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.

It’s them or the Tories. Much of a muchness 🤷‍♀️

That was part of the settlement when setting up the NHS that GPs would be allowed to be independent operators as they didn't want to be employees. Maybe time to review sit?

So being a bit more circumspect about spending plans and more aggressive on reform and efficiency would seem to be a much more sustainable approach

And where, after 14 years of austerity - where services have been already cut to the quick in the name of “efficiency” to the point that many public departments can’t deliver basic levels of service, buildings and roads are literally falling apart, prisons are unmanageable and nurses and teachers are burning out - do you propose we should make these extra “efficiencies”?

Reducing bloat has its place, but we passed that point long ago and the proof is there to anyone who’s not privileged enough to be insulated from it that the UK’s public infrastructure is severely malnourished. So you suggest we get a starving person healthy by putting them on another diet?

A big part of the reason we ended up in this state is because we trusted the private sector to invest instead. Unfortunately, given the inherent monopoly and low profit potential involved, that got neglected because, as business 101 teaches, shareholder profit should be your sole responsibility. Which brings us to…

Being wedded to nationalise things is an expensive folly

I’m sorry, but we have private water companies letting things rot, instead taking out huge amounts of debt to pay dividends to stakeholders even when the business is FAILING and you come on here and talk about folly?? Quite frankly, how could things be worse?

Bravo @Badaboop !!!

The model of GP services isn't really the problem. It's that for decades the NHS has failed to invest in primary care and there's not enough GPs to provide an adequate service. Removing administrative burden would only go so far. GPs can only see so many patients per clinic. British GPs, IIRC, see 2x as many patients a day as their Canadian equivalent and the UK spends less as a percentage of GDP than comparable nations.

Arguably we could think up a better model of GP/primary care services but it will be nothing but paper if we don't have the people to staff and implement it.

What taxes would you have raised? There's a black hole in the public finances and nothing left to cut.

Actually I think the basic model of gp services - with the GP as the gate keeper to specialist services - is deeply flawed. I also think the limited nature of the service - nothing at night, nothing at the weekend, no evening appointments- makes it fit for purpose. We need more gps, no argument there, but we need a greater input into how their time is deployed.

So, especially if we compare the NHS to other systems: the NHS relies on GP as gatekeeper more than others. Many countries require some degree of referral to specialist care, at the very least to weed out the completely unnecesary, but the role the GP takes on in determining a referral is much more interventionist and UK GPs are expected to do more at primary care level and keep patients from accessing specialists. Changing that would also require more staffing for secondary care.

The thing about off hours services is that the heaviest users of GP services are available during ordinary business hours and you also need to staff the surgery to be open. I believe that when it was trialled it simply wasn't viable for many surgeries. The flaw here is 1) the changes to out of hours services made by Labour and 2) the UK has been slow to develop a good walk-in/urgent care system to fill the gaps between GP & A&E. There's been some progress made there.

But it's simply not true, is it? Come on now.

If your business is doing well enough to have a minimum wage for vet nurses of 40k and 50k for vets, then it seems very peculiar to me that you are forced to sell out because paying your lowest earners the new minimum wage with NI increase will force you to sell.

It doesn't quite add up, and it cannot be both that the business is absolutely flourishing, but at the same time you cannot afford to pay the new NMW and NI increase, whilst your partner also isn't even able to take home the going rate of pay for his role, and you need to sell.

You have a large client base because your consult fees alone are less than it generally cost even 15 years ago (and I'm talking in very poor, deprived areas of the North West of England here). You cannot find the extra money because you are selling yourself short.

You don't need to be VetsNow, there is an in-between of where you're at with fees now, and them.

I understand though, it's easier to blame the poor working class (of which you most certainly are NOT) and their minimum wage, than it is to take a look at yourselves and where you could improve your business.

I'm currently one of these 'unskilled' working class workers many describe on this thread (after a spectacular fall from grace and not being a low nor a high earner, due to an illness and disability), and yet even I can work it out in 2 seconds flat.

And yes, as I've said before, it can happen to you, in a flash. I've seen first hand how hard the fall from grace comes crashing down. I'd imagine it's all the more a sore landing when you consider yourself above others in class, as too many on this thread, do.

I, and others like me, are not to be blamed for your poor business decisions.

Do you also need to pay your lowest paid workers a wage they can live on?

Oh, I'm all for people getting a eage that they can live on. My comment was was off-topic, I'm afraid, in response to some daft "rich doctors playing golf" stereotype.

I don't think gp practices should be bloody businesses. They are a fundamental part of our health system and should be properly financed by the state!

@Pizzapup as I’ve said a dozen times, not every business has £130K randomly available.

Please stop tagging me - I feel shit enough about this budget as it is, I don’t need people like you and that other one being nasty. It’s not necessary. I also never blamed the ‘poor working class’ - I blamed increase in business rates and increase in ALL costs. Please learn how to read - it’s not hard - as well as investing in manners and empathy.

@Pizzapup i also never said anyone was to blame. As it is, this budget means I’ll never have to work again because of the money from the sales - because vet practices will never not be attractive investments. Even if we can’t sell as a practice we can sell the prime real estate. So I’m ‘winning’ - it’s the working class who will suffer when costs everywhere go up! I’m upset for them - not for me or my DP 😉

Op you were pre the press really picking up on this but you are not alone

I also wonder what will happen with social care. It’ll push up prices but for councils too? They are struggling as it is

www.bbc.com/news/articles/c79z87wzv2no.amp

@knitnerd90 "The model of GP services isn't really the problem. It's that for decades the NHS has failed to invest in primary care and there's not enough GPs to provide an adequate service. Removing administrative burden would only go so far. GPs can only see so many patients per clinic. British GPs, IIRC, see 2x as many patients a day as their Canadian equivalent and the UK spends less as a percentage of GDP than comparable nations."

It is not the NHS that has failed to invest - the NHS can only invest what it has been given by central government. It was the government of the last 14 years that made a political decision not to invest sufficient in healthcare. Germany invests 30% more per capita each year on healthcare than the UK does - every 3 years or so Germany invests an entire years' worth more than the UK does, so over 14 years, this is an underinvestment in the UK of over 4 years' worth of investment. This is the real investment black hole facing the new government - and it is duplicated in the police and justice system, in social care, in education and in local government funding and much more.

All so that Hunt (who told the NHS that balancing the books was more important than treating patients) could keep taxes low for his chums, and drive those who can afford it, and many who can't afford it, into the greedy jaws of the private health providers. In any other country, allowing the waiting list to reach over 6 million - more than 10% of the population - would have seen the minister responsible being booted out on his arse, never to be seen in a position of responsibility again. In the UK, he was made Chancellor, a position from which he could smirk while telling Parliament and the voters that he was not going to make any money available to fix the cock-ups that he himself had caused.

Good post @Havanananana

Yes, Kemi!

Now I feel newly optimistic that this shower of a Labour Govt will prove a one-term affair.

Rejoice!

Why are you so keen on the possible return of a party which for the last 14 years has systmatically dismantled the UK, mismanaged the country, taken it out of the largest,most unified trading block on the planet, destroyed public services and despite having the responsibility of governing for the benefit of all of the population has spent 14 years deliberately making the rich richer and widening the inequality gaps in wealth, education and opportunity?

Why are you now, after just 4 months, so dismissive of the government trying to get to grips with the shit-show that they've been handed?

What would you like to see happen instead - and who do you think is capable of delivering it? [Clue - it's not Kemi and her Tufton Street minders]

Serious question - what exactly is a ‘shit-show’? People use the expression liberally and I would like to know its origin and its etymology.

To your question - Labour’s actions in four months, has already shown me the absolute horlicks they are making of this country. The Tories needed to lose the GE unfortunately - just so they could reset, and so the electorate can see what a disaster a socialist government is. I hope and pray that Kemi can be the proper leader the Tories need.

I despise Labour with every fibre of my being - their hypocrisy, their attempt to buy the public sector vote, their grovelling to the unions, their economic incompetence, their pettiness (WFA and PS VAT)…

Let the firing gun start on their slow and inexorable demise.

Rejoice about what exactly? The Tory party were in power for 14 long years and the UK dramatically deteriorated during that time. What exactly are you celebrating about?

See my PP above.

If you think The Tories will suddenly change their spots and that Kemi will be 'a proper leader', you will be sorely disappointed. Heavens knows what you think 'a proper leader' is anyway.
The reality is that they are both Neoliberal parties, are very similar and that this political thinking has been and will continue to be a disaster.

@EverythingAllatOnceAllTheTime

Happy to be if service. Here’s the top result on Google from Dictionary.com, which you can look up yourself to confirm:

Shit-show
Noun: US Vulgar Slang
A situation or event market by chaos or controversy

Given broken promises over Brexit, Boris and Truss’s behaviour, the state of our water supply, schools literally crumbling, lack of capacity in prisons meaning they have to let prisoners out early, just to name but a few, I feel the criteria for “chaos” and “controversy” have been adequately met.

Note: whatever you may feel about this state of affairs personally, governments generally don’t receive the absolute bloodbath the Tories got at the last general election unless they’ve seriously upset the general population. I mean, Brown inherited an illegal war in Iraq and saw the banking crisis on his watch and Major had Black Wednesday and sleaze scandals by the bucketload, but they still survived by a better margin than Sunak’s government. Drubbings like that are rare. The fact the Tories experienced one has a reason.

It’s awesome to have a political scientist on this thread, thanks.

Happy to help @EverythingAllatOnceAllTheTime!