Monday, 5 October 2015

Crocodile tears ....

Today the Gruniad is crying crocodile tears that young doctors, who feel no attachment to the NHS having been saddled with in excess of £60,000 in student debt, are walking away to better paying jobs overseas. Of course the Gruniad would like to blame the Tories and their new contract imposition on Junior Doctors or the Juniors Doctor's lack of commitment to the NHS, white washing over the insidious privatisation by other means of the UK's NHS every UK Government has been pursuing since the late 1980's while the British Medical Association acted in a Bishop Nemier like manner;

"First it was the opticians and the BMA said squat
Then it was pharmacy and chiropodry and the BMA said squat
Then it was the dentists and midwives and the BMA said squat.

Now it is 'medicine' and the BMA are squealing like stuck pigs."

Blair's 'competitive tendering' to provide ccompetition between hospital trusts was a fairly fat wedge which lead inevitably to the point where the Tories are now. In the 1990's the dental profession tried to warn the medical world of what was coming their way having watched NHS England Dental contracts being squeezed past the point of no return but the BMA said the UK Government would never do to NHS medicine what they did to NHS dentistry in England. Well all I can say that the BMA's head in the sand attitude has worked out well, has it not?

It is a pity the Gruniad has stayed silent over the last 3 decades while most of the damage was carried out under Thatcher and Blair's NHS England 'marketisation' reforms, damage which brings us to this point where the NHS England's future work force is walking away at a rate all the Nurse Practitioners in the world can not cover, even if they could be trained in time.

NHS Scotland was only turned around when Holyrood politicians remembered the NHS was about delivering patient care and not about political dogma. Whether Dugdale likes this or not the truth is NHS Scotland's turn around has much to do with the stripping out of Labour's NHS Scotland 'competitive' health market, to expect all the problems in terms of manpower and PFI facilities created since the mid 1980's in NHS Scotland by Tory and Labour policy can be resolved by the SNP since 2007 is just one of the many NHS myths her and Ruthie's wittering fails to address while being, unsurprisingly, ignored by the Unionist media. The amazing thing is how since 2007 the SNP have managed to change the direction of NHS Scotland by the amount they have, given the inherent inertia in an organisation of this size. 

The problem is the future of GP services under Labour's plans were so bad that no young doctor would consider being a GP, as a result there has been a long standing shortage of GP trainees in Scotland. It is this shortage combined with the 'baby boomers' of the 1950's and 60' coming to retirement that is creating the current GP crisis in Scotland, not any current inept governance. Simply put, there are not enough GP's in Scotland, their work load is excessive because of this key fact, the cost of joining a medical practice as a partner is seen as prohibitive (medical practices are private partnerships of doctors which take on an NHS contract to provide NHS care), all which combines to make GP practice even less inviting to young doctors already looking down the barrel of a £60,000 debt. The Catch 22 here is, if no new doctors buy into existing practices the medical practices close down, as is now happening across NHS England, leaving the local Health Boards, Trusts and Authorities with major problems achieving their own core, legally binding, provision targets for GP coverage.

The exit of Junior Doctors is not all about money, it is also about job satisfaction which is increasingly in short supply in the NHS across the UK because political dogma rather than patient need has been king since the late 1980's.

NHS Scotland's own decline has not yet bottomed out but at least the decline has been slowed almost to a stop. The issue of the resolution of future GP services provision in Scotland has a long way yet to go to address the inherent problem of young doctors not wanting to train as GPs but rather than bumping heads at least BMA Scotland is active in being part of the solution and has a government at Holyrood seeking to work with them to solve the problem, even if some of the solutions are not to the doctors advantage.


  1. You forgot how Thatcher shafted Registered Nurses in the 80s by introducing General Managers who sidelined and belittled what little influence and that they had. Clinical Grading was also a major factor in causing distraction whilst these changes occurred.

    1. The factors are many and complex but the impact of new management practices was ill thought through and failed to engage with the front line in NHS care, I could have used many examples but then I would have been writing a scientific analysis, with references rather than a piece seeking to help non NHS folk understand why the NHS is where it finds itself ... maybe one day I will write such a paper on why the NHS is now so F'd up but not for this blog .... in part it starts with the Bristol Royal Infirmary Paediatric Cardiac scandal in the mid 1990's and Blair's pathetic response to the radical changes the original plans for Clinical Governance would have implemented because they would have focused on patient need and not political expediency .... and involved New Labour in a lot of back tracking from them continuing the Tory privatisation plans dressed as mutton they inherited in 1997.

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  3. A unionist friend of a friend, who recently finished his nursing training in Scotlabd, reckons he cannot get work as a nurse due to lack of experience, which if true, I guess is reflected in many industries. Just wonder though why this is the case, if it is true. And, as a unionist, he is very negative about his homeland anyway. I can't stand that sort of Scotland baaadd stuff from people born and/or brought up here. I forgot to point out that at least he won't be left with a massive tuition fees debt, but no doubt he would still complain, SNP baaaaddd.

    1. He will find it just as hard to get vocational trainee positions in NHS England as one result of current UK Government NHS funding has been to reduce the number of VT trainee positions. Across the board whether doctors, dentists or nurses there are not enough VT positions for new graduates and competition for places is fierce.

      Your friend's "problem" is he is struggling to get a placement for this very reason. This is also part and parcel of the reason an increasing number of new UK grads across health care are heading out of the country.

      The really daft thing is a new grad from out with the UK can walk into a job new UK grads can not because of EU transferable skills regulations, this is the current nonsense underpinning New graduate UK health professional registration requirements and is why many of the Dental Companies behind NHS labelled practices recruit new graduates from Eastern Europe as it avoids the costs involved in VT training.

      While NHS Scotland has made more funding for VT available it is not sufficient to meet the full demand and the restriction is a result of Barnet consequentials.

      Further nearly 60% of new grads from Scottish medical, dental and nursing course are from anywhere other than Scotland but Scottish VT places have to be open to all new Scottish grads, most of whom will go elsewhere on completion of their VT program. Many students from England have latched on to this as a better option than going to an English Uni.