Wednesday, January 25, 2012

Have Pay Rates Peaked for Locums?

Despite what we might read about in the daily mail (other equally contrite newspapers are available for GP bashing) the average pay of GPs has gone down in real terms in the last few years. It probably peaked with the onset of the new contract around about 2005.

However several factors have eroded the pay of partners – increasing costs such as rises in running costs eg heating and lighting (although I have yet to see a practice with solar panels), increasing staff costs and the recent pension rules changes that mean the practice has to pay the employer pension contributions of not only their staff, but their own pension contributions – and of course this is to increase soon. Locum costs of course factor and these have gone up by about an average of 20% since 2005 in my area.

The BMA lists the average net pay of GPs as going down from £102k in 2005 to £96k in 2009

Now of course as a locum of course I am keen for locum costs to go up, but is there not a danger that we are pricing ourselves out of work? As practices look towards ways of cutting costs they will look at how they can rearrange workload, perhaps using nurse practitioners, or salaried GPs even more than they do. Add this to the increasing number of GPs that seem to be coming out of training and the increasing number of training practices with an extra pair of hands. There may even be a shift back in locus towards having more partners - although this is a double edged sword for locums

But I have seen, perhaps for the first time in many years, a few fallow days and I am aware that this year has seen in my locality, a big swell in locums looking for work. This at the same time as the local trust is looking to save money, and one of the (arguably short sighted) ways they are likely to cut costs is to reduce the monies they pay GPs to come out of practice for various reasons temporarily.

Of course there will always be a need for locums, but I predict that the average fee a locum can expect to negotiate will perhaps either stagnate or even go down over the next few years. It's simple supply and demand; Hungry locums are going to be willing to undercut their competitors. There has always been an interesting relationship between fellow locums – we seek each other out for some peer support and mutual moaning about practices – but at the end of the day we are competitors and are not going to starve ourselves so that others may binge. It's symbiotic at times of plenty, but competitive at times of need.

It's not clear if as many GPs as have threatened to will take retirement as the pension rules change, but this of course may change the locum landscape again favourably. For as long I can remember I have been reading about the impending shortage of GPs, as the medical politicians parade their doom-mongering on sandwich boards around the medical media. It has never happened and I see no reason why it will happen this time.

That doesn't mean i am about to dust of my CV and browse the jobs section of the BMJ. I do locum work as a lifestyle and professional career choice, not just to make a living. I love the variety of systems, people and socio-economic areas that I encounter. But in the back of my mind there is a little anxiety about the future – although this is a familiar feeling for locum GPs.

Sunday, January 8, 2012

Trouble at Mill

18 months ago I received a piece of mail I guess we all dread. A letter from the GMC – I could tell from the thickness of the envelope it wasn't just a reminder about impending fees – a thick brown envelope – and i was pretty confident it didn't contain a bundle of cash. It didn't, it detailed that a patient had complained about me to the GMC.

The complaint was, I guess, justified – in that i had over stepped a professional boundary. Lest your minds concoct a scenario worse than it actually was, I will briefly explain what it was about. In a dark and bad time of my life I had misinterpreted the friendliness shown to me by a patient as something more than just pleasantness. I had subsequently looked up the patient on facebook and invited her to be my friend socially. There was nothing lurid, sexual or offensive and she hadn't alleged anything of the type.

She had done what was right and complained about me to the GMC as it had made her feel uncomfortable

I don't condone what I did, nor do I hold any ill will towards this person. I should have known better. My thinking was coloured. I had justified it in my own mind as acceptable – albeit flirting with the rules – in that I would never see her again as a patient ( for various reasons, which I will not go into, I was never going to work in the practice again) and I had only met her once – in what was a fairly simple medical consultation. She wasn't depressed or vulnerable; I was merely reaching out the hand of friendship

That as I8 months ago, so what happened after that? Well in my mind i had visions of impending doom, financial ruin (never far away anyway), suspension, front page headlines in the Sun, being unemployable, and my various employers suddenly not requiring my services and so on. Actually what happened was a whole lot of nothing. I continued getting work, although one or two practices stopped booking me, but the majority of practices didn't stop. To those that continued employing me I will be forever grateful. It wasn't just the income, although that was important. It was more the personal endorsement that I was not bad at my job.

One of the problems as a doctor is that you are not just a person who works as a doctor; it's your whole identity, the one thing you are trained to do, something you have worked years and years to achieve. The skills aren't particularly transferrable. So when your work life is in crisis it affects your whole being. So when practices and out of hours GP practices continued to employ me (which i hadn't expected them to do) it not only continued to provide me with income, but with a little self belief.

Months went by with nothing, until nine months later another letter arrived through the same letterbox saying that my case had been reviewed and no further action would be taken....although there was a caveat. In the past I had been to occupation health to be assessed as being fit enough to return to work after a bout of depression following the breakup of a relationship and this had been mentioned to the GMC when my employers were given the opportunity to comment on my performance

The long and short of it was that the GMC now wanted access to my occupational health records and because of my previous depression and admission that I might imbibe a little too much wine – I would now have the be assessed by two consultant psychiatrists. Another 9 months passed before I could finally put the matter to bed

I tell this story not to defend myself – as I did wrong, not to berate the GMC or the complainant. But I feel it best to be open and honest about the events that have shaped my professional life. Perhaps others in professional strife – be they doctors or otherwise – will find some comfort in them.

And yes..there are some chinks in my armour!


Wednesday, January 4, 2012

I love the signs that find themselves adherent to various walls in GP surgeries. Some surgeries seem to manage without them, whereas other practices seem to use them as wall paper. Of course they are all there for a reason of some sort. I will give you a sample of some of those that i have seen

    "any patients more than 10 minutes late for an appointment may not be seen"

    "violence or aggression towards staff will not be tolerated"

    "please switch off your mobile phone in the surgery"

Of course these are examples of signs which express some of the major problems or irritations that GPs face. There is no doubt that a few select signs can remind patients of their obligations – but if a whole wall is wall papered with signs they sort of lose their effect

Perhaps surgeries would be better placed drawing up a patients charter which patients are expected to sign before they can register

    "As a patient of this practice i agree to –

  • Turn up on time for appointments
  • Let the practice know if I am unable to attend an appointment (prior to said appointment)
  • Only request a home visit if i require to be seen and am only able to attend the surgery due to immobility caused by severe illness*
  • Request home visits by 9am in the morning
  • If i do have a home visit – before the doctor arrives - to switch off the TV, clear the house of smoke fumes, keep the hounds locked away and ensure the number of my house is clearly visible from the road
  • Attend to my personal hygiene before presenting various parts of my body to be examined by a doctor
  • Order prescriptions on time (ie 48 hours or more before they are due)
  • Not expect miracles**
  • Keep my children under control
  • Not sell the medication I am prescribed
  • Provide only decent wine or whisky or chocolate as presents at Christmas to my hard working GP

*examples of reasons that do not justify a home visit; awaiting a delivery (beit a dfs sofa or a baby), car broken down, bad weather

**examples of miracles that GPs are currently unavailable to perform on the NHS include; shortening hospital waiting times, reducing the caloric content of all the food you consume, getting various parts of your body enlarged or reduced, giving you a kick up the arse, making your spouse listen to you more and so on

By using such a charter practices could make patients aware of what is expected of them without affecting the feng-shui of their practices. Practices with too many notices not only risk hiding the important notices with overkill, but also too many messages simple gives the impression that not only are they struggling to cope with their workload and education of patients, but that they also are unhappy and negative persons – and of course we all know they are happy and enthusiastic caring individuals...or something like that

However i would like to share my all time favourite notice

"Only two complaints are allowed per consultation"

Really, that's impressive! I struggle to generate even one complaint per consultation – even on a bad grumpy day!