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GP numbers continue to fall but the UK isn’t unique in losing family doctors

How can the UK hold on to its GPs? Here are some solutions.



The 2019 Conservative manifesto promised to increase the UK’s GP numbers by 6,000 by 2024. That target will clearly not be met. In fact, the proportion of GPs working full time in England has fallen compared with last year, according to the latest figures from NHS Digital.

There were 26,706 permanent qualified GPs working in England in December 2022, down from 27,064 in December 2021. And if projections from the Health Foundation prove to be accurate, the shortfall is set to increase to around 8,800 GPs by 2030-31, equivalent to one in four posts being vacant. But is the UK unique among wealthy nations in suffering from a crisis in primary care?

It appears not. Australia has a GP shortage that is predicted to grow to more than 11,000 by 2032, with the demand for GP services increasing by 38.5% in that time. Likewise, Canada and New Zealand have similar GP workforce problems.

In New Zealand, half of its GP workforce intends to retire in the next decade. While Canada has seen a modest 1.2% increase in the number of family doctors, the demand for primary care services continues to outpace the supply of doctors.

In the UK, a quarter of all doctors are GPs, whereas it is one in three in Australia, and nearly one in two in Canada. Extrapolating from World Health Organization data, Australia and Canada have roughly similar numbers of GPs per head of population (12 and 11 per 10,000 population respectively), but the UK lags considerably behind (less than eight per 10,000 population).

However, international comparisons are difficult because how GPs are defined and what they do differs from country to country.

In the UK, the nature of general practice has changed considerably in the past two decades. British GPs deal with more than minor ailments.

In addition to triaging referrals to hospital specialists and providing health screening and vaccination services, they also manage patients’ chronic diseases (such as diabetes), which were previously handled by hospital specialists. They also play a key role in coordinating healthcare for patients in long-stay care facilities, such as nursing and residential homes.

British GPs are also having to care for more patients with complex health conditions because the population is ageing and many people have more than one chronic condition – known as “multi-morbidity”. One English study estimated that over a quarter of patients have two or more long-term conditions.

Having multi-morbidity is associated with increased health service use. These patients account for more than half of all GP consultations and hospital admissions. Multi-morbidity is also much more common in older populations.

A large Scottish study found that more than 80% of patients over the age of 85 years had multi-morbidity, and, on average, they had more than three long-term conditions.

It is unsurprising that the demand for GP services has gone up over the years in the UK, and will continue to do so, as the proportion of the population that is elderly increases. The UK Office for National Statistics estimates that the proportion of people aged 85 years and over will almost double over the next 25 years.

With falling GP numbers, the pressure felt by GP services will continue to increase as demand outstrips supply.

The number of people of pensionable age is projected to grow the most

Office for National Statistics

Reasons for leaving

So why do so many GPs leave the profession? One consequence of the high work pressures and long hours is burnout. This phenomenon is not unique to the UK and has been reported worldwide, with some estimates as high as one in three GPs suffering burnout. The pandemic has also had an impact on GP burnout worldwide.

Burnout and job dissatisfaction have been identified as key reasons for British GPs leaving the NHS. In one survey, three-quarters of British GPs reported their workload to be unmanageable or unsustainable.

Another UK study conducted in 2016-17 suggested that more than 70% of GPs reported severe exhaustion. Burnout was associated with spending more hours on administrative tasks, seeing more patients daily, and feeling less supported.

Australia and New Zealand have for some years been attractive options for British-trained GPs for numerous reasons. The current NHS climate and workload may be driving some doctors away from the UK.

One survey of UK-trained doctors in New Zealand found that 70% had relocated for a better lifestyle, due to poorer job satisfaction in the UK and disillusionment with the NHS. Doctors in New Zealand also had comparatively more leisure time than NHS doctors.

So what can be done?

How to keep GPs

To increase the number of GPs in the UK, sustained government funding and a long-term GP workforce strategy and plan are essential. To fix its recruitment and retention crisis, the UK needs to address the unhealthy work climate for GPs by improving support, reducing their administrative workloads, and tackling their patient workload intensity and volume, as well as long hours.

England is also trying some innovative schemes such as the “additional roles reimbursement scheme”, where networks of GPs are able to recruit additional staff such as physiotherapists, paramedics and pharmacists to augment their clinical teams and enable some tasks to be shifted from GPs.

However, the workforce for these roles is also in short supply, and some will need time and GP supervision to learn the skills needed to operate effectively in the community.

Trying to recruit more GPs or these allied health professionals from abroad is unlikely to succeed given the global shortage of both these groups of professionals.

Contrary to public myth, GPs generally also wanted more direct contact with their patients and valued the continuity of care – the loss of which has been cited as a reason why GPs leave general practice early. Public expectations will need to be managed, and negative media portrayals and criticisms of GPs are unlikely to help improve the worsening primary care situation.

Andrew Lee has previously received research funding from the National Institute for Health Research. He is a member of the UK Faculty of Public Health and the Royal Society for Public Health. He was previously a GP in Sheffield.

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Which New World Order Are We Talking About?

Which New World Order Are We Talking About?

Authored by Jeff Thomas via,

Those of us who are libertarians have a tendency…



Which New World Order Are We Talking About?

Authored by Jeff Thomas via,

Those of us who are libertarians have a tendency to speak frequently of “the New World Order.”

When doing so, we tend to be a bit unclear as to what the New World Order is.

Is it a cabal of the heads of the world’s governments, or just the heads of Western governments?

Certainly bankers are included somewhere in the mix, but is it just the heads of the Federal Reserve and the IMF, or does it also include the heads of JPMorgan, Goldman Sachs, etc.?

And how about the Rothschilds? And the Bundesbank—surely, they’re in there, too?

And the list goes on, without apparent end.

Certainly, all of the above entities have objectives to increase their own power and profit in the world, but to what degree do they act in concert? Although many prominent individuals, world leaders included, have proclaimed that a New World Order is their ultimate objective, the details of who’s in and who’s out are fuzzy. Just as fuzzy is a list of details as to the collective objectives of these disparate individuals and groups.

So, whilst most libertarians acknowledge “the New World Order,” it’s rare that any two libertarians can agree on exactly what it is or who it’s comprised of. We allow ourselves the luxury of referring to it without being certain of its details, because, “It’s a secret society,” as evidenced by the Bilderberg Group, which meets annually but has no formal agenda and publishes no minutes. We excuse ourselves for having only a vague perception of it, although we readily accept that it’s the most powerful group in the world.

This is particularly true of Americans, as Americans often imagine that the New World Order is an American construct, created by a fascist elite of US bankers and political leaders. The New World Order may be better understood by Europeans, as, actually, it’s very much a European concept—one that’s been around for quite a long time.

It may be said to have had its beginnings in ancient Rome. As Rome became an empire, its various emperors found that conquered lands did not automatically remain conquered. They needed to be managed—a costly and tedious undertaking. Management was far from uniform, as the Gauls could not be managed in the same manner as the Egyptians, who in turn, could not be managed like the Mesopotamians.

After the fall of Rome, Europe was in many ways a shambles for centuries, but the idea of “managing” Europe was revived with the Peace of Westphalia in 1648. The peace brought an end to the Thirty Years’ War (1618-1648) in the Holy Roman Empire and the Eighty Years’ War (1568-1648) between Spain and the Dutch Republic. It brought together the Holy Roman Empire, The House of Habsburg, the Kingdoms of Spain and France, the Dutch Republic, and the Swedish Empire.

Boundaries were set, treaties were signed, and a general set of assumptions as to the autonomy within one’s borders were agreed, to the partial satisfaction of all and to the complete satisfaction of no one… Sound familiar?

Later, Mayer Rothschild made his name (and his fortune) by becoming the financier to the military adventures of the German Government. He then sent his sons out to England, Austria, France, and Italy to do the same—to create a New World Order of sorts, under the control of his family through national debt to his banks. (Deep Throat was right when he said, “Follow the Money.”)

So, the concept of a New World Order has long existed in Europe in various guises, but what does this tell us about the present and, more important, the future?

In our own time, we have seen presidents and prime ministers come and go, whilst their most prominent advisors, such as Henry Kissinger and Zbigniew Brzezinski, continue from one administration to the next, remaining advisors for decades. Such men are often seen as the voices of reason that may be the guiding force that brings about a New World Order once and for all.

Mister Brzezinski has written in his books that order in Europe depends upon a balance with Russia, which must be created through the control of Ukraine by the West. He has stated repeatedly that it’s critical for this to be done through diplomacy, that warfare would be a disaster. Yet, he has also supported the US in creating a coup in Ukraine. When Russia became angered at the takeover, he openly supported American aggression in Ukraine, whilst warning that Russian retaliation must not be tolerated.

Henry Kissinger, who has literally written volumes on his “pursuit of world peace” has, when down in the trenches, also displayed a far more aggressive personality, such as his angry recommendation to US President Gerald Ford to “smash Cuba” when Fidel Castro’s military aid to Angola threatened to ruin Mr. Kissinger’s plans to control Africa.

Whilst the most “enlightened” New World Order advisors may believe that they are working on the “Big Picture,” when it comes down to brass tacks, they clearly demonstrate the same tendency as the more aggressive world leaders, and reveal that, ultimately, they seek to dominate. They may initially recommend diplomacy but resort to force if the other side does not cave to “reason” quickly.

If we stand back and observe this drama from a distance, what we see is a theory of balance between the nations of Europe (and, by extension, the whole world)—a balance based upon intergovernmental agreements, allowing for centralised power and control.

This theory might actually be possible if all the countries of the world were identical in every way, and the goals of all concerned were also identical. But this never has been and can never be the case. Every world leader and every country will differ in its needs and objectives. Therefore, each may tentatively agree to common conditions, as they have going back to the Peace of Westphalia, yet, even before the ink has dried, each state will already be planning to gain an edge on the others.

In 1914, Europe had (once again) become a tangle of aspirations of the various powers—a time bomb, awaiting only a minor incident to set it off. That minor incident occurred when a Serbian national assassinated an Austrian crown prince. Within a month, Europe exploded into World War. As Kissinger himself has observed in his writings, “[T]hey all contributed to it, oblivious to the fact that they were dismantling an international order.”

Since 1648, for every Richelieu that has sought to create a New World Order through diplomacy, there has been a Napoleon who has taken a militaristic approach, assuring that the New World Order applecart will repeatedly be upset by those who are prone to aggression.

Further, even those who seek to operate through diplomacy ultimately will seek aggressive means when diplomatic means are not succeeding.

A true world order is unlikely.

What may occur in its stead would be repeated attempts by sovereign states to form alliances for their mutual benefit, followed by treachery, one- upmanship, and ultimately, aggression. And very possibly a new World War.

But of one thing we can be certain: Tension at present is as great as it was in 1914. We are awaiting only a minor incident to set off dramatically increased international aggression. With all the talk that’s presently about as to a New World Order, what I believe will occur instead will be a repeat of history.

If this belief is correct, much of the world will decline into not only external warfare, but internal control. Those nations that are now ramping up into police states are most at risk, as the intent is already clearly present. All that’s needed is a greater excuse to increase internal controls. Each of us, unless we favour being engulfed by such controls, might be advised to internationalise ourselves—to diversify ourselves so that, if push comes to shove, we’re able to get ourselves and our families out of harm’s way.

*  *  *

Unfortunately, there’s little any individual can practically do to change the course of these trends in motion. The best you can and should do is to stay informed so that you can protect yourself in the best way possible, and even profit from the situation. That’s precisely why bestselling author Doug Casey just released Surviving and Thriving During an Economic Collapse an urgent new PDF report. It explains what could come next and what you can do about it so you don’t become a victim. Click here to download it now.

Tyler Durden Wed, 10/04/2023 - 03:30

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As yen weakens and interest peaks, Bank of Japan balances on a policy precipice

Quick Take The Bank of Japan (BOJ) stands at a critical juncture, striving to maintain a delicate balance amid a changing economic landscape. Recent data…



Quick Take

The Bank of Japan (BOJ) stands at a critical juncture, striving to maintain a delicate balance amid a changing economic landscape. Recent data shows that the 10-year yield, which the BOJ has endeavored to keep below 1%, has touched 0.8, a peak unseen since 2013. Simultaneously, the BOJ has labored not to let the Yen weaken, yet it continues to be pressured as it drops further against the US dollar, crossing the 150 mark for the first time in over a year.

There is burgeoning speculation about possible BOJ interventions in these market movements. As the central bank continues to uphold negative interest rates, a shift towards positive rates might become inevitable in the foreseeable future. It’s a precarious fulcrum of financial strategies that the BOJ is balancing on, with market tempests stirring on one side and the stability of the national currency on the other.

This scenario highlights the intricate dynamics of monetary policies and the profound impact they can have on both national and global economies. A closer look at the situation illuminates the complexities in the BOJ’s policy decisions and the broader implications on the financial landscape.

JPY: (Source: Trading View)

The post As yen weakens and interest peaks, Bank of Japan balances on a policy precipice appeared first on CryptoSlate.

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Poland, Austria, & Czechia Introduce Temporary Border-Checks With Slovakia To Curb Illegal Migration

Poland, Austria, & Czechia Introduce Temporary Border-Checks With Slovakia To Curb Illegal Migration

Authored by Thomas Brooke via Remix…



Poland, Austria, & Czechia Introduce Temporary Border-Checks With Slovakia To Curb Illegal Migration

Authored by Thomas Brooke via Remix News,

Poland, Austria and Czechia will all introduce random checks at the countries’ borders with Slovakia from midnight on Wednesday following an influx of illegal immigration.

Temporary checks will be conducted along the length of the border for an initial 10-day period until Oct. 13.

They will focus specifically on road and railway border crossings, although, pedestrians and cyclists may also be asked for documentation. Anyone within the vicinity of the border may be requested to identify themselves.

“The numbers of illegal migrants to the EU are starting to grow again,” said Czech Prime Minister Petr Fiala following the announcement. “We don’t take the situation lightly.”

“Citizens need a valid passport or identity card to cross the border,” the Czech Interior Ministry added.

The Czech policy would also be adopted by neighboring Austria, the country’s Interior Minister Gerhard Karner confirmed.

Poland had already announced its intention to reintroduce checks on the Slovak border with the number of migrants along the Balkans migration route continuing to surge. Prime Minister Mateusz Morawiecki said last week he was “instructing Minister of Interior Mariusz Kamiński to check on buses, coaches, and cars crossing the border when it is suspected there could be illegal migrants on board.”

“In recent weeks, we detected and detained 551 illegal migrants at the border with Slovakia. This situation causes us to take decisive action,” Kaminski added.

Slovak caretaker Prime Minister Ludovit Odor acknowledged the growing issue of illegal migration in his country but insisted that the problem needs a European solution rather than individual nations restricting border access.

He claimed that the decision by the three neighboring countries had been fueled by the Polish government, which is involved in a tightly contested election campaign, with Poles heading to voting booths on Oct. 15.

“The whole thing has been triggered by Poland, where an election will soon take place, and the Czech Republic has joined in,” Odor said.

Slovakia revealed last month that the number of illegal migrants detained by its authorities this year had soared nine-fold to over 27,000. The majority of detainees comprise young men from the Middle East using the Balkan migratory route through Serbia as they seek to migrate to northwestern Europe.

The winner of Sunday’s general election in Slovakia, former Prime Minister Robert Fico, has vowed to tackle the issue more robustly by promising to reintroduce border checks with neighboring Hungary.

“It will not be a pretty picture,” Fico told journalists as he threatened to use force to dispel illegal migrants detected on Slovak territory.

Tyler Durden Wed, 10/04/2023 - 02:00

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