Shortage of family doctors leaves health care in crisis
The NHS is facing a chronic shortage of family doctors after official figures showed some GPs were responsible for 9,000 patients. More than a million people were registered with a GP who served more than 3,000 patients, almost twice the average list size of 1,600.
Experts warned that doctors with vast numbers of patients might not be providing the best service, with their practices seeing poorer care and longer waiting times.
The figures show the worst surgeries for securing a doctor’s appointment within two days have 50 per cent more patients per GP than the average practice.
Leading doctors warned that the problem was likely to be exacerbated by reforms planned by Andrew Lansley, the Health Secretary.
Dr Michael Dixon, chairman of the NHS Alliance, which represents the UK’s primary care trusts, said it was a question of whether doctors were “able to cater as well for each patient with a list once they get much over 2,000 or 3,000”. He said shortages were already being seen in inner cities, but recruiting GPs had become a problem even in affluent rural areas such as his practice in Devon.
“We’re not producing enough GPs as opposed to specialists,” he said. “Our workforce is in the wrong place. It’s in hospital whereas it needs to be in the community. This is already beginning to show and it will get worse over the next year or so.”
England has 25,000 family doctors, but there are growing concerns that the NHS faces a retirement crisis. According to a survey by the British Medical Association published in June, one in eight GPs is planning to retire within two years. A third of that group raised concerns about NHS reforms while pay freezes, pension changes and increasing workloads were also significant factors.
The shortages have been exacerbated by the retirement of a generation of Asian GPs who came to Britain during the 1960s and 1970s.
The search for replacements is hindered by restrictions under which the NHS is only allowed to employ foreign doctors if there are no suitable staff in Britain or the European Union.
Prof Aneez Esmail, from Manchester University, said: “There was an influx of Asian doctors in the 1960s and 1970s. Many of these went to work in under-doctored areas in inner cities and my research shows they were retiring in the 2000s. “There was also a clampdown on recruitment of doctors from the subcontinent around 2009. We thought we had enough British graduates but most were going into hospital medicine.”
There are also concerns that the growing number of female GPs, many of whom work part-time because of family commitments, will lead to further shortfalls. Two thirds of trainee GPs are women and research by the Royal College of Physicians has found that women GPs will outnumber their male colleagues by 2013.
Dr Sarah Wollaston, a Tory MP and former family doctor, said: “It creates all sorts of pressures as women take time out with family commitments. There is a real risk of a shortage.”
The Centre for Workforce Intelligence has recommended that an extra 450 GP training posts should be filled each year over the next four years. However, the number of doctors training as GPs fell by 7 per cent this year, even though more places have been made available.
Dr Wollaston added that many medical students perceive hospital careers to be more glamorous. She has written to Mr Lansley warning him there are “real problems brewing” around the number of GPs. “I do not think if you have 6,000 people on your list you can possibly be delivering the best service,” she added. “It’s just not possible.”
Doctors in the South East are having to deal with the greatest number of patients, with average list sizes of more than 2,000 in primary care trusts such as Westminster, Brighton, Essex and Hounslow, west London. In comparison, GPs working in Devon, Bristol and Somerset have only around 1,300 patients on average. Overall, one in five GPs has a list of more than 2,000 patients.
According to the Department of Health data, two GPs — one in Camden, north London and one in Newham, east London — have 9,000 patients each.
The shortage of GPs in some areas means some family doctors have to work harder than ever. Dr John Harban, a family doctor in Barnsley, South Yorkshire said he coped with a list of more than 6,000 patients by offering a walk-in system where no appointment was necessary and by working from 8am to 8pm. “It means they might have to wait a bit longer but they will always get seen,” Dr Harban added.
A spokesman for the Department of Health said there was “no evidence of difficulties accessing GPs”. However, she said the department planned to make training more flexible to ensure the right people became GPs.
British taxpayer funding £100,000 a day for failed asylum seekers
The British taxpayer is spending more than £100,000 a day to house failed asylum seekers who have no right to be in the country
The Home Office spent almost £40 million last year supporting so-called “hard cases” – asylum seekers who have had their claims rejected but cannot leave for one reason or another. It is usually because of unsafe conditions in their home country, a medical condition or they have launched a judicial review on a legal point in their case.
But in the meantime the taxpayer must fund their accommodation and living allowances.
And the cost of the asylum system is growing after separate figures showed the number of asylum seekers who are still awaiting a decision and need accommodation increased in 2011.
Sir Andrew Green, chairman of Migration Watch UK, said: “This is a measure of the lengths to which people will go to stay in Britain. “But in the end, if their cases fail they must leave or the credibility of the whole system is completely undermined.”
Under what is known as Section 4 support, asylum seekers who have had their claim for shelter rejected but cannot currently return home are given accommodation and living support. In the 12 months up to September 2011, a total of 4,430 people were awarded such support – the equivalent of 12 a day. Some of those will have since left the country but others may be here indefinitely if their particular circumstances do not change.
Over the period, the Home Office spent £38.2 million on Section 4 support or £104,658 a day.
To be eligible for such support, a failed asylum seeker must be destitute and satisfy one of the following requirements.
They taking all reasonable steps to leave the UK, cannot leave because of a physical impediment to travel or for some other medical reason, cannot leave the UK because, in the Secretary of State’s opinion, no viable route of return is currently available or have applied for a judicial review of their asylum application and been given permission to proceed with it.
As well as accommodation, recipients are given a payment card, worth £35.39 per person a week, which is used to buy food and essential toiletries. However, they cannot use the payment card to obtain cash from a cash point or car fuel.
It emerged in May that the public are paying more than £1 million a month to “bribe” illegal immigrants and failed asylum seekers to go home.
Up to £74 million has been spent in the past five years on a voluntary return scheme for those who have no right to remain in the UK. The programme offers packages worth up to £2,000 of “in kind” support, such as help setting up home or a business, in return for them not fighting removal.
Destitute asylum seekers whose cases are still being considered and who are not detained are also given support. Some 2,406 applicants were given such support in the first nine months of 2011 suggesting the annual total will be higher than the 2,551 awarded it throughout the whole of 2010.
The Queen reminds us of the power of family
The Queen’s Speech focuses on the families that support us in times of crisis. A reflection on her Christmas Day message
When Her Majesty the Queen chose to focus her Christmas message on the importance of family, she was unaware that her own closest relation would be taken from her side. As it was, there was a special poignancy – for those watching on television – to the images of husband and wife on screen, given that Her Majesty and the Duke of Edinburgh have been separated by illness at this least appropriate time of year.
Studying that broadcast, it would be hard to think of a better illustration of how dedicated a servant the Duke remains to his wife and Sovereign, even in his 90th year. Elsewhere on these pages, Philip Eade sets out the many ways in which he has strengthened and supported Her Majesty over the years, greatly to the benefit of his adopted nation. As the Duke recovers from his operation, both he and his wife will be able to draw similar strength from the family around them, this year enlarged with the marriage of two of their grandchildren. Indeed, it was appropriate that this was the very theme of Her Majesty’s Christmas message: the way that family, and the support of those we love, enables us to cope with times of hardship, and how such trials often draw out “the most and best” of the human spirit.
Her Majesty was not just talking about our immediate families, however. As she reminded us, “family” can define more than simply those related to us by blood. She cited the example of the Commonwealth that she has done so much to hold together – “a family of 53 nations, all with a common bond, shared beliefs, mutual values and goals”. Similarly, her definition of hardship was a broad one, encompassing not just the natural disasters that struck Queensland in Australia and Christchurch in New Zealand, but also being separated from loved ones serving overseas, or the more mundane pressures of austerity.
It is, of course, a cliché of the festive season to talk about the importance of family and community, and of being supported by those we love. But it is a cliché for a reason. Our families, our friends, our communities – and yes, our faith – are what sustain us in difficult times, and make life about more than simply the accumulation of wealth (or, in times such as these, the protection of what wealth we have).
This was a theme taken up in the Archbishop of Canterbury’s Christmas sermon, too. Next year is the 350th anniversary of the 1662 Book of Common Prayer, and the temptation will be to concentrate above all on the ways in which it has shaped our language. Yet as Dr Rowan Williams argued, the book also matters because it is of common prayer, offering a shared experience and shared devotion. Our society, the Archbishop suggested, all too often lacks such anchors: as a result, “bonds have been broken [and] trust abused and lost”, making space for the misbehaviour both of “mindless” urban rioters and irresponsible fiscal speculators.
In difficult times, with the future all too uncertain, it can be tempting to harden our hearts as we tighten our wallets. Yet if we lose our connection to those around us, we become – as Dr Williams put it – merely “atoms spinning apart in the dark”. And as the Queen reminded us yesterday, “finding hope in adversity is one of the themes of Christmas”. Jesus himself, she pointed out, was born into a world “full of fear”.
Over the next 12 months, Britain will witness a series of truly grand occasions. Her Majesty’s Diamond Jubilee promises to be a marvellous celebration of a monarch who has served her people with dignity and dedication for so long. The Olympics will bring the world to London and many other parts of Britain. Yet of equal importance to such national spectacles are the humbler moments of familial or communal pleasure. Just as the Duke of Edinburgh will be aided in his recovery by having his family around him, so are the rest of us supported by those we care for. If we can hold on to that sentiment, it might make the new year happier for us all.
Hunting ban? Tally-ho!
This is the seventh Boxing Day since the ban took effect, the sport has never been more popular
Hunting ban? What hunting ban? Today, more than a quarter of a million people are expected to turn out at some 300 hunts, on what is traditionally the biggest day of the hunting calendar. Even though this is the seventh Boxing Day since the ban took effect, the sport has never been more popular.
For supporters of hunting, this presents a difficulty. Ever since the Labour government pushed the ban on to the Statute Book, using the Parliament Act to overcome the objections of the House of Lords, there has been a campaign to reverse the decision. The Coalition Agreement promised a free vote in Parliament, though the addition of the words “when time allows” was a convenient get-out clause.
The Hunting Act is a bad law, not least because it is almost impossible to uphold. Last year, 36 individuals were convicted under its provisions; yet only one of those individuals was associated with a registered hunt. Yet, while bad laws should generally be repealed, the House of Commons – as we report today – would be unlikely to do so, even if ministers were inclined to hold a vote. In any case, any legislation to overturn the ban would reignite a fractious debate, at a time when Parliament has serious economic matters to consider.
What we see at work today, therefore, is a classic piece of British pragmatism. The Act is wrong, does not work and should be scrapped. But an uneasy compromise has been achieved that allows many thousands of people to carry on hunting. The time will come when a sensible Parliament will reverse one of the most illiberal and pernicious laws of recent times. Until that day arrives, tally-ho!
The Anglican priest who thought Stalin was a saint
BOOK REVIEW: Charles Moore reviews ‘The Red Dean’ by John Butler (Scala)
As Canterbury Cathedral this week marks the anniversary of the death of its most famous “turbulent priest”, Thomas Becket, it is a good moment to study the life of its second-most famous one. Hewlett Johnson became the Dean of Canterbury in 1931, when he was already getting on for 60, and clung on to the post, despite numerous attempts to get him out, until 1964.
Over those 33 years, Johnson devoted the bulk of his astonishing energy to proving that Soviet Communism, especially as practised by Stalin, was heaven on earth: “While we’re waiting for God, Russia is doing it.” In his bestseller The Socialist Sixth of the World, which was published not long after Stalin’s most extensive programme of mass murder, he wrote: “Nothing strikes the visitor to the Soviet Union more forcibly than the complete absence of fear.”
No Communist outrage could put Johnson off his stride. He supported the Nazi-Soviet Pact of 1939. In the face of all evidence, he praised the Soviets for their toleration of religion, excitedly reporting, after a private audience with Stalin, that the great man favoured freedom of conscience. He always refused to condemn Stalin. Neither would he condemn the Soviet invasion of Hungary in 1956.
His methods, too, were sometimes unscrupulous. He repeatedly accepted free trips from VOKS, the Soviet cultural front organisation which suborned Western writers and intellectuals, never questioning its itineraries or facts. When he wrote his books, he copied out the economic statistics that VOKS sent him, without inquiry or even comprehension. The uncritical tribute he published on Stalin’s death was in large part plagiarised, without acknowledgment, from an existing piece of Soviet propaganda. The British intelligence services may well have been right to consider him an “agent of influence”.
Johnson did well from his views. In 1951, he was awarded the Stalin Peace Prize, for which he received £10,000 (roughly £230,000 in today’s money). The sales of his books were made enormous by the print runs which Stalin decreed for them. His stupendous vanity was gratified by meeting the dictators (including Mao, Fidel Castro and Rakosi in Hungary). He became a world celebrity, and regarded his main book as “dynamite, the most powerful war weapon, that starts factories working”.
He was also, arguably, a hypocrite. Although certainly not personally luxurious (he liked nothing better than rolling in the snow in the Deanery garden rather than wallowing in a hot bath), he was pretty rich and employed several servants. He came from a prosperous Northern industrial family (Johnson’s Wireworks) and his first wife was richer still. When she died, she left him Chippendale, Sheraton and Hepplewhite furniture, silver, jewellery, fine carpets, Chinese and Japanese sculptures, a Broadwood grand, tapestries, paintings, glassware etc. By 1952, he owned 11 houses and garages, and plenty of shares, including some in Lonrho.
In 1937, when the pupils at the King’s School were making too much noise for his taste, he grabbed some of the school’s land for his garden to keep them at a distance. Criticised by the Archdeacon, he told him sharply that he should not be “worrying over small matters when so great things were at stake in the world”. He was off to the Soviet Union, he said, because “I ought to use all my spare time for bigger things” – without surrendering his horticultural conquest.
During the war, it distressed Johnson that the servants were getting uppity. He was angry when his handyman got a bigger boiled egg for breakfast than he. Writing to his second wife – who, in wartime exile in Wales, was having trouble with her maid – he advised her: “Let her see that you are a lady and if she cannot rise to the privilege of comradeship then the older relationship of mistress and maid must continue… It is moral training. Russia has had to do this.”
What makes this book so interesting, however, is that the author wants us to see the good in Johnson. While never concealing or excusing his politics, John Butler draws on personal archives never before seen to paint an attractive picture of the private man – vigorous (his second wife was 32 when he married her at the age of 64), affectionate to his children (he first became a father when he was 66), brave in staying in Canterbury all through the war. He was popular with the people, though not the Chapter, of Canterbury. With his domed pate, long white hair, tall, imposing figure and old-fashioned decanal gaiters, he was a “character”. He worked relentlessly and preached often and well. In an odd way, he kept alight the beacon of the Anglican world at a time of great trial.
I am glad that Mr Butler has approached his task in this way, because it makes the book much fresher than a work of character assassination. But its effect is to point up how extraordinary it was that a free country like ours could excuse people who defended mass murderers so long as they were from the Left. If Johnson had spoken of Hitler as he did of Stalin, no one would have received him in polite society.
For his unusual views, Johnson suffered nothing worse than a few cross letters from the Archbishop and semi-successful attempts to dislodge him from various Canterbury positions (“Ominously, the governors began to plot Johnson’s removal as Chairman of the Governing Body”). By contrast, the victims of the man he worshipped died in their tens of millions. His speeches and writings helped legitimise this. Johnson was told by Raul Castro (who, replacing brother Fidel, rules Cuba to this day) that people believed his pro-Communist writing because he was a priest. That is a terrible thought.
Large climatic variability over the last 2,000 years in Britain
The record is one of the highlights of the most comprehensive record of English weather, dating back to 56BC, which identifies the worst winters seen in Britain in over 2,000 years.
Using a wide variety of sources, including some which less diligent researchers might have eschewed, Jim Rothwell, a retired meteorologist, has built what he believes to be the fullest study of weather across central England in existence.
He has found striking examples of extreme weather going back hundreds of years.
In 1357, after a dry early summer then downpours throughout the autumn, winter saw starving wolves prowling through Sherwood Forest, taking livestock and even threatening humans.
The winter of 1458 saw a bridge destroyed over the river Trent because of floodwaters caused by melting ice which followed prolonged and heavy snowfall.
In 1635, severe blizzards led to very deep snow with drifts up to 20ft deep in Lincolnshire.
However, he had also found evidence of particularly mild winters.
In 1607, in the reign of James I, flowers were reported to be in bloom on Christmas Day.
Four hundred years earlier, in 1249, witnesses claimed the winter was so mild that there were “birds singing like it was spring”.
The summer of 1375 is also noteworthy, as evidence shows the warm, dry weather lasted well into October.
As is the rainy summer of 1315, which was so wet that on July 15 that it is thought to be the origin of the St Swithin’s Day belief that if it rains on that day, it will continue for 40 more.
Mr Rothwell worked for the Met Office for 38 years but was also the expert forecaster for filming of the 1965 James Bond film Thunderball.
On his retirement in 1989, he began to piece together everything that was known about central England’s weather, a roughly pear-shaped area which extends from the north Midlands to Winchester and London in the south.
He chose the area as it is largely flat to make chronological comparison more relevant as hills create local weather patterns which are not necessarily representative of the weather for the country.
Mr Rothwell, 80, who is also a Fellow of the Royal Meteorological Society, has now compiled The Central England Weather Series, which begins at 56 BC in the era of Julius Caesar and is housed with Nottinghamshire County Council’s archives service.
His sources, which number over 50, range from county council and university archives; to historical reference works, particularly those with pictures showing the weather in detail; to the writing of Samuel Pepys and John Evelyn, the 17th century diarists.
He also used local newspapers to corroborate information and even used the library of De Bilt, a publication in Holland, to get weather reports for the Middle Ages.
One of the quirks he had to overcome was the 11 days added to the calendar by the government in 1752 when England swapped the Julian calendar for the Gregorian to being it into line with the rest of Europe.
Mr Rothwell, who has a Masters degree in climatology as well as degrees in history and geography, said his combination of skills had helped him in his research.
He said: “I have used history books containing references to key periods in history as part of the research. If there was a photograph or image showing snow, I have pinpointed that date in the records.
“There has been much analysis of data to ensure I have the truest record possible. For example, Samuel Pepys and John Evelyn had a tendency to exaggerate some of their descriptions of weather in their diaries.”
Mr Rothwell said: “The records show that all sorts of unusual weather has occurred during all of the seasons in central England in the past.
“People are alert to unusual weather patterns at the time they happen, but do tend to forget these exceptions as time goes on.”
Mark Dorrington, of Nottinghamshire County Council, said: “This is a fantastic and comprehensive record of weather in Central England and we are privileged to have it in our archives.
“The weather is always a fascination for people and this collection of records is a hidden gem, so we are delighted to let people know it is available.”
British crackdown on bad teachers branded a failure as figures reveal just four a week are being fired
Only four incompetent teachers are being sacked a week, despite David Cameron’s pledge to crack down on poor standards. Figures released under the Freedom of Information Act show that 154 teachers at primary and secondary schools in 82 council areas were dismissed in the past 18 months.
If the pattern is repeated across the 448,000 teachers employed by all of England’s 152 councils, that works out at some 200 a year, or four a week.
The figure is far fewer than the 15,000 incompetent teachers that former chief inspector of schools Chris Woodhead has estimated exist. The FOI answers revealed that of the 740 teachers subject to complaint in the past 18 months, 154 were sacked, 174 resigned, 132 cases are unresolved and the rest stayed in post or retired. Some had received a written warning.
After the election the Coalition promised to tackle the scourge of bad teachers, and the Education Act streamlines procedures for dismissing them.
But Professor Alan Smithers, director of the Centre for Education and Employment Research at Buckingham University, said not enough was being done. ‘Too many poor teachers remain in their jobs year after year after year,’ he said. ‘They do harm. We owe it to the children to intervene effectively.
‘At present, it’s nearly impossible to prove a teacher is bad. On top of this, powerful unions fight on behalf of teachers.’
Mary Bousted, general secretary of the Association of Teachers and Lecturers, said that while the dismissal rate was low, teachers accused of poor standards are being ‘managed out of the classroom’ in other ways.
Woman left a virtual recluse by Tourette’s syndrome ‘cured’ by electrodes implanted in brain
A woman with Tourette’s syndrome who suffered such terrible spasms she became a virtual recluse, has been given her life back following pioneering surgery. Jayne Bargent, 55, said she has been effectively cured of the uncontrollable and violent tics that left her unable to read, cook or walk in a straight line.
She had suffered from Tourette’s syndrome since childhood but over the past few years medication taken to treat the condition had started to make it worse.
Doctors at the National Hospital for Neurology and Neurosurgery in Bloomsbury implanted two tiny electrodes into her brain which were then connected up to a pacemaker battery in her chest.
The battery delivers mild electrical pulses via the electrodes to parts of the brain which control movement. The procedure, known as deep brain stimulation, or DBS, has already proved effective for other movement disorders including Parkinson’s.
It is not known exactly how the stimulation works but it is thought to harmonise the electrical circuitry in the brain.
Within an hour of the electrodes being switched on this week, Ms Bargent, from Hampshire, was showing dramatic improvement. Doctors said she would continue to get better over the coming weeks.
She said: ‘It’s amazing – I just don’t feel like the same person. This is going to give me my life back. I’ve had three years of getting gradually worse and they press a few little buttons and everything improves dramatically.
‘We had stopped socialising. I wouldn’t eat in front of anyone because the food would fall out of my mouth. I couldn’t even lie on the bed to relax if I was having a bad day because I would still be twitching and have pain in my neck. I couldn’t imagine living the rest of my life that way. ‘But now I’ll be able to phone people, go for walks and start riding again. It’s going to totally change my life.’
Her partner Mark Trick said: ‘I’m astounded by the difference in Jayne. I cannot thank the hospital enough.’
The hospital and the UCL Institute of Neurology are carrying out the UK’s first trial to evaluate the impact of DBS on Tourette’s, which occurs mainly in childhood. Only a small percentage of sufferers shout inappropriate comments. Most, like Ms Bargent, suffer from involuntary movements.
The trial is taking place at the Unit of Functional Neurosurgery which is backed by the Parkinson’s Appeal, the Edmond J. Safra Philanthropic Foundation and the Monument Trust.