No GPs?

maddyone

Doodledog

Why is it 'punitive' to pay for someone's training in return for their staying in the country that paid for it?

My daughter worked in the NHS for fourteen years after she qualified. Is that enough?
(She also worked in clinical practice for the last two years of her training. Whilst she was learning, she was also doing much of the routine work so that more qualified doctors didn’t need to do those more routine things.) So a total of sixteen years including those two on clinical practice. Is that enough?

I don't have a clue what's 'enough'. I am simply suggesting a different model - one where medical students don't pay for their training in return for whatever it costs to pay back the cost. Obviously they would still have to contribute to things like their own health, education for their children and so on, as we all do, so the 'payback' would be on top of that basic taxation, and probably wouldn't cover the full cost of training, or it would be a deterrent, but it seems like a good deal to me. No student debt, no need for parents to make sacrifices, and enough doctors trained each year to ensure that any who do leave are replaced.

It's not punitive, as people could still leave if they wanted to, but as with my son they would be expected to pay at least some of the cost of their training. They would be no worse off than if they had paid for it themselves (my son would have had to pay the whole cost of his postgrad qualifications plus a penalty clause). The details would be for people with far more knowledge and understanding of the NHS and how it works than I have - I don't pretend to know enough to come up with what is 'enough'. Maybe it wouldn't work, but I can't see the harm in discussing it.

Thanks for your support Annajay.
And I agree about asking Pharmacists for help. They are very useful at times.

Doodledog what I don't understand is why you want to discriminate against doctors. There are lots of professions that require training post graduation that is effectively supported by the public purse eg social work, teachers, civil servants etc but you only focus on the medical profession. A third of teacher leave the profession in the first five years, the proportion for social workers is even higher. There is still a cost to training them post qualification but this is never mentioned and I don't understand why.

I don't want to discriminate against anyone.

This thread is called 'No GPs', not 'No teachers, or civil servants'. When people complain that they can't see a GP they are told that this is because so many of them leave the country to get better pay and conditions abroad. This means that we are paying a lot of money to train (eg) Australia's doctors. We are also told how expensive it is for doctors themselves to go through the lengthy training, and the cost to the public is over £250,000.

A possible solution to that would be to pay the whole of the training costs for them, and to ask for the payback to be that they either stay in the UK for X years, or pay back the cost of their training, as is normal in many professions.

Teachers, social workers and civil servants don't get years of expensive training subsidised by the public. I think that some teaching courses have bursaries, but that is for one year during which they teach, and it is the same for social workers (I think - I'm not certain whether the bursaries apply nowadays). Civil servants go straight into work from university AFAIK, unless you mean spies and the like. Anyway, if we were discussing the dropout rate in those groups, a similar scheme may well be mooted, but we aren't.

foxie Absolutely. Why pick on doctors when other people who provide public services wouldn’t be included in such a scheme? As you rightly point out, teachers have a very high level of leaving the profession within a few years. There is a huge teacher shortage but people don’t notice it because they’re not affected by it. Class sizes are rising and teachers are teaching subjects that they are unqualified to teach, but no one notices. However they notice when they can’t get a GP appointment.

Doodledog your son could choose to work for any company, he didn’t have to accept the conditions, but doctors can’t choose to not work for the NHS. Consultants can work privately much, much later on, but all doctors have to work for the NHS. Their choice, when they’ve had enough, is to emigrate. Presumably your son didn’t need to do that in order to get a good deal.

My son is just an example of how it is not discriminating against medical professionals to have a payback deal in place. They are not unusual.

Yes, he could have worked elsewhere - as it happens he is happy where he is and isn't looking to leave, but that's not the point.

Payback deals are always time limited though, aren’t they?

That’s my point Casdon. Doctors who emigrate have already worked in the NHS for at least two years as F1 and F2. Then most go to work for longer in the NHS as my daughter did, in her case for fourteen years. No private company would put a payback term of 14 years into a contract. Private companies wouldn’t expect employees to contract themselves for more than two years, therefore since doctors already do two years, it’s a moot point. I don’t think doctors would want to not pay fees at university for a contract binding them to many years service in the NHS. It would be unreasonable and unwanted. And most do many years service in the NHS anyway.

All graduates have to be trained on the job, they don't come out of uni with the skills and experience they need to be a fully trained employee. If they go into the public sector they are being trained at the public expense. The high cost of training doctors is a reflection of the high level of training they need to be a doctor and what makes them difficult and expensive to replace which is why they should be valued, paid properly and have good working conditions. It is a stupid waste of money to do anything other than that particularly as it is the junior doctors who take the greatest load in training those doctors who are junior to them. They actually do the training that you want them to pay for! See one, do one, teach one is how it works but you do need to be able to "see one" and every doctor who leaves is a lost trainer as well as a doctor.

Casdon

Payback deals are always time limited though, aren’t they?

Yes, or they could be on a sliding scale, reducing over time.

I think it is a scheme worth considering in principle, but each time it comes up I am cross-questioned about the minutiae, when I have no idea what would be reasonable. As I see it, the issues are as follows:
The cost of training doctors is high. We have more applicants than places, so plenty of good people who want to study medicine. The cost of studying is off-putting for many, as the course is long, but each doctor still costs over £250,000 to train, which is paid for by the state. We need to train more, but the cost is prohibitive.

If people are leaving to practise medicine in other countries it is not that they are unsuitable or that they are in the wrong job - it is that the conditions here are not so good. We need to do more about that, so that people want to stay in the NHS, but meanwhile, as long as people can get subsidised training here then leave to get more money, they will do so, and we will be left with a deficit. As we are subsidising the training we need to find a way to plug that deficit without spending even more, so that we can train replacements.

Maddie, your daughter is no more a yardstick than my son. As I say, he was just an example of someone not in medicine who had a contract that he would not take the expertise that his employer had paid for him to acquire to a rival company, and I only mentioned him to show that it happens in other sectors. His personal circumstances are irrelevant. Similarly, your daughter may or may not be typical - I have no idea. I am talking in general terms though.

And for the record, I absolutely support the junior doctors' case for more money and better conditions.

I don’t disagree with your proposal in principle Doodledog, provided the payback period was reasonable, ie not longer than 5 years and crucially, that there were enough training places available for all British graduates to get placements, which is not the case now.
However, something different will have to be done if doctors are to be tempted back into general practice, because for all the incentives being offered, the bottom line is that most are just not interested.

I do disagree as I believe that the way to improve retention is for doctors to want to stay rather than putting in punitive measures to make them stay.
It's often said that medics in the armed forces have to pay back the money they have received during training if they leave early. Just to clarify this: Medical students can receive a bursary of £10K a year for the last three years of their undergraduate training and on successful graduation they receive an additional £45K (total £75K) Their minimum starting salary is £66,913 (compare this with JD's working in the NHS!). They also get heavily subsidised accommodation. It goes up once they have completed officer training. They sign up for a short commission of 8 years but can leave after 4 years. If they leave early they might have to repay some of their bursary ie £75K. This is very different to what is being proposed.

Doodledog

maddyone

Doodledog

Why is it 'punitive' to pay for someone's training in return for their staying in the country that paid for it?

My daughter worked in the NHS for fourteen years after she qualified. Is that enough?
(She also worked in clinical practice for the last two years of her training. Whilst she was learning, she was also doing much of the routine work so that more qualified doctors didn’t need to do those more routine things.) So a total of sixteen years including those two on clinical practice. Is that enough?

I don't have a clue what's 'enough'. I am simply suggesting a different model - one where medical students don't pay for their training in return for whatever it costs to pay back the cost. Obviously they would still have to contribute to things like their own health, education for their children and so on, as we all do, so the 'payback' would be on top of that basic taxation, and probably wouldn't cover the full cost of training, or it would be a deterrent, but it seems like a good deal to me. No student debt, no need for parents to make sacrifices, and enough doctors trained each year to ensure that any who do leave are replaced.

It's not punitive, as people could still leave if they wanted to, but as with my son they would be expected to pay at least some of the cost of their training. They would be no worse off than if they had paid for it themselves (my son would have had to pay the whole cost of his postgrad qualifications plus a penalty clause). The details would be for people with far more knowledge and understanding of the NHS and how it works than I have - I don't pretend to know enough to come up with what is 'enough'. Maybe it wouldn't work, but I can't see the harm in discussing it.

There are no easy answers. But if the Governemetn works out they need 'x' number of GPs for the system to work, and a small proportion never end up practising at all, an increasing number go and work abroad for better salary and conditions, a number go and work in pharma industry or private medicine for the same, and a significant and increasing number work part-time (and nowadays this apply not only to young women with children) - then you have a massive problem. Combined with an increase in population = even more so.

If on top of above, they now work much shorter hours than the previous generation, and don't do any home visits- which are delegated to other doctors - then you have very serious issues.

And this is not the fault of 'lazy modern GPs' either.

I'm still not sure about your definition of punitive, foxy48.

I don't know about medics in the Army, but I had quite a few non-medical students take the course I used to run who were sponsored by the forces. They got their fees paid, and an officer would come and talk to me about their progress once a year or so, to make sure that they were on course to pass. After graduation they had to serve a term in whichever branch of the forces had sponsored them, or pay back all of the fees.

A friend of mine's son got his course paid for by the RAF, then decided against going in, and his mum was shocked that he had to pay nearly £30k back. I don't know why she thought he would get a free education when everyone else's children were being charged, but she did. Her attitude wasn't popular in our social circle (most of us were helping our children through university at the same time), so I can't see the difference between that and what I am suggesting. The sums of money are different, but the principle would be the same.

It’s different because you’re suggesting that doctors would be put on this scheme. Not a choice like those in private industry who choose that option, nor a choice like medics planning to go into the forces. They also choose that route. Most medical students want to be doctors and there is no choice other than don’t do the course.
In any case, why pick on doctors? We pay for the university of every other student and all university education is expensive, and many students graduate and go into private industry, and get well rewarded for that, with no suggestion that they should be tied into that role, other than a few months if they were sponsored.
If this idea came into practice, which it won’t, there would be fewer medical students, not more. Most would see that situation for what it would be, the state saying we own you but we don’t own any other students. Freedom of choice is a fundamental tenet of a democratic society and we cannot go down the route of removing freedoms just because we have a doctor shortage.
The solution is simple and well known. Increase the number of medical students (many well qualified students are denied places every year) and then pay them properly according to their knowledge and skills.

I’m not disagreeing with the emboldened but of your post, maddie, and have always made that clear.

I’m not clear why there is a difference between people choosing to join the army, or choosing the private sector and choosing medicine though. In my scheme doctors would get their training free. If they wanted to they could save the money they would otherwise have spent and use it to ‘buy themselves out’ if they wanted to, which I know some of the forces-sponsored students do.

I’m not picking on doctors or being punitive. I am suggesting a way of retaining them that wouldn’t disadvantage them at all, but would, I think, go some way towards ensuring that there are enough doctors to go round, which is clearly not the case now. By all means pay them more and improve conditions- as I keep saying, I fully support that, too.

Anyway we are going round in circles, as always happens when this subject comes up, so I’ll say no more.

Bella23

sassysaysso

I think though it takes some getting used to that GPs operate in a different way, partly as a result of the shortage of GPs, partly with greater use of technology. The triage system ensures a patient sees or speaks to most appropriate professional, be it a doctor, nurse or pharmacist, it means a nurse practitioner is able to see many patients and free up a doctor. I have found that if a problem is acute (in my case UTI) I have been seen quickly.

I find the econsult system helpful and have used it couple of times for a query that I wouldn't dream of troubling a doctor face to face with. My surgery's use of texting is also very efficient. So all in all, I think things have improved greatly, its just different.

You are satisfied because you can use the system. How would you feel if you were 92 like myneighbour and lived 8 miles from the GPs and pharmacy no public transport and can not use modern technology or drive any more?

Quite right Bella. We have one large GP Practice in a town about 6 miles from here. They also operate two smaller surgeries one being about 7 miles away and the other 6 miles in another direction.

The GPs want to close one of the smaller ones and are expecting people to do either a 14 mile round trip or a 12 mile round trip in a rural area with very poor public transport and no direct link to the 14 mile one. There has been absolute 100% uproar from local residents which I think has really shocked the GPs as nearly 300 people turned up to a meeting in support of keeping it where it is. It is a purely financial decision and they have no concern for the very elderly population, the disabled and the people who do not own cars.

Doodledog if JDs were better paid with better conditions of service I think the problem of retention would largely disappear. I don't think there are many medical students who graduate and think they don't want to be doctors but the reality of working in the NHS grinds them down. I honestly don't think that your proposal addresses the real problem and would potentially add to it.

I do know one such student doctor foxie. She was the daughter of Richard Branson, and she was on my daughter’s course, the same year, and graduated on the same day as my daughter. Richard Branson was at the graduation ceremony alongside ourselves and all the other proud parents.
To be honest it annoyed me that she had taken up a place at a sought after university and she never practiced a single day of medicine after her graduation. She instead went into her father’s business. She could easily have done a different course since she obviously wanted to go to university, and allowed someone else who actually wanted to be a doctor, to have that difficult to obtain place.
Having said that, I think it is an extreme example, and I know that students who choose medicine as their course actually do want to practice medicine.

foxie you are 100% correct. The way to retain medics is to pay them commensurate with their very high knowledge and skills, and to improve their conditions of service, which by anybody’s measure, are pretty dire. I don’t think the general public have the first idea of how poor their conditions of service really are.

Yes, joining the Forces as a medical students has huge advantages as not only your fees are paid, but you are paid throughout your studies and further training- then join the Army directly at Officer Level.

OH did consider it as his family were not well off- but he was very aware that this would not eventually be free, that he would have to serve in the Army for some years, and that in case of a conflict- he would have to go and serve there.

That price was far far too far to pay. And I would have hated every minute of it - being an officer's wife, with the fear of losing him in a war.

Maddyone Like you I was so proud when my daughter qualified and it's been a real shock to see how JDs are treated in the NHS. If I had known I would have, of course, supported her career choice but I would have been much less enthusiastic! She started her new job yesterday, doesn't agree with the pay scale she's been put on and doesn't know her banding (she's not in England) She's had two different rota's already, got one day which is supposed to be an anaesthetics induction as she's never worked at this hospital before and won't necessarily be familiar with the machines they have but she's also on a theatre list! The stories she tells us are hair raising, most people have no idea what working in the NHS is really like and what JDs have to put up with. The lack of care and support towards staff in some hospitals borders on criminal and the fear of making a mistake and being scapegoated is very real for many JDs! It's a wonder that so many of them actually stay.

It’s exactly the same in general practice foxie. They are terrified of making a mistake or misdiagnosing and being sued. My daughter has saved people’s lives whilst practicing in general practice, but people don’t see that, they don’t think it happens. My nephew has too. He’s a GP and found a man collapsed on the practice steps early one morning. He resuscitated him and saved his life. My daughter has more than once saved the lives of seriously ill babies, and also I remember a woman when we were in New Zealand this year, and she (our daughter) was very delayed for a meeting with us.

She’s thinking of changing specialty, she’s had enough of general practice.

I hope your daughter enjoys her training as an anaesthetist, it’s gruelling (one of our daughter’s friends did it) it takes years, but I think she’ll enjoy the satisfaction of this extremely highly skilled area of medicine.