I AM not sure if people are aware that at present GPs are being asked to vote on a new contract, except it is not a “vote” but A non-binding poll. Whilst stating it maintains the GP as an independent contractor it is designed to create a system where support staff employed by the NHS are led by the GP as part of a team. The health board will reimburse staff wages directly employed by the GP, who in turn will have a set salary range. Recruitment and retention of doctors – which was the raison d’etre for these changes – will mystically follow, along with a strategy of “talking up” the profession.
I see several problems and many. The structure of this contract will effectively leave GP’s as zero contract employees, a strict salary range and responsible for paying and providing their own holiday cover, and both the ex-chair of the Royal College of General Practitioners (Scotland) and HMRC agree. If the practice needs to adjust its staffing level then this will only be possible should the health board be in a position to reimburse it.
The support staff who should take some of the burden must be found. Patients with back pain for instance will see a physiotherapist at first point of contact – should the patient choose to – but the physio cannot write a sick-line (sorry-fitness note) and so one consultation becomes two.
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There are some positive ideas in the proposal but at its core GPs will inevitably lose autonomy. That may not seem important until you realise that it has often protected patient’s rights.
There is habitually a knee-jerk reaction that GPs are over-paid for a salary similar to a head teacher without the holidays, but much of this is frustration over the service provided, not meeting expectations where patients are unaware of how bad the staffing crisis is. Practices are closing, partners not replaced, ever increasing demand and complexity of care with fewer and fewer doctors.
Slag off your doctor, moan about their pay, remember that about one-third of GP’s will retire in the next five years and get ready, because lack of autonomy also means limited responsibility and power to effect change. When you complain to your GP about the NHS and problems dealing with the hospital you may find that instead of an advocate who looks into it you are met with a Gallic shrug.
Denis Clifford,
25 Ladeside Drive,
Kilsyth.
SO SNP Health Secretary, Shona Robison has, this time, blamed black ice on missed A&E waiting time targets ("Lothian NHS misses target", The Herald, December 20).
Really? I suppose it makes a change from blaming Westminster for the SNP's apparent inability to support hard-pressed frontline NHS professionals. How about Nicola Sturgeon’s friend, Ms Robson, admitting she has failed and resign? When will the SNP accept responsibility for its ten years of mismanagement of our NHS?
Martin Redfern,
Woodcroft Road,
YOUR editorial (“Support for drug users left in worrying limbo”, The Herald, December 21), is spot on. We have been here before – 30 years ago in Edinburgh. At that time the city already had the highest prevalence of HIV infection in the UK. The closure of a small central chemist, the only city shop selling needles and syringes, is thought to have led to the “shooting galleries” where limited equipment was shared and infection spread. It was in October 1985 that serology testing of stored blood revealed that half of injecting opiate-dependent patients were HIV positive – and effectively then living with a death sentence.
One response to this high risk behaviour was to persuade and fund pharmacies across the city to provide a needle exchange service. Another initiative was the advent of a community drug problem service and many Lothian GPs and practices were in the van providing methadone assisted treatment for their own addicted patients. The fact that these family doctors could also treat mental and physical illness and knew the families was a bonus of that approach.
Elsewhere, responses were afoot, in Belfast, where there was little addiction, sex education was rolled out in schools for the first time and in Bradford pharmacies offered needle exchange also for the first time.
While the long evening opening hours of the pharmacy at Glasgow Central Station seem likely to have been popular with those leading chaotic lives, a bus-delivered alternative holds good prospects. Perhaps the presence of an evening bus especially bringing harm reduction support as well would complement the effort from pharmacies elsewhere in the nine till six period. The NHS has a record of innovation to meet need in preventing illness, especially infection, and deserves public support and collaboration from the other bodies involved.
Of course the public deserve protection from discarded needles, especially in places of high density and when journeying to join families in the festive season. Opiate-dependent individuals belong to families too, often the source of heartache and pain for the way there lives have changed. Addiction is an illness and there must be very, very few who prefer the risky diminished life of heroin searching and shooting-up to the health and lifestyle the rest of us enjoy as normal.
Philip Gaskell,
Family doctor,
Woodlands Lodge,
Buchanan Castle Estate,
Drymen.
THE saddest part of the pro-abortion letter you published today (December 22) from a group of signatories must be that "Abortion is vital, routine healthcare". What kind of society believes that poisoning unwanted pre-born babies is "health care?
Since there is nothing medically wrong with the mother or unborn child then calling it health care is to play with language. A progressive policy would be to tackle the causes of abortion and not resort to the primitive and barbaric policy of killing the unwanted.
Brian McKenna,
Overton Avenue, Dumbarton.
THE letter published regarding the abortion pill being available at home states that "abortion is vital, routine healthcare".
I wonder if an aborted foetus would agree. But of course they aren't able to voice an opinion.
Michael Watson,
74 Wardlaw Avenue,
Rutherglen,
Glasgow.