Interesting to see some supposed lefty types oppose Starmer/Streeting’s idea of making GPs salaried staff.

I don’t see how it helps the current crisis in primary care, and given the sample size of just my GPs it’s not massive popular. Most see it as an excuse to take away autonomy and reduce costs as opposed to making the service better for patients, so are suspicious of the motives for it. I guess the devil is in the detail, but without knowing fully what any plans (if there are any beyond just floating the idea to gauge its popularity with voters) we’re all guessing. I’m not completely anti it, but it would need to be carefully implemented; and the history of politicians messing about with folks pay and service contracts in the NHS isn’t a happy one.

Interesting to see some supposed lefty types oppose Starmer/Streeting’s idea of making GPs salaried staff

No problem with GP’s being directly employed by the NHS, less so with a layer of corporate contracts siphoning off more NHS money for shareholder profits. Which in reality would probably reduce doctors pay and increase inefficiency and the workload and stress levels of front line staff even more.

less so with a layer of corporate contracts siphoning off more NHS money for shareholder profits.

Surely directly employing GPs within the NHS would eliminate the corporate middlemen who siphon money from the system? Same goes for many other parts of the health and social care system. I see very little downside to directly employing and managing all health and social care professionals. What needs to change though is the top-down hierarchical structure so that GP practices, hospitals, care homes etc are democratically accountable and have the agility to target specific care and support to the community.

Here’s a good example of something that needs to be eliminated.. https://www.theguardian.com/society/2023/jan/15/private-brokers-earn-millions-finding-care-homes-for-nhs-patients

I see very little downside to directly employing and managing all health and social care professionals

who would you include in that? Dentists? Opticians? Pharmacists? Outside of Trusts, huge amounts of public healthcare is provided by private companies and individuals. It’s easy to label it as “corporate” with all the negative implications of that, but the reality is hundreds of small businesses employing millions of folks that will be directly effected by what amounts to huge changes if we were to make them all civil servants

I would certainly change the partner model for GP to make it easier (and cheaper) to join a practice. NHS Scotland for instance recognised that building costs were a major problem in primary care and have undertaken to take ownership of the buildings to relive that pressure. Those sorts of targeted actions have much more of an impact and save huge amounts of public cash (not as sexy a policy though)

Surely directly employing GPs within the NHS would eliminate the corporate middlemen who siphon money from the system?

Who are these corporate middlemen?

I believe salaried GPs properly incorporated into the NHS is a good thing and long overdue

However what i question here is the practicalities, costs and priorities.  To do this would cause massive disruption and upheaval and will upset GPs enormously.  Given the much more serious and important issues why concentrate on this?  Massive reorganizations take up huge amounts of staff time.  In the short term it would be counterproductive.

To me its all about copying the tory tactic of divide and conquer / find an enemy within with a side helping of allowing private heathcare companies to bid for contracts to run these directly emplyed GP services

Surely directly employing GPs within the NHS would eliminate the corporate middlemen who siphon money from the system?

The problem is they arent actually saying they would be direct NHS employees but just salaried and left it vague as to what that means.
Which quite a few are currently working for but not part of a GP partnership or for APMS contract eg Operose.

I am more than a little concerned by what Starmer has said about reforming the NHS over the last few days but just read this.

https://www.theguardian.com/commentisfree/2023/jan/16/keir-starmer-nhs-reform-tory-labour

Any thoughts guys, @tjagain?

I have not read the whole article but Toynbee has moved far to the right.  I don’t trust a word she, Starmer and Streeting say on the NHS

Starmers attacks on NHS bureaucracy are again him pandering to the express and mail readers to who this is a shibbolth.  Streeting is in the pay of private health companies.  Starmer is picking an unnecessary fight with GPs again pandering to the right wing press.

the whole thing revolts me

I have not read the whole article but Toynbee has moved far to the right. I don’t trust a word she….

She is just a woman who has managed to secure herself a job which pays quite a lot of money in return for her writing what is on her mind.

She is unelected and there is absolutely no reason why her personal opinions about anything should matter other than because people choose to attach some importance to them. I have no idea why.

I have never read more than maybe a paragraph or two of anything she has written. I very quickly ask myself “why am I reading this shite?”

She is unelected and there is absolutely no reason why her personal opinions about anything should matter other than because people choose to attach some importance to them. I have no idea why

Would this apply to any article from a newspaper columnist ever?

I think the Guardian columnists (Freeland, Rawnsley, Jenkins etc) are fascinating – push for change – change is offered, push back like liberal dopes, then spend the next few years whining about how the Tories are horrific.

I read Toynbees books way back when.  She was a leftie with clear ideas and analysis.  Over the decades she moved far away from this and became an apologist for the “centrist” wreckers in the labour party using the most absurd local contortions to reach that position.

It’s easy to label it as “corporate” with all the negative implications of that, but the reality is hundreds of small businesses employing millions of folks that will be directly effected by what amounts to huge changes if we were to make them all civil servants

Alternatively there’s no profit going out of the system to shareholders. Profits that are rarely re-invested in improvements when push comes to shove. There’s usually a lot of talk of doing more with less which in healthcare is a nonsense.

Errmmm- most GPs will be partners not shareholders and there are no profits as such

They take income after expenses. Partners do a lot better than salaried though they have to do more for it – England figs from https://digital.nhs.uk/data-and-information/publications/statistical/gp-earnings-and-expenses-estimates/2020-21 (most recent year available):

The estimated average income before tax of GPs in either a General Medical Services or a Primary Medical Services practice was:

£142,000 for contractor GPs

£64,900 for salaried GPs

That’s not pro-rata so includes part time.

All a long way from Keir. Whatever, this country currently spends in the middle range of Euro counties on health as a proportion of GDP. Less than the higher GDP per capita higher tax northern euro countries. But we pay our doctors relatively highly.

Does that figure for contractor GPs include the money they spend on the practice?  They usually have to buy a share of it and pay for improvements.  I know the contracts have changed over the years but my pal who is a GP told me his loan repayments for his share of the practice was more than his mortgage on a big posh house in a posh town.  Yes he will get the capital back when he retires if he can sell his share but he will not get all the interest back

GPs are well paid – no doubt but why do we have such a shortage of them?

I don’t think you are comparing like with like on stating we are in the middle of european spending as GDP for healthcare either

Not me. OECD, see e.g. https://stats.oecd.org/Index.aspx?DataSetCode=SHA

Does that figure for contractor GPs include the money they spend on the practice?

No. That’s after expenses etc. It’s all public. BMA, pulse mag and BMJ careers all use the same figures. GPs aren’t badly paid relative to other professions, but medical consultant careers are more attractive and can pay a fair bit more.

There’s no shortage of high quality applicants to medical school. Labour’s idea is for relatively modest spend expand the number of places on courses to pump out more doctors. I think this is a good idea (my opinion).

£64,900 for salaried GPs

The NHS has to fund NI and pension for salaried staff so the cost is more like £90k.

Wouldnt the salaried staffs NI and pension be paid for by their provider eg normally the GP partners or other organisation?

“We want a closer relationship with the EU”

Labour leader Sir Keir Starmer tells #Newsnight he’s having discussions at the World Economic Forum in Davos to see what a closer trading relationship might look likehttps://t.co/P0zxS1DNGF pic.twitter.com/V2UjooFOoK

— BBC Newsnight (@BBCNewsnight) January 19, 2023

Cakeism

He is playing us for fools.  there is no significantly closer relationship available without CU and SM which he rules out and he must know this

He can fiddle around the edges yes.  But he has ruled out anything significant in the way of rapproachment and nothing he suggests will undo the vast bulk of the damage

It’s all been said already, many times, but building a closer relationship isn’t a one step process… we have years, if not decades, of doing this. A slow thawing of relationships and stopping the slide of aggressive divergence and barrier building we’re currently still on (that’s far from over under this government). “Snap your fingers and Brexit is all undone” is fantasy politics.

Yes – and starmer is lying about it.  He is playing us for fools.The man has turned into a hard brexiteer.  He is now against any significant change.  Don’t be fooled.

This is interesting, imo anyway, nearly all the pollsters give Labour more than a 20% lead over the Tories, and have done so for a while. Except for two, Deltapoll and Opinium, both of which give Labour a 14-16% lead over the Tories.

It is considerably less than those heady days back in October when Labour were regularly showing well over a 30% lead over the Tories, but I suspect that under present conditions if a snap election was held right now the result would probably be in the region of Tories 30% Labour 45%.

And that would represent one of the worst general election results ever for the Tories, if not the worst.

🚨🚨New Voting Intention🚨🚨
Labour lead is sixteen points in latest results from Deltapoll.
Con 29% (-2)
Lab 45% (-)
Lib Dem 10% (+1)
Other 17% (+3)
Fieldwork: 12th – 16th January 2023
Sample: 1,059 GB adults
(Changes from 5th – 7th January 2023) pic.twitter.com/zBNJ5n7HmG

— Deltapoll (@DeltapollUK) January 16, 2023

Friday's front page: EU wants Starmer to become British PM

From @LeoCendro: https://t.co/fyVV8mH3fP#TomorrowsPapersToday pic.twitter.com/ms4oHrXORQ

— i newspaper (@theipaper) January 19, 2023

Wonder how this will pan out.

Yes – and starmer is lying about it. He is playing us for fools.The man has turned into a hard brexiteer. He is now against any significant change. Don’t be fooled

If it’s one thing I’ve learnt about Starmer is I don’t trust him on any position he takes.

He doesn’t have a position really.

Depends which way the wind’s blowing.

And that would represent one of the worst general election results ever for the Tories, if not the worst.

Different timeframes but I think the Tories are going to claw back some into the Summer.

The magic of inflation and lower interest rates is coming. (“Our independent friends at the BoE are now in a position to lower rates”)

Whether it will be enough and the official recession will eventually turn up, who knows. (I believe we’re well into one currently but GDP keeps doing these sneaky 0.1% numbers.) Basically no growth which ever way you cut it.

Anyway clearly there’s hardly going to be much growth – especially when last year’s figures were bolstered by GP spending (i.e government spending.)

Long term I still think the Tories are screwed.

Here in Bassetlaw we just got the 18million levelling up boost. Brendan Clarke-Smith is all over it like a cheap suit.

Imagine having to bid and beg for public money from your own government?

Here in Bassetlaw we just got the 18million levelling up boost. Brendan Clarke-Smith is all over it like a cheap suit.

Worksop is set for a £20 million boost thanks to the Council’s successful bid to the Levelling Up Fund.

Cllr Jo White, Cabinet Member for Regeneration, explains what will be happening in Worksop Town Centre 👇 pic.twitter.com/cIo4Dc7LBG

— Bassetlaw Council (@BassetlawDC) January 19, 2023

And herein is the problem with bidding and grants – it’s seen as a massive victory when you get 50p from the government. Despite decades of disintegration.

Levelling up for the red wall. Wonder if they will build an actual red wall?

And herein is the problem with bidding and grants – it’s seen as a massive victory when you get 50p from the government. Despite decades of disintegration.

And from what I can see it encourages bids for “shiny show ponies” that ministers can use for photo ops rather than “work horses” that really help regenerate an area.

Exactly.

Different timeframes but I think the Tories are going to claw back some into the Summer.

Six months ago I would have said that the Tories would claw back much of their support by the time of the general election, but I no longer believe that – imo it will likely be minimal.

The reason is that imo the Tories have become a toxic brand. And Sunak seems to be proving that – he has barely improved the Tories’s level of support after taking over from Liz Truss.

The Labour lead throughout Sunak’s premiership, and remember this is still supposed to be his “honeymoon period”, has been very considerably greater than it was even in the final days of Boris Johnson’s dying premiership.

Why is that? The huge collapse in support for the Tories under Liz Truss was fairly understandable, although it still took me by surprise, but why has it barely recovered under Sunak? He hasn’t made anything like approaching the blunders that Truss made. And compared to Truss the Tories seem fairly happy with him.

IMO no one could under the current circumstances reverse the Tories’s fortunes – after 13 years they have reached their use by date.

Yes I appreciate that inflation will fall so there will be some good news, already it is below the EU average, as is unemployment, but won’t be enough to save the Tories devastating rut imo.

Liz Truss sent the Tories into a death spiral which they can’t get out of and only several years of Labour governments will correct.

Why is that?

Starmer not painting a target on his head, and increasingly presenting his cabinet as a government in waiting not just an opposition.

Liz Truss sent the Tories into a death spiral which they can’t get out of and only several years of Labour governments will correct.

All I will say they’ve been on a downward trajectory for some time but things change fast.

Lower inflation, interest rates yet to be seen, possible stave off of recession and some angry migrant stories.

Also, as above sneaky levelling up funds popping up.

Coming into summer will be interesting.

That said they have to fail eventually.

IMO no one could under the current circumstances reverse the Tories’s fortunes – after 13 years they have reached their use by date

Yeah that’s my gut feeling too.

It only takes another crazy Black-Swan event and things could spiral again one way or another.

I think you might be exaggerating how much of the Tories’s dire situation is down to the state of the economy.

Back in August the Labour lead was mostly in single figures now it is easily double that, I don’t think this is because the economic outlook is now so much worse than it was in August.

There are other important factors which come into play, and they tend by even more out of the control of the Tories.

I agree that any perceived improvements in the economy will help them but I think the effect will be fairly minimal. Although time will tell.

I think you might be exaggerating how much of the Tories’s dire situation is down to the state of the economy.

‘Lizz’ Truss’s whole sinking was based on slightly misunderstood mechanisms of the economy and its consequences – even if her direction was cock-eyed.

And I know you love a good poll.

Which issues would most determine how Britons would vote in a General Election? (15 January)

The Economy 66%
Healthcare 62%
Immigration 26%
Education 24%
The Environment 19%
Taxation 19%
Housing 19%
Welfare 16% pic.twitter.com/QUnizijoE5

— Redfield & Wilton Strategies (@RedfieldWilton) January 20, 2023

Lizz’ Truss’s whole sinking was based on slightly misunderstood mechanisms of the economy and its consequences

The negative reaction to Truss’s economic policies came from two different directions – the markets and the voters.

The markets reacted badly to her economic unorthodoxy and voters reacted badly to total injustice of putting money into the pockets of the wealthy during a cost of living crises.

I’m not sure that voters necessarily misunderstood anything – their rejection of trickle down economics seems to have been quite sound imo.

Truss should have learnt the lesson of unfair taxation policies from the downfall of her heroine. She clearly didn’t.

rone
Full Member

The magic of inflation and lower interest rates is coming. (“Our independent friends at the BoE are now in a position to lower rates”)

Yup, they’re already trailing that halving interest rates is going to be celebrated as a gigantic win, it’s all going to be sold as “down 5%” not “up 10% and then down 5%”. And the cost of living crisis will be “solved” by the sun coming out and heating bills falling

The markets reacted badly to her economic unorthodoxy and voters reacted badly to total injustice of putting money into the pockets of the wealthy during a cost of living crises

The markets were over-leveraged (with hedging) in very simple Friday night terms. Fixed very easily with 19bn (not 60bn) BoE regular intervention.

It’s as much a problem with that as it was with Trussenomics.

As an aside watch the US going into total meltdown with their self-imposed debt ceiling. Again.

And then watch it amount to nothing.

Apparently the US government might go bust. Lmfao.

Musk going on about government being a bad business with it’s debt. Without government ‘debt’ (asset swap of government money for interest bearing bonds) there would be no private savings or money for the private sector to manipulate.

These people are crackers.

Government debt is your interest bearing savings, bonds, NS&I etc.