At Least Some People Are Keeping Up With Hpi

[Guest muttley]

Am I correct in assuming that all money collected on prescriptions is paid to the relevant authority and the pharmacist is reimbursed by the authority for the retail price of the drugs, and in fact in some cases the authority could make a profit for themselves between the prescription charge and the cost of the drugs.

Yes. The £6.65 prescription charge is a tax and has no relevance to the cost of the drugs prescribed. So, for instance, the pharmacist gets a prescription for 28 atenolol 50mg, he/she collects £6.65 for the prescription, but when he/she submits the prescription receives 86p (cost of 28 atenolol 50mg) plus a dispensing fee of about 96p minus £6.65. If the £6.65 went to the pharmacist I would be long retired and posting this mesage from the Bahamas.

Incidentally, if you pay for your prescriptions don't be afraid to ask if it would be cheaper to buy the item over the counter. The pharmacist usually makes more profit from this anyway.

[Smell the Fear]

Yo Dog

which year(s) did you fail to get into medical school?

[Guest Charlie The Tramp]

Incidentally, if you pay for your prescriptions don't be afraid to ask if it would be cheaper to buy the item over the counter. The pharmacist usually makes more profit from this anyway.

Was there not a case where a pharmacist was doing this and received a visit in the middle of he night by government heavies who issued a severe warning and broke a leg.

[dog]

Yes. The £6.65 prescription charge is a tax and has no relevance to the cost of the drugs prescribed. So, for instance, the pharmacist gets a prescription for 28 atenolol 50mg, he/she collects £6.65 for the prescription, but when he/she submits the prescription receives 86p (cost of 28 atenolol 50mg) plus a dispensing fee of about 96p minus £6.65. If the £6.65 went to the pharmacist I would be long retired and posting this mesage from the Bahamas.

Incidentally, if you pay for your prescriptions don't be afraid to ask if it would be cheaper to buy the item over the counter. The pharmacist usually makes more profit from this anyway.

Hmmmm! I would be interested to see what the prescription rate per visit is for a GP with his own pharmacy is versus one without. Also, is a doctor with his own pharmacy motivated to proscribe more expensive drugs than one without?

Yo Dog

which year(s) did you fail to get into medical school?

No, I never made it to medical school. I was not smart enough.

[Guest muttley]

Was there not a case where a pharmacist was doing this and received a visit in the middle of he night by government heavies who issued a severe warning and broke a leg.

Gosh I hope not!

There was a case of a pharmacist from Telford who was dispensing NHS prescriptions as private if the patient wanted. He charged £1 for a course of penicillin instead of the prescription fee (£6.65 today) He was hailed as a hero by the public, but the powers that be put a stop to it, and he was warned he could be struck off! The reason given was the prescription form (FP10) was NHS property!! He was accused of stealing bits of paper.

[Guest muttley]

Hmmmm! I would be interested to see what the prescription rate per visit is for a GP with his own pharmacy is versus one without. Also, is a doctor with his own pharmacy motivated to proscribe more expensive drugs than one without?

I don't think there are any figures for the prescription rate per visit for GPs with their own pharmacy. I know a few pharmacists who work in pharmacies where the doctors have a stake, and I've never heard of this going on. I suppose it must do in some cases, but I don't believe it to be rife. Believe it or not, most GPs will be motivated by giving the patient the correct treatment, rather than earning a few extra pence from a dispensing fee. Patients have the right to take the prescription to any pharmacy they choose. In house pharmacies typically capture 70-90% of the prescriptions from their own surgery.

The pharmacy actually makes more money when the doctor prescribes the cheaper generic drugs, as he is able to obtain better discounts on these. Also, the doctors are given financial incentives to prescribe generically thus saving money on the national drug bill. There is currently an effort being made to switch patients on atorvastatin (Lipitor) to the cheaper alternative generic simvastatin.The treatment is considered equally effective, but saves the NHS about £20 per patient per month!! The pharmacy makes more profit from the cheaper alternative.

I wouldn't dream of suggesting a doctor change a prescription to a more profitable alternative. I suspect he/she would do the opposite, just to be bloody minded.

[sell2rent]

I receive no direct (*) benefit for prescribing atorvastatin ("Lipitor") instead of simvastatin. However, with present recommendations for patients with heart disease suggesting total cholesterol targets below 4mmol/l or even 3.5, it is very rare to be able to achieve this with simvastatin. I would strongly fight any attempt to change any but the best controlled and lowest risk patients from atorvastatin to simvastatin.

(*) One reason we get all of our Coronary Heart Disease quality points as a practice is the aggressive use of statins, often expensive ones. We could never do it on simvastatin. Here, happily, practice income coincides with best patient management. I would still oppose a change to inferior statins if there were no quality points attached and have done before!

Locally, we can thankfully still choose which three prescribing changes we'll implement each year. I'm happy to change patients between PPIs (stomach acid pills) to save money, and various presentations of generics etc where there is truly no clinical deficit to the patient.

Edited December 10, 2006 by sell2rent

[flatnose]

The following article, written by a junior doctor in Nottingham City, the hospital where I work, appeared in the New Statesman in October 2005. Its author, Mark Jopling, is one of the least popular doctors in the land, at least among his colleagues, but he is also, of course, correct.

New Labour has bunged billions at the NHS over the last few years, and the staff, nurses as well as doctors, have pocketed the lot. They haven't worked any harder - NHS productivity has fallen by up to 1 per cent per year since 1997 according to the Office for National Statistics in 2004. In fact productivity has fallen over all the public sector, so the private sector must be working a lot harder - national productivity is steadily rising.

Meanwhile public sector pay continues to rise faster than private? Public sector workers hang on to their tax-funded pensions after early retirement, while the private sector is asked to work till age 67.

Poor Dr Jopling is taking heat from his medical colleagues just now, but the private sector workers who pay the tax that keeps the doctors comfortable will understand.

Jim Thornton 12 Nov 2005

I am one of the least qualified, least skilled and lowliest paid doctors in my hospital. My days are spent searching for missing heaps of patient notes, running errands and chasing up blood test results. I am a ‘junior house officer’, a useful but dispensable cog in a vast machine. Despite my humble position I am paid a whopping £37,000 a year.

If I became a consultant the taxpayer would be sending me home with at about £90,000. Were I to prefer a nine-‘til-five job as a GP then I would be raking in a fat £100,000, more if I played the system well. The overstretched NHS budget sets aside enough cash to ensure that the doctors’ car park is packed with luxury cars and that we can leave the chaotic communities that supply our hospital for big houses in the charming villages and estates out of town.

We are quick to justify our pay with a battery of compelling arguments: we work hard, I know that from experience; we have big responsibilities, I know that from watching my seniors; we are also well qualified and have to endure a protracted training, both in university and on the job. But teachers, social workers and other professionals in the public sector work long hours too, some of that at home and unrecognised. While peoples’ lives don’t depend upon their decisions, life opportunities and security do. It is unfair that our salaries dwarf theirs.

In medicine there has been a long-standing acknowledgement that nurses work hard and are under paid. A nurse starts on a relatively modest £16,000 and works regular nights and weekends. It is usually nurses that give patients the most support during their stressful times in hospital. If a nurse reaches the very top and becomes a nurse consultant then he or she will just about earn what I do now. This pay inequality does nothing to ease our occasionally stormy relationship. The unseen, grey-clad auxiliary-staff who work so hard to keep the wards clean receive a piffling sum. Doctors have succeeded masterfully in condemning this meanness while never questioning the justice of their own salaries.

Amazingly no one objects to our pay, but then we hide the numbers so well behind a tangle of pay bands and percentages that it is unlikely that anyone really knows the scale of the opulence. Also who is going to criticise the pay of such awesome lifesavers.

Writing this will certainly earn me a few enemies, doctors enjoy the money they earn and most feel that it is well deserved. They will not appreciate someone suggesting that their salaries are on a scale that is unjustified and reflects badly upon their motives for joining their profession. To our shame there has not been so much as a whisper in the medical press questioning the generosity of salaries, only a clamouring for more money.

Could doctors pay be redistributed to the more stingily paid members of the health professions and other public sector workers to reflect work load, training and responsibility rather then assumed social standing? Bringing some pay equality into the public sector would thrill those who rightly feel underappreciated. Maybe money freed up could go towards more drugs, machines or nurses, there are never enough. (Last week our ward closed due to a shortage of nurses, the doctors and beds sat idle.)

Alternatively that extra money could be used to address the social deprivations that the medical profession knows are the cause of so much ill health.

Some doctors would certainly rebel, throw down their scalpels, ditch their stethoscopes or fling their couches from the window. They would go private, go to Australia and go loudly. But when the dust settled we would be left with the doctors whose motivation was caring for their patients, and there are many of them. The vacancies created would be filled by the queues of doctors who are on the dole and later, by the hoards of clever sixth formers desperate to enter medical school.

Doctors have often compared their salaries to high fliers in the private sector. This is irrelevant, we are state funded service providers and a salary that befitted this role would be more appropriate than the present excess. We do work hard to for the patients in our community, but off the golden pedestal we have allowed ourselves to be placed upon we could serve them even better.

Mark Jopling. Reprinted from The Spectator

[dog]

Good post Flatnose. Doctor's pay does seem to be out of control and is probably much more than the tax payer can afford. They really need to be reigned back in.

[flatnose]

'Doctors pay themselves too much'

By Tim Castle Reuters 2007-01-19

London - Family doctors, who are now earning an average £106 000 pounds a year, should be taking less profit from their practices and spending more money on patient services, Health Secretary Patricia Hewitt said on Friday.

She told the BBC the government had not anticipated how much GPs' pay would rise under new performance-related pay contracts.

Official figures show that pay for family doctors rose 30 percent in the first year of the new contract in 2004 to an average of 106 000 pounds.

GPs work as small businesses and keep as earnings the surplus left over from their practice's income after paying running costs.

GPs kept 45 percent of their practice income as profit in the 2004-5 financial year, up from 40 percent the year before, according to data from the NHS Information Centre.

Doctors said the figures were not strictly comparable and that they will be earning less in 2007 after an inflation freeze and a rise in costs.

Hewitt said if the government had anticipated that GPs would increase the share of practice income they paid themselves as profit, it would have taken action to cap the proportion available.

The surplus could have been used for extra services for patients, such as better opening times, she said.

"We would expect them to go on investing a healthy share of the extra money from their practice in getting even better services for patients, including more convenient opening hours," she said.

Doctors have earned extra money because they have done better than expected in meeting government health targets.

They have won additional payments for providing services such as clinics for contraception, child health and chronic disease.

The contracts were agreed between the Department of Health and the British Medical Association (BMA), which represents doctors.

"It is quite true that neither the government nor BMA anticipated how much GPs would do in response to performance-related pay," Hewitt told the BBC.

Talks over this year's contract, due to start in April, have stalled over the size of the inflation rise the government is prepared to offer after a zero rise in 2006.

Hamish Meldrum, chairperson of the BMA's GPs Committee, said the rise in GP pay had been exaggerated and that family doctors would probably earn less this year because of rising costs.

He said there was a danger the government was seeking to scapegoat GPs for cost overruns in the overall NHS budget.

"The increases in GP pay were directly linked, at government insistence, to demonstrating the quality of the services they provide," he said.

"In saying she wishes, with hindsight, she had restricted their pay increases, Patricia Hewitt is effectively saying she wishes they didn't provide such high quality care for their patients."

[flatnose]

Now what really pisses me off is when a psychiatric nurse gets beaten to death by a patient because the trust cannot afford to buy security alarms or provide enough nurses to maintain a safe environment.

I restate my case: Doctors salaries are an excessive drain on the NHS and just to add a little spice to the argument I would state that they are getting almost parasitic!

[nevajism]

agreed, noticed this article in the indepenent recently (front page headline)

'Sick pay: Massive rise in GPs' salaries worsens NHS cash crisis'

http://news.independent.co.uk/uk/health_me...icle2145148.ece

it reckons the average gp is actually 118,000 rather than the 106,000 reported from other sources

[flatnose]

From the link from the last post:

Sick pay: Massive rise in GPs' salaries worsens NHS cash crisis

The average GP now earns £118,000 a year. This is a staggering rise of 63% in three years. And it gets better: instead of having to care for patients all day, every day, they are now just responsible during office hours (weekdays only). Is it any wonder the NHS is unwell?

By Jeremy Laurance, Health Editor

Published: 12 January 2007

Family doctors are lining their pockets in an unprecedented bonanza as they take an increasing share of the NHS's extra billions while wards close and services are cut back.

GPs' average earnings for last year (2005-06) rose to £118,000, according to estimates by the Association of Specialist Medical Accountants, a 63 per cent increase in three years. The average family doctor now earns, including private income, more than the Lord Chancellor, ministers of state, senior civil servants and circuit judges.

The soaring salary levels of doctors are worsening the NHS cash crisis. Two-thirds of NHS trusts are in deficit and have cancelled operations and extended waiting times. Primary care trusts, including those in Yorkshire, Sheffield, Norfolk and Surrey, have ordered GPs to delay referrals to save money.

Leaked documents published last week show the Department of Health is planning to shed 37,000 posts this year in an effort to balance the books.

Ministers have accused GPs of helping themselves to a bigger slice of the NHS cake under their contract introduced in 2004. Figures show the amount they pocket has increased from 40 per cent of the gross sum they are paid to run their practices to 45 per cent, leaving less for patients.

They are not passing on the full NHS funding increase to patients, at the same time as their workload has been reduced, ministers say. Until 2004, GPs took responsibility for their patients 24 hours a day, seven days a week. Their out-of-hours duties have since been reduced and they are contracted to be responsible for patients from 8am to 6.30pm on weekdays.

The shadow Health Secretary, Andrew Lansley, said yesterday: "The Government underestimated the cost of the GP contract to the tune of £200m in the last year alone. This has punched a black hole in primary care trust finances at a time when financial pressures through ministerial incompetence have hit an all-time high."

The Government defended the contract and blamed GPs for taking more than their due. A spokesman for the Department of Health said: "We invested extra funding in GP services in good faith to improve services and reward GPs. The money was not intended just to boost GPs' profits. We expect a higher level of these profits to be invested back into their businesses to bring about further improvements in services such as longer opening hours."

David Clough, chairman of the Association of Specialist Medical Accountants, said the pay bonanza was triggered when GPs scored twice what was expected on quality targets set under their new contract, such as the proportion of patients whose blood pressure was monitored. "That was wholly unexpected so primary care trusts were left struggling to pay", he said.

A member of the association, who did not wish to be named, said some GPs were earning twice the average income. The accountant said: "At the top end I have come across a few in the £200,000 bracket. The most profitable are the dispensing practices. If you have a dispensing practice you are running two businesses - a GP's surgery and a pharmacy. That really is a licence to print money."

GPs' rising salaries are part of a dramatic increase in spending on NHS pay. Last year, 47 per cent of all the extra spending on the NHS (£5.5bn) went on higher pay - for doctors, nurses and other staff. Hospital consultants earned £109,974 on average, up 27 per cent in three years. Nurses averaged £27,868, a 12 per cent rise over the same period.

Yesterday, James Johnson, chairman of the British Medical Association, defended doctors' pay rises as he warned the Government had "one more year" to save the NHS. Speaking at a press conference held at BMA House, Mr Johnson said doctors had worked harder than the Government expected and would fight any attempt to claw back their pay rise.

"One thing we will not tolerate is having these contracts whittled away. We will take an extremely strong line on a below-inflation rise for next year and we will not accept it."

Surveys show most patients are satisfied with the care they get from their GP but complaints are continuing about access. Difficulty getting appointments at convenient times is a problem. A survey by the Healthcare Commission found more than half of patients said they had difficulty getting through to their practice on the telephone.

The BMA defended GPs' pay rises. It said the Association of Independent Medical Accountants dealt with "blue-chip" GPs who had higher earnings than average. Hamish Meldrum, chairman of the BMA's GPs committee, said: "GPs are earning more but I still believe they represent very good value for money. The country gets good value out of its primary care services."

How doctors came into the money

* GPs have been enriching themselves by increasing the proportion of their budget they pay themselves and decreasing that spent on practices. They are paid a gross sum to run practices - hiring staff and buying equipment. What is left after paying these expenses is their "profit".

* In 2003-04, GPs earned a"profit" of £82,019 - 40 per cent of their gross earnings of £203,613. But in 2004-05, the first year of their new contract, this grew to 45 per cent.

* Between 1998-99 and 2004-05 the amount they spent on their practices declined from 62 per cent of their gross earnings to 55 per cent while the amount they took as income for themselves increased from 38 per cent to 45 per cent, figures from the NHS Information Centre show.

* Private earnings - fees for medical examinations, travel vaccinations, etc - amounting to a few thousand pounds per head, are included in these figures.

* NHS Employers, the body that negotiated the contract, admitted it was "disappointed" that the contract had "resulted in such significant increases in individual GP incomes".

* Changes in the way employers' superannuation payments (pension contributions) were made reduced the real rise for GPs by 5-6 per cent in 2004-05, and the proportion of their earnings taken as income by 1.2-1.5 per cent, the NHS Information Centre said.

* Gross earnings for 2005-06 are not yet available but average income for GPs is expected to be £116,000-£118,000, a 44 per cent increase in two years, according to the Association of Independent Medical Accountants, which provides financial services to 7,000 GPs.

* In 2002-03, average income was £72,324, according to the NHS Information Centre. The increase to £118,000 in 2005-06 is a rise of 63 per cent in three years.

[Guest Cletus VanDamme]

Now what really pisses me off is when a psychiatric nurse gets beaten to death by a patient because the trust cannot afford to buy security alarms or provide enough nurses to maintain a safe environment.

I restate my case: Doctors salaries are an excessive drain on the NHS and just to add a little spice to the argument I would state that they are getting almost parasitic!

Hopefully with the changes that are happening in healthcare provision we will, in a few years, be able to bypass GPs when accessing healthcare.

Here's how:

Privately run walk-in centres can deal with minor and acute cases, for which you pay a small fee to be seen straight away, as on the Continent. You grant them permission to access your medical record online (which you also have access to). They refer on to hospital consultants and their teams where necessary.

Chronic disease management is dealt with in the community by well-trained community nurses and therapists who can also prescribe.

GPs will eventually hoist themselves by their own petard. By pricing themselves out of the market, while simultaneously making it increasingly difficult to access their services (i.e. they'll only see you during office hours, and you have to go to them, which is the situation we have at present), they'll simply be irrelevant in the future as the public and the govt find other ways of doing local healthcare.

[crashmonitor]

Hopefully with the changes that are happening in healthcare provision we will, in a few years, be able to bypass GPs when accessing healthcare.

Here's how:

Privately run walk-in centres can deal with minor and acute cases, for which you pay a small fee to be seen straight away, as on the Continent. You grant them permission to access your medical record online (which you also have access to). They refer on to hospital consultants and their teams where necessary.

Chronic disease management is dealt with in the community by well-trained community nurses and therapists who can also prescribe.

GPs will eventually hoist themselves by their own petard. By pricing themselves out of the market, while simultaneously making it increasingly difficult to access their services (i.e. they'll only see you during office hours, and you have to go to them, which is the situation we have at present), they'll simply be irrelevant in the future as the public and the govt find other ways of doing local healthcare.

I think that being able to by-pass the GP would put more power into patients hands.I think at present too much time is wasted by GPs on minor ailments such as children's colds and women in their 20s monopolising life saving tests such as cholesterol to see if they pass the Carol Vorderman test.In the last ten years I have visited the Doctor once for an over 40 check up,despite having high cholesterol and a family history of youthful Richard Beckinsale type sudden deaths,no recall has ever been offered in over three years.I would just love to be able to walk into a centre and get a check up without feeling I was wasting the clinic's time,unfortunately women and parents do not have the same scruples and time is fatally rationed because of it.

Edited January 20, 2007 by crashmonitor

[flatnose]

Prescribing drugs to patients, then receiving profits from the NHS for selling the same drugs you have just prescribed is not exactly analogous to selling toothpaste. Why do you think all those drugs companies spend millions taking GPs & consultants on skiing trips and carribean holidays? Talk to a medical sales rep and ask them where they take their clients on 'conferences' and 'educational trips'. The drug companies don't take the GPs & consultants on these trips because they enjoy their company. Spending on drugs in the NHS represents well over 10% of the total NHS budget and has been increasing steadily.

Indeed, the government inquiry into the influence of the pharmaceutical industry lays bare the the vested interests within the NHS, Nice and Pharma. Basically the report found that the pharma industry tells the NHS what to buy!

Go to the link below for the report

The Influence of the Pharmaceutical Industry

[Smell the Fear]

The following article, written by a junior doctor in Nottingham City, the hospital where I work, appeared in the New Statesman in October 2005. Its author, Mark Jopling, is one of the least popular doctors in the land, at least among his colleagues, but he is also, of course, correct.

New Labour has bunged billions at the NHS over the last few years, and the staff, nurses as well as doctors, have pocketed the lot. They haven't worked any harder - NHS productivity has fallen by up to 1 per cent per year since 1997 according to the Office for National Statistics in 2004. In fact productivity has fallen over all the public sector, so the private sector must be working a lot harder - national productivity is steadily rising.

Meanwhile public sector pay continues to rise faster than private? Public sector workers hang on to their tax-funded pensions after early retirement, while the private sector is asked to work till age 67.

Poor Dr Jopling is taking heat from his medical colleagues just now, but the private sector workers who pay the tax that keeps the doctors comfortable will understand.

Jim Thornton 12 Nov 2005

I am one of the least qualified, least skilled and lowliest paid doctors in my hospital. My days are spent searching for missing heaps of patient notes, running errands and chasing up blood test results. I am a ‘junior house officer’, a useful but dispensable cog in a vast machine. Despite my humble position I am paid a whopping £37,000 a year.

If I became a consultant the taxpayer would be sending me home with at about £90,000. Were I to prefer a nine-‘til-five job as a GP then I would be raking in a fat £100,000, more if I played the system well. The overstretched NHS budget sets aside enough cash to ensure that the doctors’ car park is packed with luxury cars and that we can leave the chaotic communities that supply our hospital for big houses in the charming villages and estates out of town.

We are quick to justify our pay with a battery of compelling arguments: we work hard, I know that from experience; we have big responsibilities, I know that from watching my seniors; we are also well qualified and have to endure a protracted training, both in university and on the job. But teachers, social workers and other professionals in the public sector work long hours too, some of that at home and unrecognised. While peoples’ lives don’t depend upon their decisions, life opportunities and security do. It is unfair that our salaries dwarf theirs.

In medicine there has been a long-standing acknowledgement that nurses work hard and are under paid. A nurse starts on a relatively modest £16,000 and works regular nights and weekends. It is usually nurses that give patients the most support during their stressful times in hospital. If a nurse reaches the very top and becomes a nurse consultant then he or she will just about earn what I do now. This pay inequality does nothing to ease our occasionally stormy relationship. The unseen, grey-clad auxiliary-staff who work so hard to keep the wards clean receive a piffling sum. Doctors have succeeded masterfully in condemning this meanness while never questioning the justice of their own salaries.

Amazingly no one objects to our pay, but then we hide the numbers so well behind a tangle of pay bands and percentages that it is unlikely that anyone really knows the scale of the opulence. Also who is going to criticise the pay of such awesome lifesavers.

Writing this will certainly earn me a few enemies, doctors enjoy the money they earn and most feel that it is well deserved. They will not appreciate someone suggesting that their salaries are on a scale that is unjustified and reflects badly upon their motives for joining their profession. To our shame there has not been so much as a whisper in the medical press questioning the generosity of salaries, only a clamouring for more money.

Could doctors pay be redistributed to the more stingily paid members of the health professions and other public sector workers to reflect work load, training and responsibility rather then assumed social standing? Bringing some pay equality into the public sector would thrill those who rightly feel underappreciated. Maybe money freed up could go towards more drugs, machines or nurses, there are never enough. (Last week our ward closed due to a shortage of nurses, the doctors and beds sat idle.)

Alternatively that extra money could be used to address the social deprivations that the medical profession knows are the cause of so much ill health.

Some doctors would certainly rebel, throw down their scalpels, ditch their stethoscopes or fling their couches from the window. They would go private, go to Australia and go loudly. But when the dust settled we would be left with the doctors whose motivation was caring for their patients, and there are many of them. The vacancies created would be filled by the queues of doctors who are on the dole and later, by the hoards of clever sixth formers desperate to enter medical school.

Doctors have often compared their salaries to high fliers in the private sector. This is irrelevant, we are state funded service providers and a salary that befitted this role would be more appropriate than the present excess. We do work hard to for the patients in our community, but off the golden pedestal we have allowed ourselves to be placed upon we could serve them even better.

Mark Jopling. Reprinted from The Spectator

Mark Jopling is clearly a total bell-end. If he wants to be a saint why not give his "excess earnings" to charity, or volunteer to pay extra tax?

As a junior house officer on £37k he will have to be working 70-80 hrs a week when he wrote this. Which means his hourly rate is about 2/3 the national average wage. What a pr*ck to criticise juniors for taking this pay after years of training and expense (which is increasing all the time).

As for doctors swanning off to their large houses - it's the same story as the rest of the housing market. He clearly hadn't attempted to buy himself a 4 bed luxury pad on his £37k salary. Indeed, it would be barely possible in most of the country even on a consultants £70k salary.

Does he think "public sector" = "employment for people with a Mother Theresa complex"? I don't know if he has published anything since this article, but just perhaps reality hit the tw*t between the eyes and he realised what a load of balls he was talking.

Here is a response to his comments from a real doctor (Jopling had been working for a few weeks when he wrote the article): Telegraph letter

As for GP pay - that was the governments doing. The GPs are rewarded for hitting targets set by government. Don't blame the player, blame the game.

Edited January 20, 2007 by Smell the Fear

[Wario]

Hopefully with the changes that are happening in healthcare provision we will, in a few years, be able to bypass GPs when accessing healthcare.

GPs will eventually hoist themselves by their own petard. By pricing themselves out of the market, while simultaneously making it increasingly difficult to access their services (i.e. they'll only see you during office hours, and you have to go to them, which is the situation we have at present), they'll simply be irrelevant in the future as the public and the govt find other ways of doing local healthcare.

With any luck they'll spit their dummies, like the dentists.

I take the Baby Bowsers to the GP for the various compulsory injections and tests. OK, we're the innerest of inner-city areas, but what a freaking zoo! And the GPs are worse than useless for anything other than antibiotic creams or tabs, and methadone scrips. That's yer lot. One of them has a fearful rep. in the area's sheltered housing, allegedly accidentally offing crumblies by dodgy diagnosis and prescription. You should hear the oldies bitching in the shops! Everybody younger just gets told to come back in a fortnight if "it" (whatever) gets any worse. Nice work if you can get it.

I spend daft amounts of cash keeping my few crumbling teeth in my head. You don't say no to toothache.

No druggies, loonies and drunks there. Pourquoi?

[flatnose]

Don't blame the player, blame the game.

A lot of Nazis said that at the Nuremburg Trials!

[THE BALD MAN]

I think that being able to by-pass the GP would put more power into patients hands.I think at present too much time is wasted by GPs on minor ailments such as children's colds and women in their 20s monopolising life saving tests such as cholesterol to see if they pass the Carol Vorderman test.In the last ten years I have visited the Doctor once for an over 40 check up,despite having high cholesterol and a family history of youthful Richard Beckinsale type sudden deaths,no recall has ever been offered in over three years.I would just love to be able to walk into a centre and get a check up without feeling I was wasting the clinic's time,unfortunately women and parents do not have the same scruples and time is fatally rationed because of it.

In France there is no need to go to a GP you can go direct to a specialist. Also you can go to the GP of your choice. There is little evidence of abuse of teh system.

Gp's are mainly gate keepers restricting patients from getting care i.e a middleman with not much added value.

Why do you have to have a specialist referral then have to have the results sent to the GP?

[Smell the Fear]

A lot of Nazis said that at the Nuremburg Trials!

Is that the best you can do? What was your gripe again? You wanted to be paid £100k for being a nurse?

But that's never going to happen, so you would rather drag everyone else down. If it's so easy to be a GP why not just go and do it yourself?

[Smell the Fear]

In France there is no need to go to a GP you can go direct to a specialist. Also you can go to the GP of your choice. There is little evidence of abuse of teh system.

Gp's are mainly gate keepers restricting patients from getting care i.e a middleman with not much added value.

Why do you have to have a specialist referral then have to have the results sent to the GP?

You're right, because the patient always knows their diagnosis in advance, so can just go straight to the gastroenterologist when he gets severe stomach pains.

Oh, but it turns out he actually had a heart attack...........

If you had an NHS without skilled gatekeepers it would cost a huge multiple of what it costs now as everyone would approach a specialist with any minor ailment.

I'm not convinced that this is how the French system operates anyhow. Can you back this assertion up?

[shouter]

Yep. I studied for 8 years. I have the classic 3 degrees - a Bachelor and a Master of Science (both the top grade) and a Ph.D. I work over 60 hours a week for arguably the world's best technology company and I earn way less than half the salary of my local dentist or G.P.

I'm on a constant learning curve and I have a weight of commercial pressure that interferes significantly with my personal life. Work has to come first.

Doctors and G.P.'s get to repeat their basic skills over and over again without having to retrain, pick up a text book or ever suffer the frustration of a non-working piece of hardware or software on which your favour and hence your career seems to hang. My local dentist is strictly 9:15am to 4:30pm and he swaps his car every year (nothing smaller than a 5 series).

I haven't come into contact with one doctor who isn't involved in their skill development and professional development. Being competent in the use of new technology is a necessity if you don't want to get struck off for not knowing about contemporary developments in care provision.

But I do think there are fundamental flaws in how GP's earn money. As a midwife every woman I care for earns money for their GP. Their GP may never even look at them whilst they are pregnant. They may receive all their care from midwives and/or hospital staff. In fact many GP surgeries when a pregnant woman rings, tells them to ring the local maternity unit (even if the woman has a sore throat/diahorrea and vomitting/has an arm hanging off). But Dr GP gets a lump sum anyway. Likewise they receive payments for achieving targets attained by other staff within their practices, usually the practice nurses who hold all the preventative clinics. Do midwives and nurses receive more money in return from the GP's - NO!

[flatnose]

Is that the best you can do? What was your gripe again? You wanted to be paid £100k for being a nurse?

But that's never going to happen, so you would rather drag everyone else down. If it's so easy to be a GP why not just go and do it yourself?

Oh dear, press a button did I? Unfortunately we do not live in a meritocracy thus your arguments smack of immaturity and are fatuous. If you bothered to read my posts correctly, you will have noticed that I have never argued for a salary of £100k for being a nurse. GP's bellies are full, yet you are still hungry for more in spite for having a 60% increase in salary. The resulting wages are crippling the NHS. Indeed when my colleague is getting beaten to death because of a lack of resources, it can be argued that GP's bloated wage packets have contributed towards his death. It seems that you do not have the reflective abilities or the emotional intelligence to see through your arrogance, consequently your arguments rely on sarcasm and are without substance. You believe that you are worth the money. I, as do others, believe that GP's wages have reached a parasitical level and thus are detrimental to our health service. Indeed, your comment 'blame the game not the player' is a classic example of shifting your personal accountability for the latter and points to a subconcious recognition that there is indeed an issue here that you wish to distance yourself from.

[nevajism]

I take it you'd be one of the doctors throwing down their scalpals if mark jopling got his way his article certainly managed to wind you up. I'd imagine he regrets writing it already if his collegues are anything like you!

Mark Jopling is clearly a total bell-end. If he wants to be a saint why not give his "excess earnings" to charity, or volunteer to pay extra tax?

As a junior house officer on £37k he will have to be working 70-80 hrs a week when he wrote this. Which means his hourly rate is about 2/3 the national average wage. What a pr*ck to criticise juniors for taking this pay after years of training and expense (which is increasing all the time).

As for doctors swanning off to their large houses - it's the same story as the rest of the housing market. He clearly hadn't attempted to buy himself a 4 bed luxury pad on his £37k salary. Indeed, it would be barely possible in most of the country even on a consultants £70k salary.

Does he think "public sector" = "employment for people with a Mother Theresa complex"? I don't know if he has published anything since this article, but just perhaps reality hit the tw*t between the eyes and he realised what a load of balls he was talking.

Here is a response to his comments from a real doctor (Jopling had been working for a few weeks when he wrote the article): Telegraph letter

As for GP pay - that was the governments doing. The GPs are rewarded for hitting targets set by government. Don't blame the player, blame the game.