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.

As sad as I am for you, I think it is for the best.
Maybe they can nationalise GP surgeries with some of the £20bn extra.
GPs never should have been privatised to begin with.
The government knew the types of people that go into healthcare would bust a gut and drive themselves into bankruptcy or a breakdown rather than see patients suffer. It was done to save money off your back and the backs of other GPs.
It needs to be brought back into the NHS and properly funded and staffed.

OFGS. The budget happened today. There is no "give it three months". They have told us today what will be happening.

You have clearly never run a business that employs people. Or paid rent. Of course you need to know what you're doing in three month's time 🙄

Not allowed to offer private services at the gp practice to your own patients like this.
it’s so stupid.

heavily penalised for renting out a room too

Then if they can't cope, and I'm not surprised they can't, they are doctors, not business administrators, its time for the NHS to absorb all the GP practices, apply economies of scale and standardise the service.

Then the doctors can get back to what we want them to do, and I'm sure they want to do, practice medicine.

It would seem to me to make sense for GPs to just be employed by NHS rather than run as separate businesses.

(And I say that having sat in meetings where three different sets of lawyers and surveyors and"managers" sat, along with GP partners , for endless hours to negotiate just one lease of on GP surgery)

Also some GPs seem to be raking it in (our local ones all have very nice cars and send their children to private school with my kids -which is great but suggests the "business model" creates huge inequalities in healthcare and remuneration for health care)

I am not a GP but from a GP household.

I think some GPs would like to be on salary, and others would find it demoralizing. Loss of autonomy in practice can be a big deal in skilled professions, and I think you could easily end up with bureaucratic, poorly run GP surgeries.

Not all doctors are interested in or good at business , but the ones who are tend to be where you see new models and such developed first. The state just tends not to be dynamic in that way.

There are also other things that could play into it - for example, in places where there are GPs on salary, they often don't see very many patients compared to fee for service type models. (Again - this has down and upsides. Good to give each patient the time needed, but then, it's already a problem to have enough GPs for all.)

I think a European model is more likely to be fruitful that this kind of increased centralization.

I work for a charity in a paid role not much above NMW. Increases to minimum wage and NI will have a huge impact. Many of our projects are funded by the government and there is no increase in funding year on year (even with inflation or NMW increases) but they expect the same level of service as “agreed” and for us as a charity to absorb the additional costs of staffing etc. where’s the corporation tax?

Yes, they have, but why does that mean that you cannot 'now afford to keep employing our staff at the hours they are currently doing'. Did you just want to be extra dramatic by implying the impact would be felt overnight?

It’s not economies of scale that help big ‘gp companies’ it’s using less experienced staff and employing unqualified PAs or insisting you see a nurse rather than getting near a GP!

Somebody has to pay for the absolute shitshow the Tories left us with. Everyone always wants someone else to pay.

Should I just drop them in it in three month's time?

I’m sorry, we do need to lobby government re: the fact you can’t apply for employment allowance (the subsidy that small businesses and charities get to soak up the NI costs). At the moment any kind of public sector or those with public sector contracts as their main work aren’t eligible but smaller organisations like dentists and GPs do need this subsidy.

I didn't say I was poor. I said it would make my practice unsustainable. Or do you think I should work for free?
I can be pretty sure you will be one if those screaming at my poor receptionists on the phone because they can't do exactly what you want/demand

Wells Churchill supposedly said, governments trying to tax their way to growth is like standing in a bucket and trying to lift yourself out by the handle.
I get that the politics if envy works, but the job of governments is to provide opportunities, not gerrymander outcomes. Why would I bother with all the shit I do at work if I could just earn half as much for half the hassle and more than half the take home.

The Tories were rubbish, but don't forget that when Labour last left power they left a note saying "sorry, no money" which started Camerons austerity measures to rectify that, but it never did.

The employment allowance relates to total employer NI payable of £10k, not individual salary. So if you have more than about 4 members of staff on minimum wage you’re not covered. There can’t be many businesses, especially in hospitality, that have fewer than 4 members of staff.

They took over one of the practices in my area….

It now costs and EXTRA 43% to run, patient satisfaction is through the floor and they try to register elsewhere in droves.

The government have no idea how much work is unseen in GP and how much goodwill is used there.

Which has nothing to do with the minimum wage being put up again.

That's absolute nonsense. This is what businesses do: as soon as their profit is taxed a little bit more, they all say they go bankrupt, realy?🤣 What a big, fat lie. Are you telling me that you are overdrawn $10k every month? Haha. Who in their right mind would run a business with such a hole in their turnover?

Have GPs ever been “nationalised”?

I thought this was just hyperbole, until I quickly punched a few numbers into a calculator and was surprised to see that you are actually correct.

£12.21 an hour at standard 8 hours a day and 5 days a week provides a salary of over £25k a year. Definitely on the lower end of the spectrum, but I have seen jobs with "PhD" listed as a requirement advertised with £25k salaries within the past few years. Though no doubt, those have been not-so-good employers who have sought to recruit foreign people who sadly don't know any better.

Then as you said, these are unskilled positions, so their work tends to stop once they clock out. And then they have the option of overtime shifts. So an unskilled worker who takes on a bunch of overtime and works 6 days a week will find themselves earning a good £30k salary.

Now all of a sudden, I think the living wage is a bit bonkers. All people should be able to make ends meet, but why are unskilled workers being paid so much relative to people who complete skilled work, or who have degrees, or who have professional registrations, or who undertake annual exams or professional development? Makes absolutely no sense.

The fact that Drs receptionists are hired on the basis of being as rude and obnoxious as possible is another thread.

Should have put 2p on income tax and I have voted labour my entire life. Employers NI and uplift in minimum wage will have huge impact on everyone. Business will reconsider expansion or scaling up, reduce staff numbers or staff hours, be reluctant to take on new staff. Rise in income tax, which no one would like admittedly, spreads the burden more equally and is far more straightforward. And the outcome would be more known.

If you can't afford to pay your staff a living wage something needs to change.

Really, after that Tory shit show . . . get real 😂