(Following on from PC 456; I was talking to Lisa in the Hope Café)
“Earlier this year I recognised that my ‘gut health’ was in a poor state following three general anaesthetics in 14 months, so started taking a probiotic, Symprove, one recommended by a dietician/nutritionist called Caroline Laidlaw.”
“Surely you can just eat more fermented fruit and vegetables and drink Kombucha. Isn’t that the same?”
“Possibly!! According to the various health bibles, ‘you can support your gut health by eating a diverse, fibre-rich diet, managing stress, prioritising sleep, exercising regularly and staying hydrated, while also limiting processed foods, sugar and excessive alcohol.’ I wish! Anyway, I decided to follow Caroline’s advice and sense a big improvement. Sadly the ‘original’ flavoured liquid tasted like cat’s piss, so now I’ve opted for the Strawberry & Raspberry flavour.
“Cat’s piss? How would you know what that tastes like? Actually don’t answer that!”
“We use ‘piss’ in a variety of ways. There’s ‘weak beer’s the colour of piss’ and then ‘he’s pissed’, in informal English suggesting someone’s angry and annoyed, a contraction of ‘pissed off’. Confusingly ‘he’s pissed’ might also mean ‘he’s drunk’, probably because one’s subsequent actions may piss off those around you.”
“Come on Richard. Forget about gut health for a moment, I need you to concentrate on GPs etcetera. Having done lots of research already I suspect that low level healthcare provision in the United Kingdom is not in a good shape.”
“Well, I looked at my own, Trinity Medical Centre, the one I am registered with in Hove.”
“Ah! I am just up the road with Charter. And ……”
“According to their website, they have eight doctors who are partners and eight who are salaried general practitioners, but not all the doctors spend five days a week in the practice, carrying out other roles within the NHS, committee work, training research etc.”
There’s a certain symmetry in having a medical centre in a decommissioned church!
“So, 16 doctors in total. The World Health Organization norm is one doctor for 1000 patients. Here in the UK the average is some 2250, an increase of 17% in ten years. ….”
“That’s a huge increase!”
“My doctor at Charter says they plan on some 8-12 minutes per patient ….. and you can only present one issue!”
“Trinity has, according to their website, about 24,000 registered patients. GP Surgeries are paid £136 per patient per year for the Practice’s operational costs, including heating, staff wages and administration. There are separate funds for specific patient care services such as specialist referrals or prescription drugs. Twenty-four thousand registered patients give them an income of £3,264,000. One of the doctors told me that unscrupulous practices just sign up as many individuals as possible, giving them more revenue and making that patient/doctor ratio unworkable.
“You know that one in seven GP Practices have closed since 2018? There are now 6,229 active practices in England, down 14 per cent on seven years ago. Just at a time when there are additional 5 million individuals registered”
“I had an interested comment from one of the GPs at Trinity. Some years ago, very few patients needing to see a doctor were in the 18-50 age bracket, so a practice could cope with a large number of registered individuals. Today everyone clamours to see a doctor – especially the ‘worried well’ and the anxious Millennials and Generation Z; and they want to be seen ….. now!”
“I assume that, when they can’t get an appointment, in frustration they head to the private practices, of which there are more and more.”
“Well I have certainly done that …….”
“I’ve got this note: The Royal College of General Practitioners’ plan ‘Fit For the Future’ urges new investment and retention measures, warning of a mass exodus of nearly 19000 GPs in the next five years.”
“That’s interesting; I have first-hand knowledge of this. I asked a couple of GPs, actually friends, actually a couple, how they were. “We are in the process of moving out of NHS general practice in the main due to the issues outlined in the RCGP’s ‘Fit for The Future’ plan. We as a bunch are highly resilient, committed and actively excited by the ability to change, to suit our patients’ needs, but the clunky system is no longer able to deliver this and we are fatigued. For a long time we’ve been squeezed financially and our newly qualified GPs don’t have job prospects. And those of us with experience have to work longer hours to earn the same pay, as our practices are aware they can employ someone willing to earn less because there is such demand. Morale is low! All a bit gloomy I’m afraid! But we are fine!” This really annoys me! On the one hand we have a high wastage rate of skilled individuals, on the other the Department of Health and Social Care saying: “GPs are front of centre of the Ten-Year Health Plan …….. that’s why they will benefit from an increasing proportion of NHS funds, and we’ve already made great progress, including recruiting over 2,000 extra GPs in a year”.
“Wouldn’t it be better to try and reduce the wastage rate? I was told about 30% of trained doctors leave within five years. This seems such a waste of time, talent and experience.”
“My daughter says it’s the same, the wastage rate, in the teaching profession. Maybe it would be possible to work on some retention scheme ….. or improve the working conditions. No business would accept this loss of skill; they would start looking as to why it was happening and how to lessen the wastage.”
“Richard this has been really useful and I’ve probably got enough copy for my article. Thank you!”
“No problem. Before you go …… we were talking about cat’s piss ….. in Estoril, Portugal Celina feeds a black cat that lives on the street and has also made friends with Mirela Gatos (Note 1), a Romanian who looks after dozens of strays down on the promenade.
Celina and Mirela
“Ah! We always need examples of good deeds. Enjoy Singapore, Perth and New Zealand.”
“Thank you. We will.”
Richard 19th September 2025
Perth Australia
PS The provision of both good health care and education are the bedrocks of a mature society.
Note 1 ‘Gatos’ is Portuguese for Cat!
postcards 