Michael Ingram, Telegraph.,co.uk, 8th February 2010

Another day, another of the seemingly incessant attacks on "lazy, overpaid, inaccessible GPs". There they sit, runs the mantra, enjoying their 9-5 days and handsome recompense while lives are put at risk every night and weekend through second-rate or dangerous out-of-hours service. It wasn't like this in the old days…

Of course it wasn't. What could match the arrival of the avuncular doctor who, seemingly at your beck and call, would visit at all hours of the day and night? But in those days patients also died rapidly and prematurely of diabetes, heart disease or cancers. There were fewer elderly patients and very little monitoring or treating of long-standing conditions. Hospitals kept patients in for weeks until they were fully returned to health; there was no concept of day surgery or early discharge. Our consultations were short and the welter of paperwork, emails, telephone calls and meetings was absent.

These days though, the GP's lot has changed. As we take the strain for the hospitals, the complexity and weight of our daily workload has changed irrevocably – yet we remain avuncular.

Before the much-maligned re-negotiation of the GP contract in 2004, I was doing all my own duties day and night and was just about coping. But only just. There was no day off after a night on duty. There was no shift system in place. I was exhausted. Yes, I had the satisfaction of helping those in distress but they were outnumbered by patients who would wake me up in the early hours to tell me that they could not sleep.

My colleagues were withering and morale in general practice was at rock bottom. New graduates would contemplate 24‑hour duty and walk away. It was a desperate situation.

Then we were relieved of out-of-hours care and it changed general practice for the better. Though many GPs still do work some shifts, it meant we were better able to cope with the core 10½-hour daily practice responsibility.

But even though we work on increasingly complex cases – and contrary to popular belief it is not just sore throats and backache – GPs are still criticised for shirking their social responsibility. As we strive to cover the gaps appearing in the NHS, it really is demoralising to feel that we are the scapegoat for anything that the NHS fails to deliver. The conveniently forgotten fact here is that responsibility for out-of-hours care no longer lies with GPs; it was handed in 2004 to the Primary Care Trusts (PCTs). Yet when the PCTs fail to cut the mustard, we still get the blame.

The situation couldn't be clearer: if PCTs choose to cut cash and cut corners, then they will get a badly run, badly delivered out-of-hours service. If they fail to employ high quality doctors, then they will get bad care. If they fail to vet the companies that they contract to, then they can hardly expect to escape the blame for any unhappy consequences. Out-of-hours services need good management, good resources and high calibre staff. That is why the profession is getting involved. Here in Hertfordshire, and in many other areas, it is local GPs themselves who work out of hours, as the PCT has contracted with the local GP co-operative to provide cover. I can rest assured that my colleagues, working a co-ordinated shift system, are delivering a high quality of care. In other areas, often those where spending is lower, other providers have been used and there have been some terrible accidents.

If I, my partners and colleagues can deliver a high standard of in-hours general practice care throughout the country, why is it that some PCTs cannot deliver the same quality out of hours? Ask them. And stop pointing the finger at those who are keeping the NHS lights on.

Dr Michael Ingram is a full-time GP in Hertfordshire

Mark Briegal, Partner at www.rallipartnershiplaw.co.uk comments on the article:

“This is an interesting article and one which will ring true for many of our GP clients.  Some of the comments it has elicited from readers are slightly scary and may make GPs wonder why they bother.  GPs can feel squeezed between the demands of their patents, the PCT contract, the acute hospitals and an aggressive media.  GPs are of course also running a business, with all that entails, on top of the demanding medical role.”

Alex Spence of the Times Online reports that one of America's biggest law firms is defying the turmoil in the commercial legal market with plans to build a London office of more than 200 lawyers within three years.

Greenberg Traurig, the tenth biggest law firm in the United States, with 1,800 lawyers and revenue of $1.2 billion (£754 million), has hired Paul Maher, a highly regarded dealmaker who was formerly vice-chairman of Mayer Brown, another big American firm, to build a City office.

Mr Maher, 50, born into a working-class family in North London, rose to become one of London's top mergers and acquisitions lawyers and a senior executive at Mayer Brown, where he earnt more than £1 million a year. He left the firm in April after he was passed over for the role of chairman.

He had planned to set up his own firm in London, holding talks with private equity investors about funding his start-up costs, but he decided to join Greenberg Traurig instead after he was persuaded that its senior partners' global ambitions fitted with his own.

Since July, Mr Maher has hired 30 lawyers, some from Mayer Brown and some from White & Case. He expects to have 50 by the end of the year and said that the London unit would need to recruit 200 lawyers within three years to reach "critical mass". That would make it one of the five biggest offices for an American law firm in London.

Lawyers at rival firms said that the move was a huge gamble at a time when others were cutting back in London and profits were plummeting.

Mr Maher told The Times that he had been given a broad remit to expand and planned to turn the traditional City law firm model "on its head".

In a rare move, Greenberg's American partners allowed Mr Maher to put his name above the door, calling its London office Greenberg Traurig Maher (GTM).

Its lawyers will be paid depending on performance rather than seniority, with a smaller ratio of junior feeearners to partners — some City firms employ as many as seven associates for every senior lawyer — and increased use of flexible working.

"We're taking every aspect of a law firm and turning it on its head," he said. "Do we even need offices in the City? Could we have everyone working from home, or should we put them all in Luton? I don't just want photocopiers with views of the Thames."

Mr Maher also hinted that GTM would become one of the first City law firms to float when new rules allowing external investment in law firms come into force in 2012. "A lot of stakeholders will need to be convinced," he said, but he added that it was inevitable that law firms would seek to raise outside capital when regulations allowed: "The rules of nature don't do a right turn when they get to legal services."

He said that the traditional law firm business model had been rendered obsolete by the downturn and the "golden age" of City firms was over.

Mark Briegal, Partner at Ralli comments: "It's interesting to see a US firm planning to take advantage of the new rules.  In any business good players can succeed by adopting a new model or by being better than the competition, even in a recession.

There will be good lawyers looking for jobs or looking to further their careers and joining an aggressive new firm with a different slant on the traditional model will be attractive. Flexible working and home working will appeal to staff and lower cost offices will appeal to investors.  Clients need to be convinced that they will get as good or better service for the same or less cost.

Here at Ralli, we have taken work from London firms as clients realise that we don't need to be geographically close (although we can and do visit them, as Manchester is only 2 hours from London) and they can get a better service for a lower cost.  Time will see how GTM gets on."

Gareth Iacobucci reports that GPs have been advised to check the small print on their contractual insurance policies, after PMS practices involved in a PCT dispute learned they would not be covered if their case was referred to the NHS Litigation Authority.

Practices in Havering, Essex, were confident they would be covered if their dispute over PMS claw-backs went beyond local appeal, as their policy safeguarded against contractual disputes concerning 'the purchase, hire, sale or provision of goods or services.'

However, they were informed by insurance firm Wesleyan, which took over the policies of hundreds of practices in 2002 when it acquired the BMA's own insurance broker BMA services, that their case fell outside these parameters.

The firm has now been accused of selling inappropriate cover to GPs, and failing to clearly state that practices would not be covered if their contractual disputes progressed as far as the NHSLA.

One practice manager in Havering, who wished not to be named, said any contractual policy that didn't cover GPs beyond local disputes was not suitable.

'The contract doesn't say that it won't help you if you have to go to the NHSLA. If they're selling legal insurance for a doctors' surgery, and they know that that case has to be heard at the NHSLA, they should insure you for legal cover.

They added: 'It seems very poor. They have sold us cover which is inappropriate. I bet there are lots of surgeries who think they are covered for legal expenses, and are under a misapprehension. They need to check the terms of their policy.'

Andrew D'Arcy, Wesleyan director of general insurance said the terms of the policy were very clear, but that disputes with PCTs were different to other forms of contractual dispute.

'The policy is designed to protect the rights of the practice facing specific legal problems in areas such as employment disputes, property matters, contract disputes, criminal prosecutions, recovering debts, partnership disputes and tax investigations,' he said.

'The agreement that a practice has entered into with its PCT is very different to contracts it might have with other parties.

'It is governed by specific legislation which clearly and specifically denies normal contractual rights to the practice and requires any dispute to be resolved through an internal NHS Dispute Resolution Service.'

Mark Briegal, Partner at Manchester law firm Ralli, and head of its specialist partnership law team, www.rallipartnershiplaw.co.uk, said "it is important for all businesses to check the terms of their insurances carefully.  It is possible to sue insurance companies if they fail to provide cover when they should and we at Ralli have a track record of doing this.

However, if it is clear that a specific area of cover is excluded it will be difficult.  A group of practices may wish to club together to fund a special insurance counsel's opinion on the terms of this insurance policy.  If the policy was bought through a broker the broker may be liable for mis-selling

Manchester based solicitors Ralli has launched a new website to highlight its specialist legal services in the area of partnership law.

Ralli Partnership Law, which can be found at www.rallipartnershiplaw.co.uk, aims to provide an invaluable resource for those looking for more partnership law information, whilst setting out what bespoke services Ralli Partnership Law can offer to clients.

Ralli Partnership Law is made up of a team of expert solicitors, based in Manchester and is part of Manchester law firm Ralli, which comprises experts in a range of legal fields.

The website is focused towards those people who are in partnerships or who are planning to form a partnership or joint venture or those who may be in partnership dispute. The website explains how Ralli Partnership Law's specialist team of expert partnership lawyers can help, whatever the issue.

Ralli Partnership Law covers all aspects of partnership law from traditional partnerships, Limited Liability Partnerships (LLPs) and Limited Partnerships, whilst the Corporate Department at Ralli can help with Limited Companies.

Ralli Partnership Law is the latest Ralli website to be built by Text Internet Marketing and represents an evolution online of the Ralli branding, incorporating the implementation of a hub and spoke SEO strategy.

Mark Briegal from Ralli Partnership Law commented, "We've got such a good relationship with Text, we know how good their content management system is and we know they can deliver. Text was the obvious choice for Ralli Partnership Law."

Gillian Nuttall, PR & Marketing Manager at Ralli described yesterday, The Christie, as "peaceful, calm, and different to any other hospital I have been to".

Like Gillian, hundreds of people have raced to help the cancer charity to get back the money they have lost by signing a petition that will go straight to Number 10. Hospital bosses tried to get their money back through the Financial Services Compensation Scheme (FSCS), but were refused. They have now pledged to take legal action to overturn the decision. It is understood the hospital, in Withington, has been advised it has a strong case.

Gillian started to support The Christie after her friend, Jonathan Herron, became ill with malignant melanoma.

She said yesterday: "I was stunned and appalled when I heard the Christie would not be getting their cash back.

"I really hope someone will step in and help get the money back. It takes a lot of time, a lot of effort to raise this cash it should not be allowed to disappear. It has made me more determined than ever to help - they need the cash even more now."

Both Gillian and staff at Ralli have help raise money for cancer charity Factor 50 since December 2007, taking part in the race for life, three peeks challenge, marathons, swims and bucket collections at Oldham Athletic Football Club.

The 25th April will see the first star studded Factor 50 His & Hers Ball at the Lowry Hotel. The event will celebrate the life of Jonathan; raise the importance of skin care and protection from the sun; and in addition raising much needed funds to bring a trial to the UK, currently only available in the USA.

Dr Lorigan, Lecturer in Medical Oncology at the Christie Hospital believes that such a trial can help develop and evaluate new treatments for the benefit of all patients with Melanoma.

To sign the petition please click here, and for more information about Factor 50 please visit http://www.factor50.org.uk/

A number of Ralli staff are taking part in the Bupa Great Run, on 17 May 2009. They are running to raise funds for Factor 50.

Anyone wishing to sponsor them may do so online using the following link.

http://www.factor50.org.uk/sponsorship_events?event=38

Managing Partner Martin Coyne said "I am very proud to have so many people working for Ralli who are prepared to put themselves out to make a difference. We'll be at the finishing line cheering them on"

The runners are:-

Lorraine Kelsey

Richard Biggs

Eimar McCartan

Caroline McCarron

Maria Penny

Mary Walsh

Chris Deay

Mark Ellis

Victoria Crook