me before I quit) does OOH consults and then bills for any operations or medications and the appointment as a normal one (if indeed anything is needed - most of the time it can wait until morning) we don’t need to charge an extortionate OOH feed when we rarely get calls and when we didn’t need the money. Companies that do are all about greed and family run practices the same. Our ‘cheapest’ vet earns £50K. Our ‘cheapest’ nurse is on £40K. We pay our staff well.

As it is, we’ve approached a company to sell it to and expect an offer that will make my DP incredibly wealthy with the buy out and he’ll still keep his job (based off their last offer) and still be able to consult elsewhere etc. It’ll be the clients who suffers as a result of this. Not us. Not our colleagues. Our clients. So really I’m annoyed for them - doesn’t bother me or my DP in terms of finances - because once again labour have buggered over the lower-middle/working class. They could have taxed Amazon/ikea/John Lewis. But they didn’t

She was attempting a PR campaign prior this -
I know from my role.

I also said - before my temp MN ban - that the markets would influence policy. Some of the Islington tribe wouldn’t hear of it.

Increasingly hard for them to bang on about Truss.

Yes I’m sure re PR

For all the Labour pp on it’s the unfair media etc, it’s the market reaction that cannot be sidestepped in the same way. I have no doubt big efforts were made to avoid this by Reeves but extra costs won’t help.

Definitely, Eastern.

Reeves is handing out pay rises totalling £9.4bn for public sector workers – almost as much as the £10bn she is expected to raise from a raid on employers’ National Insurance that will be borne exclusively by private companies…

Black Friday?

Increasingly hard for them to bang on about Truss.

Not really. It’s not a good reaction but it was never going to be with all the borrowing.

“The rises in gilt yields and falls in sterling in recent hours and days are still far shy of what took place in the run up and aftermath of the mini-budget. This does not yet feel like a crisis moment for UK markets.”

That's all well and good but current set up doesn't suit patients and doesn't suit GPs. No one is happy. Patients are complaining they have to jump through hoops and are lucky if they can get an HCA appointment in three weeks. GPs are complaining they are overrun with patients and spending vast amounts of time trying to manage their dwindling budgets.

It's 2024 not 1950.

So.. people on minimum wage get paid a bit more and the employers who like to pay minimum wage aren’t happy.
I mean…really???

(government is evil like every other government we’ve ever had blah blah blah)

You ask our patience re Labour, now we ask yours re the market reaction.

Just watch.

I'm old enough to remember this argument being trotted out- almost line for line- when the National Minimum Wage was introduced.
In the end most businesses were just fine.

God forbid you should pay your cleaners more than they’re worth.

You’ve missed the point.

So you think that the Tories introduced austerity measures because of that joke note from Liam Byrne?

Jesus Christ.

Which is?

Not sure but the pre GE obfuscation pre electorate and this massive tax hike will be problematic for Reeves if it goes bad

It sounds like you have access to info, I can’t say how it will go. But Labour doesn’t have anyone to mop up or fix stuff

It's not "jumping through hoops" it's triaging patients so that Mrs Jones who is able to get to the surgery for 745 to queue up every Monday morning because she's retired and just wants a chat with a doctor gets seen by the appropriate people and referred to the appropriate agencies for her isolation while Mrs Bloggs with her poorly baby who finally fell asleep at 7am after a horrible night can still get an appointment with a GP that would previously have gone to Mrs Jones when they are able to call at 1130.

It’s in my earlier post.

If it helps, think of it this way: GPs’ independence is not the cause of stress on the system. You have to look to what’s imposed on them to find the causes of that.

We get very good value and a great deal of goodwill from the 25% of doctors who have never been NHS employees. At least one GP on this thread has spent time explaining why.

I agree with this. The vets I go too are independent and give fabulous care and value, if they had to increase their prices, I would prefer that than them being taken over, by a mile. I know money is tight for lots of pet owners, but even when money has been tight for me in the past, I haven’t begrudged a single £ of a bill. There has been a lot in the press lately about smaller vet practices being taken over, so pet owners like me know how lucky we are, and I will never complain what I am charged as I trust my independent vet literally with my beloved animals lives at times and certainly health, and whatever business it is, we all know costs rise.

I agree. And despite the claim that consultants were bought off with gold, their salary is very similar to the average GP partner income and they also provide a lot of ‘goodwill’ (aka professionalism). Though there are issues with their contracts too.

I think a lot of the issues faced by the nhs today come from the way it was set up and the compromises made to bring thousands of individual businesses together whilst meeting the interests of those who ran them.

Yields are breaking higher from open.

Up 1%.

Under pressure….