大象传媒

Basically like all politicians,you are saying that he is going to fudge the issue.
Therefore there will be no real change at all,could this be called spin?????
Sounds like it to me,so much for change then.

It's wrong to say Gordon Brown must fight with doctors to improve out of hours access, or that you can be on the side of either doctors or patients but not both. I take it you mean people want to be able to see a doctor about a non-urgent problem at an unsociable hour. I don't think GPs are adverse to this idea but simply would want to be paid more for working more at unsociable times. The reason the current GP contract is generous is because nobody wanted to work as a GP. It was necessary to make the job more attractive in order to recruit enough suitably qualified people. Rather than bashing GPs and accusing them of costing too much money for doing too little work, it would be better to have a public debate about what as a country we want from the NHS. If we want to be able to see a GP for a non-urgent problem at all times of day or night then we must be prepared to pay for that.

With respect to being "on the side of" patients or doctors, you are creating a needless antagonism between two interdependent groups. Nobody becomes a doctor without a deeply held sense of a duty to sort out peoples' problems and make their lives better. Every doctor I know goes out of their way to help their patients and does not complain aboutworking late/ starting early/ being busy etc etc. Everybody will need their professional expertise at some point or other. It is in each and every one of our interests to support and respect the medical profession and pay them well as we want to attract the best and brightest as our doctors if we want our health to be cared for properly.

I am a junior hospital doctor myself - so probably not an unbiased opinion, but one with sick and elderly family members with a lot of experience of the NHS as a patient's relative

This government finds itself in a paradox, mostly, though not entirely of its own making.

The public want the right to any treatment which has half a chance of improving their life quality and extending life expectancy, no matter what the cost.

Much of the NHS expects the right to be able to dispense a service based on similar principles, especially the one about improving life quality ( eg pay and working hours) for those who work in the NHS.

The government, whilst not exactly promising quite that level of service, hasn't clearly said ( apart from generalities like shorter waiting times) exactly what can be expected for a given level of expenditure in a given time-scale. Probably because they have no proper plan themselves. They have thus spent and committed for the future huge amounts of money for ill defined service qualities and then wonder why so many feel shortchanged. They have as in so many other areas failed to comprehensively spell out clearly what they expect to achieve, by when and at what cost. Which also includes spelling out what the public won't get unless more funds and or time are allowed.

They seem incapable in any area of expenditure to be able to get things done on time or on cost to an agreed quality. Something as specific and well defined as the latest submarine was four years late and heaven knows how much over budget and it thus wouldn't be surprising if God let alone Gordon Brown has no idea when and what the NHS IT project will finally deliver, let alone the eventual price tag.

Basically the government have failed at basic planning, failed at budgetary management of the plan and failed to communicate and manage expectations clearly with either set of stakeholders.

Would you want these people running your business?

well, he could start by breaking the control that the clinicians currently have inside the hospitals.

it is because of these highly-paid and highly-vocal professionals at the top of the informal hierarchy (ie. the consultants) that costs have run out of control, and department heads have inflated staff numbers for their own aggrandisement.

GPs do get a lot of money for not much work. Lets face it, the BMA agreed to support the govt. reforms in return for substantial increases in pay linked to 'performance', and we've all seen the results. How the BMA can speak with any authority, when all they are are a union for Doctors first and foremost. I don't see ANY other union having so much control and influence in any other part of the public sector.

I agree that most doctors do got out of their way to help patients, etc. as the junior doctor below has stated. This does not excuse the tactics that some GPs have used to meet pay-related performance targets, knowing full well that they are reducing the quality of care and access in order to increase their income.

Get real, doctors can be like most other professionals, you get influence, you get power, and then you make sure you look after yourself first.

In comparison, look at how badly nurses have been treated in the last couple of years. And all we hear from the doctors, GPs and consultants is me, me, me.

The government are hoist with their own petard - because the situation has become: 'New week; new NHS initiative'.
I agree with Clare Thornton that it is not a case of being either on the side of the doctors or the patients; surely the doctors' anger is, as I've summarised above - that the government is forever poking the NHS with a stick...
The Brownite suggestion of having an NHS Board has some merit. True it would be difficult to interfere with politically, which is anathema to NuLabour; but you could have an arrangement as Gordon Brown has with the Bank of England; 'Here are the parameters within which you work; stray outside them and I require an explanation'. Lets face it; the Bank of England has been independent for ten years now, and the sky hasn't fallen in....

I would also like to add a final comment on the following:

"The reason the current GP contract is generous is because nobody wanted to work as a GP. It was necessary to make the job more attractive in order to recruit enough suitably qualified people."

This is complete rubbish. I know that European doctors would dream of coming over here to work, even at the pre-increased salaries. The average GP in France earns around 艁60K before tax (and their tax rate is higher than ours). Now, what's our average GP take home pay again...?

GPs hold far too much power in the NHS and Mr Brown would do well to strip them of it. Partners in GP practices are obsessed with money because they are running small businesses, so they are more interested in funding streams than patient outcomes. Instead they should be employees of the NHS and managed effectively to produce improved public health. Also, in a typical surgery there may be half a dozen GPs and a couple of nurses, but it would make much more sense if those numbers were reversed. Nurses are more than capable of dealing of most of GPs' casework, yet cost a third as much to employ

Typically, the NHS is in good form, yet you would not know it. Reconfigueration of services is what it says on the tin. What point is there in keeping duplicate facilities open when in reality what we want is a fast, efficient NHS that looks after us when we need it?

No point in having an NHS in old buildings that spread infection?

The press should remember this and behave properly on these issues.

The NHS should explain what it is actually up to in each area and why it is doing what it is proposing.

Isn't it amazing that these policians have the cheek and make statements about how they are going to listen to the people more, and in Gordon Brown's case, when he becomes PM. It makes you wonder what he has been doing whilst in the government. Did he, as part of the government, not listen to the people when he is/was the chancellor, but overnight, when he becomes PM, turn into a new person, one who listens? If such metamorphosis can really happen, pigs indeed can fly! It is one thing to say one will listen, but to do something about it is something totally different. No wonder the public has lost confidence in our politicians and many do not vote or be bothered to do so. After all, it is often full of empty promises.

The GPs contract was far too generous and I think the resulting salary levels (脗艁100k and more) have been detrimental to how GPs are viewed in society and their communities. Is it right that they are on 4x or 5x the national average salary? They are perceived as having lost sight of the importance of patient outcomes in favour of making moeny from their practitioner businesses. This may be unjust but a small-scale straw poll indicates that is what people think.

Nurses are more than capable of dealing of most of GPs' casework

This is only true if one looks at the caseload in retrospect, unfortunately.

The two nurses at our practice are utterly indispensible, and they provide a fantastic service to our patients. But what they are not are doctors.

The reason it takes ten years of intensive study - at a minimum - to become a GP is not to enable you to deal effectively with minor illness, it's to develop the insights needed to pick up more serious illness when it presents. The vast majority of the sore throats I see are just sore throats. However, today I saw one which might just be cancer. This is actually one of the most important roles we have - picking up on pathology in it's early stages. And that is a responsibility that requires a lot of training; and one that our nurses would be unwilling to take on. It's also the reason wny I spend over 艁3000 a year on my professional indemnity (as do all GPs). The consequences of missing something can be enormous.

As a footnote, to give you an idea of the clout I have within the NHS: I pay a mortgage on the surgery premises as I am the owner occupier. I would like to build an extension with my own money to improve our facilities. However I can't - because I need approval from the Primary Care Trust to do this and they won't let me (because of I left and they needed to take the surgery over they wouldn't want to bear the costs of the increased value). I emailed Patricia Hewitt about this when she accused us of not re-investing in our services.

In reply to some of the comments above.11 years of long hours, constant exams go into be becoming a GP.A lot of the work previously done in secondary care id being pushed into primary care. Our pay was once linked to civil servants- this was changed in the Thatcher era- and as a consequence is much lower than would have previously been.
The reality over the new contract is we recieved one year of good pay- the goverments mistake was underestimating the amount of goodwill in general practice- things were done for free.Working out of hours meant I was payed less than the hospital porter for that time, butwer did for the good of our patients.
Now we ahve a pay drop- a significant pay drop- carefully managed by the goverment spin.
We have more and more work put on us- choose and book for one- a grossly inefficient system that actually makes choice less, and doesn`t work half the time.
Most of my Gp colleagues feel demoralised and picked on for the goverment mistakes, many of us younger ones are already thinking of alternative careers, that`s apart from the GP`s taking early retirement.
Juniour and senior doctors are no better off- poor morale, and lack of control, again badly managed by inefficient managers- innovation is quashed, and burn out increasing.
One thing we all worry about is General Practice going the same way as dentist- a private service for those that can afford it, this is not what we signed up for.

Nurses, doctors, consultants. Solicitors, barristers, judges. Local councils, quangos, and Whitehall. What's the difference? Not much, in principle. It's just the same old power, status, and wealth game in different clothes. Colour me unimpressed.

Most medical costs seems to be for the very young, very old, and disaster. By eating, sleeping, and exercising properly most illness can be prevented. In China, doctors were paid while you were healthy and treated illness for free. Being healthy made them wealthy.

If I had to I could live without the law, institutions, and NHS. These people are no better and don芒鈧劉t deserve any more special treatment than anyone else. Might turn out fine if they all went on strike. Never know, we might found out how much we don't need them.

Tune out, turn off, drop kick, or something.

In my experience, what patients want is good medical care. In other words, exactly what doctors want to provide.

The conflict is with what the Government thinks people wants and tells them they should want, e.g., choose & book for example.

Over the past year, the Government has chosen to make doctors the scape-goat for its own failings. That, and the disaster that is MTAS is what has caused the current conflict.

Would I be right in thinking that whatever Gordon Brown (MP for somewhere in Fife) may think about the NHS, he has no power to alter anything to do with the NHS in Scotland? Is this yet one more example (like John Read's posturing in the Home Office) of a politician elected by Scots telling the English how their country will be run but without any power over the lives of their own constituents? What have we allowed to happen in this country to democracy and accountability?

The NHS is too big to be run centrally. It's ludicrous that Ministers have to respond to local NHS news stories. We use the NHS in 2 circumstances - elective and non-elective. Non elective is an emergency. Elective is always planned use. Nationally, we should focus on Policy & Research, Accident and Emergency, and Primary (i.e. preventative) Care only. The rest of it, including post operative, could be delivered by the private sector on a compulsory insurance basis with greater efficiency and choice with, maybe, discounts to encourage people to look after their health (but NO increases for people with health problems)

The whole notion of 'choice' is that consumers of health have access to good information (that is externally collated/evaluated) on which to base their decison/choice.

Currently, large sections of GPs implicitly make the choice for their patients and refer them to their local hospital.

Consider the difference if patients knew the following info-set: clincial competence/outcome, standard of food, car parking, infection rates (e.g. MRSA, C-diff), and kindness of staff.

Then they would make a 'choice' that would inject the market 'creative tensions' that drive innovation, efficiecy and effectiveness and not just 'waiting times'. Now there's an idea...

I don't see the legal profession being nationalised. I don't hear a clamour to 'break' the legal profession.

Not much comment on the pay of lawyers around either.

Is it really so preposterous that professionals who work 13 years to get to the top of the profession the public say they value most highly, get paid on average 80 grand a year once they get there (for working at least 56 hours a week)? You'd pay a plumber 300 quid to come out during the night to fix a leak, but you want to go back to paying your doctors 3 pounds an hour for re-starting your heart? Who's greedy now?

Medicine is held back by the nationalised monolith that is the NHS. Gordon Brown showed how ignorant, cynical and unsuited politicians are to making long-term decisions when he stopped Chancellors manipulating interest rates to the electoral cycle.

Is it really so preposterous that people who actually work in hospitals and GP surgeries might have a better idea how to run the service than those mandarins who work in Whitehall and the academic isolates whose ideas they cherry pick from?

If the NHS goes (and it should) then you'll soon realise you've been getting it on the cheap with everything that that entails.

Just a quick reply to Timothy Godfrey's post,

Has ANYONE in the media, or public ever considered that the exponential rise in so-called 'hospital superbugs' like MRSA and C-Difficile, may have more to do with the 'reorganisations' of hospitals and VAST numbers of bed closures???

It follows that with an aging population, requirement for healthcare will increase, including those warranting hospital admission, but we currently have massively less inpatients beds than before, and much less than any other healthcare system you may care to mention.

Indeed, if all the beds and hospitals were closed that the government wants to; then according to other models of healthcare, we would have sufficient resources for a population of about 2 million, (30x less than we have)

We need MORE beds, MORE local hospitals, and MORE frontline staff, nurses, PTs, doctors etc

By treating inpatients like battery chickens, you obviously greatly increase the chance of hospital acquired, cross-contamination...

Popular themes in NHS.

Choice:
Choices patients want are - which hospital, which doctor, when to book an appointment.

Choices they get are between waiting times.

Pay:
Pay is now based more on performance targets handed down by the government than ever before - so if pay goes up, it's down to doctors delivering more of what the government asked them.

Targets:
It's madness to set targets for service without outcomes. Once you go down that road, you're operating a system designed to please patients, not to make them better (there is a difference).

This stifles some kinds of innovation. If you have a target for X operations for a disease but there is a new drug which avoids the need for an operation or vice versa, the hospital would miss the target for innovating and providing better care.

Doctors have always tried to choose treatments which result in the best outcome with regard to mortality and quality of life while operating within a restricted budget - rarely for popularity and never for votes.

Efficiency:
The government tells us market reforms are required to increase efficiency.
USA - market well-established but has the most expensive system anywhere.

The question for the public is: what do you want from the NHS as a universal, free-at-the-point-of-care health system - the best health for your money or the easiest access to mediocre care?

I think it would be immoral of me to choose the latter and I can't support the government's attempts to deliver it.

Where is the evidence for the idea that politicians 'have to fight with doctors to get what patients want', or that 'you could either be on the side of doctors or patients or not both'? As a practising GP my views will probably be dismissed as biased, but I think that the countless surveys over the years that show Doctors (especially GPs) to be highly popular with, and trusted by, the general public can not be so easily ignored. In reality, the current GP-bashing in the media is likely to be partly due to those surveys that constantly show doctors to be considerably more popular and trusted than either politicians or journalists, with political commentators presumably half way between the two.

What we see at the moment is doctors, nurses and other clinical staff protesting alongside patients at plans to close hospitals, limit availability to certain drugs, squander resources on yet another reorganisation etc, etc.

Maybe I'm deluded, but I think that a more realistic assessment is "patients fighting with doctors against what politicians and senior NHS management want."

The vast majority of doctors are dedicated professionals who take great account of the well-being of their patients.

However, that doesn't stop them responding to economic incentives like anyone else. The medical profession is an extremely strong lobby in the UK - much stronger than the majority of people realise, and as such it acts to distort the market.

Doctors (for example GPs) will take more money if it's put on the table. They'll also close ranks to protect their benefits if they think those are threatened. The issue is that it's difficult to create a flexible market where those providing excellent care (including services such as extended out of hours) are rewarded above the average if the very people supplying that market are able to put up significant barriers to entry - the medical profession can use standards and the media-led threat of "making the NHS less safe" to prevent open competition for the services they provide and block reform, and hence can enjoy the benefits of revised contracts without the competition.

That situation is a pretty simple one. It's called a monopoly, and the only winners are those who extract the economics rents (i.e. the doctors).

PS> I work in the NHS and have a partner who is an regular user of GP services, so I've seen this from both the patient and the NHS perspective.

As long as the NHS has a healthy supply of public money, there is no incentive for it to act efficiently or in the interests of its patients. Like all socialised services inefficiency means nothing to them becuase, working hard or working easy, the pay is the same.

The NHS should be returned to its original vision of being the treatment of last resort. Doctors and hospitals should be encouraged to practise privately so that they are incentivized to act prudently and efficiently.

Once people start *paying* for healthcare the hospitals will become cleaner, the waiting lists will drop, efficiency will go up and less staff will do more work for better pay. A lot of the deadweight can be sacked and the total NHS cost to the taxpayer will become more manageable.

Experience has shown that if something is free, people neither care for it nor value it. That is true of the NHS as well. If Brown really wants to reform the NHS then only one thing will work, and centralised control is not it.

The NHS is not on good form, and it is not a business, it is "what it says on the tin" a service. Business seeks to maximise efficiency to return profit. This usually involves working employees as hard as possible (doctors, nurses) and making job cuts (or not expanding numbers to meet needs)to save on the largest NHS outgoing, wages. The cost overworked, stressed health care staff resulting in decreased quality of assesment/care and more mistakes. The loser: the patient. Business would also naturally seek to limit the access to drugs, another huge expenditure.How would they do this? A) Negotiate cheaper prices for expensive drugs (unlikely given that much of NHS management is cross-pollenated by healtcare/pharma executives) or B) limit the access to drugs? The loser: the patient

I declare an interest: I was a junior doctor for 14 years before becoming a consultant. I am also an NHS patient, and I have been a carer for elderly parents, and a disabled sister.

Most people who work in the NHS are also patients or carers at some point: we therefore have a vested interest in making the NHS as good as possible, because we too are users.

There are a lot of doctors including consultants like me who are committed wholly to NHS work, and do not do private work at all - it is not possible to be the servant of two masters.

Mr Robinson compares the NHS with nationalised industry: perhaps he would like to consider whether the 大象传媒 would still have its international reputation if it had been run like the NHS for the past 20 years?

Who introduced day case surgery? Keyhole surgery? Who do all the studies to assess whether the latest drugs really are any good? It wasn't politicians, or managers.

My prescription:
- listen to staff at every level, not just the unions & their career politicians
- make sure the staff dealing with patients day-to-day feel valued
- get the basics right: respect & dignity
- remove politically-motivated targets which get in the way of good care
- reward those who commit to NHS patients alone, and discourage private practice

Believe it or not, there are a lot of doctors, nurses and other healthcare workers who care. Perhaps Mr Robinson should get away from the Harley Street brigade and meet the majority who don't work in the Westminster village.

It's sad isn't it! It's either patients or doctors; doctor's or nurses reading one of the blogs below. There's an awful lot wrong in a system which is so bureacratic, and so large that no sense of consumer satisfaction or of employee satisfaction can be achieved.
Yes GP's are highly paid. They certainly deserve it, given their expertise, skills, dedication and on an intelligence and job responisbility comparison would be equal to many senior managers in industry. But let's realsie that GP's latest pay increase was on the back of hitting governement targets aimed at preventative medicine. Are they achieving their targets. Yes! Are the targets having the desired effect on reducing hospital lists etc. Who knows? But that's what the government should be held accountable for.
Nurses do a great job as well, aren't as well paid as probably they should but shouldn't have a go at their health service colleages based on jealousy. They too could have become doctors, don't carry the same responsibilities but some are still worth their weight in gold.. How to resolve it within such a large burecaratic organisation????

Basicaly, the organistaion is too large to manage, ministers are too incompotent and have too much of an eye on the political sprectrum to be trusted with it.

Finally the governement needs to be held accountable for the huge loss of money being wasted on hair brained IT schemes which are long overdue, overbudget and wont deliver.
Tony Blair's and Ms Hewitt's response has been to pick fights with doctors. Nick is suggesting that Gordon Brown needs to do the same to give patients what they want. But as Tony also said, there's a third way. Stop promising patients they can have everything they want. Some abuse what they have already. Stop spending money on ill-advised projects, respect the need to invest in having quality doctors and nurses, transfer the NHS to an independent Mangament Board, with clear guidelines for its management and with a task of designing an organisation which is manageable. That will mean some break-ups of current structures and certainly the cost effective loss of a significant number of political administrators, but the health service will move into the 21st century.

A couple of years ago, down in Christchurch, NZ, I read an article that stated that the UK NHS and NZ NHS both produced the worst health outcomes in the developed world.

Meanwhile recently, Dr. Thomas Stuttaford in the UK, initially an NHS enthusiast, says he realised in the late 1970's that the NHS model was failing.

So, if you accept that, then what we have in England is a system fundamentally flawed but held up by politics, either political inertia, cowardice or as a blind totem.

In essence, health care should be a highly personalised service, the diametric opposite of a near State monopoly.

When you really think about it, in the most personal areas of their lives, that is, health and education; English people are almost totally enslaved to the Government.

Sad, isn't it?

But that is the price you {English} pay for not being interested in politics.

The idea that the NHS is some 3rd world health care system is a pretty abstract judgement, and one arrived at by a public addicted to the sensationalist.

I nearly think some people who are always complaining about the NHS should try living in the USA for a few years, and see how our healthcare services weighs up then.

Am not complaining. Very perceptive analysis of state of NHS, that, with luck, GB will get beind.

Regards

Henry Peterson

"This is complete rubbish. I know that European doctors would dream of coming over here to work, even at the pre-increased salaries."

Yes, and this has happened when out of hours care was transferred to the local primary care trust (PCT). The government underestimated how much GPs were working out of hours and so they underestimated how much it would take to fund. With reduced funds, the only doctors the local PCT could afford were first German doctors then Polish doctors. There were lots of complaints. There were huge language difficulties - especially when dealing with the elderly or patients in pain or distressed. There were also mistakes in clinical care.

"Partners in GP practices are obsessed with money because they are running small businesses, so they are more interested in funding streams than patient outcomes." British General Practice is recognised as very efficient and has been at the forefront of innovation in primary care throughout the world. This is, in large part, because of the desire of partners to provide good quality care to their patients with whom they develop a long-term relationship and to do this without the constraints of working directly for a huge monolithic organisation.

I agree that nurses can indeed manage a lot of patients who present to GPs. And a good nurse will earn a third to a half what a GP will cost. But they will also take 2-3 times as long to deal with each patient as a doctor, so you need 2-3 times as many to replace one GP.

What is needed is a truly NATIONAL Health Service. There are parts of the country with Trusts in surplus while others - like Cornwall - struggle to meet the damand of population increase.

Unfortunately, at some point in the future someone is going to have to take on the BMA in the way that Thatcher took on the Miner's in the 80's otherwise the only other way is to somehow scrap the whole system, say, by privatising it through the backdoor!! Unions such as the BMA may once have been a force for good but I'm not so sure now. The main culprits in all of this in my opinion are the consultants more so than the GP's. Waiting lists will never come down as consultants know full well it is in their own interests to keep waiting lists artificially high. It just shows you they have too much power when the Government can't force them to have NHS only contracts which would stop them from doing lucrative private sector work outside the NHS. GP's and consultants are in effect charging patients hundreds of pounds for short consultations. If the service was worth it I could understand it but unfortunately they offer poor value in my opinion. The BMA deserve credit for looking after their own so well - they manage to help their members reap large rewards at the expense of the public while at the same time keeping the public on their side. While the Goverment which is trying to get better patient value and service gets all the flak for being antagonistic towards the NHS staff!! Pouring money into such a fundamentally weak system has been a waste in my opinion.

In response to comment made earlier that GPs should be paid more money to work unsocialable hours for non-urgent cases is ridiculus. Some doctors do not even turn up for urgent visit, its seems that some doctors haven't heard of 'home visits'.

Teachers are paid far less than doctors yet have less respect and have to work extremely unsocialable hours. A half term is not a holiday, its time for marking coursework, doing reports, lesson plans for OFSTED inspections that causes major stress.

It is unfair to say doctors deserve a pay rise when there are other people far more deserving.

I'm a daughter of two comprehensive teachers and work in a pharmacy taking A levels.

Scott wrote the comment "Nurses are more than capable of dealing of most of GPs' casework, yet cost a third as much to employ"

If that is the case then why is it that since GP's gave up out of hours work that the service is a complete shambles? Why then are the government desperate to get GP's back working out of hours?

Why then have the audit commission deamed that the nurse-led NHS Direct puts an unnecessary strain on the NHS. It has been shown that 40% of referrals passed on by them to other services are inappropriate.

'GPs do get a lot of money for not much work'. It would be great if people could shadow me on a day to day basis, busy surgeries with extras, home visits, filing and reviewing test results, compiling reports requested by patients, reading consultants letters, sorting out referrals, reviewing repeat prescriptions... Some days my feet don't touch the ground and it is rare that I am home on time. My pay is nowhere near the figures that are being mentioned. I enjoy my work and love seeing patients, but 'not much work'? Comments like this make me feel disheartened when I know how hard GPs work.

GP's and doctors in general work in medicine to improve patients lives, not for financial reward. If this was the case then we would be facing a worse crisis than we are now.
On the subject of GP's, firstly they took their new contract after the DoH offered them about a 艁6000 pay cut not to do nights or weekends. If you are earning about 艁60k, then who wouldn't take that?
Secondly, the DoH were told categorically that services would suffer, did they listen, No. The DoH radically underestimated the amount of work that GP's actually do as proved by their payments by results scheme. The DoH has since discovered that funding private out of hours cover would have been cheaper by not offering this contract.
Thirdly, GP's receive, on average, 艁50 per patient on their books, per year, no matter how many times they are seen. It costs more to insure your hamster for a year.
And compared to a similar status in the city, they would be earning well over six figures easily

And Scott, if you are happier seeing a nurse who has 'done a few courses' as most nurse practitioners have, rather than a see GP who has had 10 to 15 years medical training then I suggest you need to rethink your attitude to healthcare.

Complete twaddle.

Doctors are on the side of patients. The reason there is currently a policial scrap is because doctors feel that politicians are mismanaging the NHS. Doctors feel that resources could be better managed if NHS somehow ceased to be a political football, endlessly suffering from the latest whitehall gimmick.

The debate is over how to effectively run the NHS. The ultimate goal for everybody is better patient care. To suggest that doctors do not share this aim is ludicrous.

I agree entirely with the above posters who have pointed out that the doctors versus patients issue is non-extant.

I get most angry with the 'doctor bashing. Let's get our facts straight here, firstly it is the primary care trust that is responsible for providing out-of-hours care - not GPs. Your (justified) anger about 'sevice' out-of-hours should be aimed at those primary care trusts.

Secondly in response to PP's post(#6) about how shortages in GPs could have been filled more easily with European doctors, could I suggest you do a quick search on the 大象传媒 for 'GP shortage' and you will see exactly the scale of the problem that existed and even articles about efforts to tempt GPs from other countries.

My final point is that doctors are not the enemy here and is diverting the debate from the real issues. Doctors, like all medical professionals, work hard and try constantly to make the NHS better for patients. If doctors were having such an easy time as some of you believe, why would they be so angry?

It has been ill management and the lack of realisation that constantly changing initiatives can be a detriment that are really to blame here. It is not unions or their members' fault for trying to get contracts that actually acknowledge and pay for the hours they work.

I for one am pleased with the service the NHS provides today, I will be seen and treated in record breaking time and have far more advanced and expensive medications at my disposal. It's not all doom and gloom!

"Nurses are more than capable of dealing with most of GPs' casework, yet cost a third as much to employ"

This is WRONG. Nurses are a vital part of patient care but they do not have the training to deal with most medical problems, i.e. diagnosis and treatment decision making. This is what takes years of medical training and experience and should not be undervalued. Nurses are trained to nurse patients and are excellent at this. It is a mistake to think that nursing training equips a nurse with diagnostic skills. this is a different area of expertise and there is significant danger if patients are medically assessed by people not trained to do this.

Nick - in your list you forgot to mention getting NHS financial management on track. The Audit Commission produced a very interesting report in 2006 on the NHS's finances; it's very easy to read and is very entertaining if you're a little bit financially aware.

Bear in mind too the target ridden culture we have in public services; priorities are skewed and if someone actually overachieves extra money doesn't automatically follow - there has to be cuts and delays to save money until extra funding is voted or a new spending round is started. The private sector mentality doesn't fit easily with public service ethos. There clearly has to be financial boundaries, but it may be that local managements should decide on what the priorities should be for their area and commit the appropriate level of resources, rather than having them set centrally.

Nick, I agree with your analysis of the politics. But don't see 'the doctors' as a term representing NHS staff. If you talk to a nurse or a physio or a pharmacist, many are deeply frustrated by the power that doctors hold over the NHS. For some reason doctors always have to be on a contract that pays them a whopping salary then pays them yet more money to actually do their job: no other health care professional gets this in the NHS. Giving more and more power to GPs and primary care trusts is one of the main reasons for much of the NHS being near to collapse despite record spending - it isn't a solution.

'GPs hold far too much power in the NHS and Mr Brown would do well to strip them of it'.

Scott, you really are an amateur. GPs were independent and were coaxed into the NHS. The current situation of quasi-independent fundholding practices was first introduced by Thatcher. It was reversed by New Labour. It was then re-introduced by New Labour.

And you want it to be reversed again.

Why don't you let the staff work out what is best for patients and go fiddle somewhere else.

at last you are covering the major topic in the pubs up and down the land

you should check out

for various views

in essence my view is the patients have got to be empowered to take their health spend where they want, it is only their little walking feet that will force sites to get cleaner, staff to be less rude, appointments with consultants rather than nurses, and real end to end wait and qualiy improvements

brown has no idea what to do, but running a big organisation like the nhs just the same as maos rice production is not the way to do it, having said that pat hewitt has got to go before somebody shoots her

I am a hospital doctor. I studied for 6 years at Oxford. I have 5 years of postgraduate training, and have taken 3 sets of postgraduate exams (which I had to fund myself).

My basic salary is less than that of a london tube driver (艁31000).

Thought it best to set the record straight that we're not all money-grabbing power-freaks.

And I love my job.

"Unfortunately, at some point in the future someone is going to have to take on the BMA in the way that Thatcher took on the Miner's in the 80's otherwise the only other way is to somehow scrap the whole system, say, by privatising it through the backdoor!! Unions such as the BMA may once have been a force for good but I'm not so sure now." Richard (Post #32)

Hear Hear!

As for Tom (Post #38) and just who do you think would most lose against more foreign doctors over here? that's right, the good old BMA once again taking action to protect their members. As for all the language issues, etc. come on, these can all be overcome in one way or another.

The BMA well understands that oversupply of doctors would lead to a drop in renumeration. And now look what's happening, junior doctors up in arms at the possibility of not having a job at the end of their training (and I do sympathise with the whole MTAS situation). Maybe that substantial increase in salary, could have been better utilised in actually employing more doctors? rather than caving in to the demands of the BMA.

I have some very good friends that are GPs and recent conversations have seen them get very defensive in justifying the income increases. GPs as managers? for crying out loud this is the NHS! why are they 'profiting' from it?

Maybe GP surgeries should be run similar to schools, with GPs as employees (ie. not as a 'headmaster' equivalent).

My wife works in the NHS, and I hear all the stories, anecdotes, etc. The harrassment, subservience, blatant nepotism, and the HR departments do all they can to protect these so called professionals. Is it any wonder that other staff in the NHS feel so frustrated with them?

All I can say to doctors (and all other public service professionals) is: expect more of this. For better or worse, the public are being treated as consumers, where we place ourselves first, and so we will behave in that way. Citizenship, where we all cared and considered each other is almost extinct in today's society in Britain.

It is unsuprising if GPs object to being "on call" 24 hours a day - why can't the responsibilities be split over shifts like any other service that is needed any hour of the day? It may mean a bit less continuity between the two GPs but I would have thought most people would prefer to have a doctor when needed than none at all.

The ignorance of some posters is astonishing.

For instance, one person argues that consultants will prevent waiting lists from coming down. They've dropped to 18 weeks in a lot of places, from more than two years for some procedures in ages past.

If doctors jobs are so easy and well paid even when training, hours, responsibility etc is taken into account, why don't you switch jobs?

BMA is weak, according to most doctors I've talked to, just like the royal colleges. All talk, no substance.

Some of the changes brought about by Labour has been beneficial for patients. Waiting lists, QOF, etc. But other things seem to have been introduced based on ideology (ISTCs being one of them) rather than cost-effective benefit to patients.

I'm especially disappointed at one poster though: Nick.

Nick, why do you say that Gordon has to fight doctors for patients to get what they want? Is it not doctors and other healthcare staff who deliver what patients want? Doctors are more than happy to provide services, but yes, if he wants them to do more work for no more money, then they might put up a fight. Would you work an extra 12 hours a week nights for no extra pay, Nick? Although you probably feel passionate about delivering news (as doctors love being able to help patients and not be tied by policies etc.), I'm sure you also enjoy being able to spend time with family or friends. I guess the spin is getting to you.

It's always easier to attack others than to praise, always easier to point at others instead of oneself, and unfortunately, always easier to come with easy solutions when one has less understanding of the complexity of things. How many of you even know how money flows in the health sector, and which body is paying for what and is paid by who? The internet truly has the most vocal experts with the least knowledge.

All institutions in this country are being broken up, so I suppose the institution called voactional doctors should expect no less. However, those in society who are so keen to do this need to consider what will replace that which you demolish - perhaps the power of multinationals - so powerful that they are able to manipulate governments. What about the instituition called society - that went with Thatcher; remember respect and manners, well they went too.

Replace vocational doctors with employed ones and they do what their employer tells them, not what patients need. Shop elsewhere - well 80% of the population shop with the big 4 retailers - can you tell the difference between them other than their packaging? Don't forget one day health policies will change and patients will be charged, then you pay the multinationals whom by the way influence governments and sponsor universities. Yes they will open 24/7 and even sell you food - but at what cost? Extinct vocational doctors will seem rather cheap by then..

I have a small but important point for those saying that "the doctors" have too much power over the NHS. Over the broad system they have next to nothing, thats the NHS executives job ( as in an organistation of bureaucrats that organise the organisation of clinicians).

As for power within the hopsitals themselves, if other professions really want it, they're welcome to it. The minute they accept full responsibility for patient care, still currently held solely by doctors. ( The buck stops here if you will)

Finally the patient choice agenda and its money-following-patient scheme gives one national price for every condition,irrespective of actual cost, which furthermore drops for extended stays. In other words it designed to ensure care that is cheap and fast.

As the man said "you can have it cheap, fast, or good. Pick two"

1. I hope Mr Brown will re-examine the establishment of Foundation Trusts.

and

2. He MUST abolish the postcode NHS for cancer and cardiac patients.

"I'd find it interesting to have PP as one of my patients. So much venom in one body....so little cure for hate too. Hope his GP friends can stomach him. Do they know what he's posted here?" Daniel #46

Daniel, I'm not against individual doctors, I'm against the collective power of the BMA, and the informal power that senior clincians have inside the NHS.

And yes, my friends are aware of my 'views', but quite rightly they give me their views on the sector that I work in, local government! I can take as good as I give, thank you.

All this talk about members leaving the BMA in droves, hardly a significant number, and lets face it I didn't see any exodus when pay rises (oops I mean performace-related pay) was negotiated.

You want to to work less hours? Well, just maybe, we should be paying doctors less and employing more of them. There is a huge number of junior doctors that are currently going through the system, that are facing the real possibility of not having a job. And just why is that? because there's not enough money to employ them. You can see where I'm going with this.

As for comments about NHS Executives ruling the roost, they may hold responsibility, but it is the consultants that run the show in the hospitals, always has been.

In my eyes, the problem lies with the BMA. They are a union for doctors first and foremost, and any suggestions they make to do with the running of the NHS, in my mind will always be viewed a tinge of skepticism. I agree that this applies to all unions, it's just that the BMA hold a 'special status', the equivalent of Union/CBI rolled into one.

I beseech Mr Brown will re-examine the establishment of Foundation Trusts and that he will abolish postcoce health service in which many cardiac and cancer patients are denied life saving drugs on account of cost and without consideration to the value of life.

I beseech Mr Brown to re-examine the establishment of Foundation Trusts. I pray that he will abolish postcoce health service in which many cardiac and cancer patients are denied life saving drugs on account of cost and without consideration to the value of life.

PP has it absolutely correct about the BMA.

Why do doctors think they're automatically owed job security, insulation from economic pressures, guaranteed career paths, etc.?

As for those who claim that doctors could find better paid careers elsewhere, this is at odds with several authorative surveys that show medicine pays, on average, more than 30% more than any other profession. It even pays more, on average, than working in the city, let alone other careers in the rest of the country. Pensions and job security are also far better.

Most doctors really have no idea about salaries, pressures and job security in other careers - they just compare themselves to the few who are exceptionally well paid. It was interesting to see GPs compared to senior managers in industry by someone above. The average MD of a medium sized business gets nowhere near as much as a GP!

There is absolutely no shortage of suitably qualified people wanting to be medics - let them train and let market forces decide pay levels.

"In response to comment made earlier that GPs should be paid more money to work unsocialable hours for non-urgent cases is ridiculus. Some doctors do not even turn up for urgent visit, its seems that some doctors haven't heard of 'home visits'."

I am NOT a GP, but this is absolute and utter nonsense.

1. Do you understand what the term 'non-urgent' actually means? That's right - it doesn't have to be dealt with immediately, and therefore can be deferred to a time when the GP practice is open. If you want your GP practice to open at times that are more convenient for you (in other words, unsociable hours) then why should the GP not be paid extra for providing this service? The problem is NON-URGENT. A lawyer won't see you at 8pm on a Thursday because it's easier for you - you'll have to go to his office during office hours. And as mentioned above, if you call a plumber outwith his normal working hours, you will pay through the nose.

2. Home visits are an anachronism. In 95% of cases they are unnecessary, and despite popular belief nobody has the 'right' to one.