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Now here actually is a good idea from the Senior Lecturer

It’s more difficult to get an appointment to see the GP in a poor area than a rich one.

I might perhaps suggest that GPs, who are paid well, don’t like living in poor areas. Fancy that, eh? People who can afford not to live in grot prefer not to live in grot.


Ritchie suggests:

As I would also add, based on personal knowledge, once the second trend is in place it becomes increasingly hard to recruit because workloads are so much higher for those GPs who do work in such places.

What to do?

Differential pay would be a start. I can see no reason why not.

Well, other than that the TUC, every union up to and including the BMA would kill you for suggesting it. Because if there are no longer national pay scales then there’s no point in national pay bargaining, is there?

Why, we might even move to market determination of wages, how much do we need to pay to fill this job in this place? Expect this idea to be backtracked upon.

30 thoughts on “Now here actually is a good idea from the Senior Lecturer”

  1. Another idea would be a variant on student loans – make Medical students repay the cost of their training if they don’t work for the NHS in the UK. So providing a disincentive for those like Mrs Murphy who choose not to work to take up a scarce space in Medical schools.

  2. When we lived in Oz newly graduated schoolteachers would be sent off to work in the Bush for a while before being allowed to drift back to Real Australia i.e. the suburbs.

  3. Bloke in North Dorset

    John77 +1

    When the Army put me through an 18 Month HND I had to commit to 5 years service after completion.

  4. TRUK is going to be late filing accounts yet again.

    Yes, I know it’s only a few days, and he might have posted them already. But he gets the blank accounts for Finance for the Future LLP filed (obviously not much finance in the future judging by those).

    Maybe he needs a better accountant.

  5. Tim

    I had hoped to have seen out 2018 without a reminder of Murphy.’s existence. Please don’t let this be your last blog this year

  6. “Expect this idea to be backtracked upon.” – no need for back track to be wrong. North is poorer, thus higher salaries for the North. Cherry on top will to describe the higher salaries as investment.

  7. The exercise of how Spudda maintains this view alongside his previous claim that “the price signalling mechanism of the market is an unsuitable indicator for allocating resources with regard to health” is left to the reader.

  8. @ Hallowed Be
    North is poorer so cost of anything whose price is not set nationally will be lower in the North so one gets a higher standard of living for the same salary in the North. We don’t need higher nominal salaries in the North to achieve that.

  9. North is poorer so cost of anything whose price is not set nationally will be lower in the North

    Not necessarily. Supply might be lower too; with jobs that would mean having to pay more to persuade someone to move to Rotherham or any other northern shithole.

  10. @ Bloke in Wales
    Supply of UK-produced food is higher, per head, in the North. Supply of housing is better.
    I admit that there is much more subsidised public transport in the south, but travel by car and, particularly, parking is easier in the north.

  11. Let us not forget that it was the EU that banned employment contracts binding employees for more than 2 years, thereby putting the final dagger into apprenticeships, and any other job training with a pay-back > 2 years.

    There are of course exceptions (what EU rule doesn’t have those), the military & Football spring to mind.

    So training doctors to work in the NHS hasn’t been possible for the last 25 or so years.

  12. @ Raffles
    It’s not an employment contract – it would be a contract to pay medical schol fees with a waiver for those who worked in the NHS for N years, and once we are out of the EU, their rules cease to apply unless we choose to make them apply.

  13. “Supply of UK-produced food is higher, per head, in the North. Supply of housing is better.”

    Why, I asked, a Sainsbury’s filling station attendant in Harrogate, is petrol more expensive here than at my Sainsbury’s in Suffolk? Because you have to come farther to buy it, he immediately quipped.

  14. My Murphy highlight of 2018 (in reply to hassling to supply data under GDPR).

    Dear Unknown Person Who Cannot Be Identified

    I am replying to your request of 18 June. The Information Commissioner’s Office has reversed the advice previously provided, saying that the person who advised me (quite emphatically) that I should not supply information without further proof of identity was wrong to do so.

    I now attach copies of two email chains which are the only ones I have on my system barring that requesting this data, which you already have.

    I attach copies of 187 comments on the Tax Research UK blog. These are all there are. They include one on a post now not available on the web. There are no deleted blog posts that were once published.

    I attach a PDF of 12 comments in the trash folder.

    I confirm that in 2010 your email address was added to software that usually automatically blocks comments submitted from it. These do not, as a result, usually appear on our systems and are never processed

    There is no data on this blog not under my control.

    The attached comprises to the best of my knowledge all the data that satisfies your request.

    Yours faithfully

    Richard Murphy

  15. Many years ago a doctor mate told that GPs are essentially allocated on the basis of population, not need – a GP in Gerrards Cross has roughly as many patients on the list as a GP in Newham and is paid on the same scale. However, the Newham GP has a higher workload – more manual/unskilled labourers, poorer housing, poorer diet, a higher incidence of tropical diseases, a more transient population, and a greater need for interpreters all make for a massive imbalance

  16. Does a GP who lives in Hambleton ( not deprived ) but works in Middlesbrough ( deprived ) count as a Hambleton or a Middlesbrough GP?
    It isn’t immediately clear – the only think that is clear is that Ritchie doesn’t know either and wouldn’t have read the source material. It’s an article that says modern Britain is unfair and that’s what matters.

  17. I live in a poor area. Lots of ex-council estates (only not currently council estates as our council has no housing anymore).
    I can get an appointment same week most of the time, sometimes same day if its urgent, if not then one or two days later.

    The local surgery company owns two surgeries, one in my village and one in next village over. Staff are shared between the two and same number for booking appointments.

    Perhaps there are others in poor areas who share similar experience of booking appointments. I mean I only go to the surgery maybe 14 to 18 times a year.

  18. john77 – as is common for debts those who don’t work or don’t earn much generally pay them off in peanuts or less – say a £80k debt at £1 a month. Or not even that if no income.

  19. Actually the NHS is more likely to kill you if you live in a rich area because of national pay scales.

    Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labor Markets on Hospital Performance

    In many sectors, pay is regulated to be equal across heterogeneous geographical labor markets. When the competitive outside wage is higher than the regulated wage, there are likely to be falls in quality. We exploit panel data from the population of English hospitals in which regulated pay for nurses is essentially flat across the country. Higher outside wages significantly worsen hospital quality as measured by hospital deaths for emergency heart attacks. A 10 percent increase in the outside wage is associated with a 7 percent increase in death rates. Furthermore, the regulation increases aggregate death rates in the public health care system.

  20. @ Martin
    Accepted albeit I haven’t seen a rate of £1 a month, which would only amount to £60 over the five-year period of a normal IVA. My point was the deterrent effect on an 18-year-old girl who wants a medical degree but not to work afterwards as very few of them will know how IVAs and DROs actually operate so fewer of them will take up spaces that could otherwisw be avalable to some lad who would thereafter put in 40-odd years’ work.

  21. @ Martin
    In my far-from-poor Green Belt town it has got a lot more difficult to get GP appointments over the last decade – for the last one I had to wait for more than two weeks. In the industrial town (more than 90% working-class) in which I grew up there were no appointments – one went to surgery and waited to be seen that day.
    It is just possible that Murphy is wrong as usual.

  22. @j77

    “In the industrial town (more than 90% working-class) in which I grew up there were no appointments – one went to surgery and waited to be seen that day.”

    Almost certainly not the way it works there now though – as I understand it, GP booking systems have changed a lot partly in response to the changing targets they are supposed to hit.

  23. @ MBE
    Admitted – I don’t know how it works now but I should be pleasantly amazed if they still had that simple sensible system. i was just highligghting the contrast.

  24. @j77

    The problem with that from a manager’s PoV these days, I suspect, is they couldn’t show how many people were obtaining their appointment within X days without them having a recorded booking for a time-specific appointment. Hence can’t be compared to target…

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