General practitioners like me save hospitals from being overrun. But years of underfunding have led to a chronic shortage
- Tom Holdsworth is a GP and clinical director of a primary care network in Sheffield
In summer 2020 I had been working at the same GP practice for 10 years and had seen the workload increase steadily. Each Monday morning I would start at 8am to get through the list of 50 phone calls and to see those needing urgent face-to-face review. I would finish my morning list just before 3pm and start my afternoon surgery 10 minutes later. At 6pm I would start looking at paperwork and around 8pm I would leave for home with the day’s work unfinished. Despite a 12-hour shift, it still felt as though the job was only half done.
For a long time, the Sunday evening dread had been arriving earlier in the weekend. On a Saturday in June last year I was due to go with my family to the park for my son’s birthday, but all was not well. Choking with emotion, I muttered some excuses and disappeared to work my way through the backlog of emails and blood results. That’s when it hit me: things were so bad, I couldn’t even be there for my son’s birthday on a day off. A few months later I walked away from the practice, to the sadness of many patients and the great distress of my GP partners.
My husband spends his life trying to brief me on things I should anxiously engage with. But I can’t worry about a dearth of Christmas turkeys so far in advance
I tend not to worry about things until they have happened. This is somewhere between a policy and a habit – and has its ups and downs. Sometimes I think it would be nice to have fewer appalling surprises, but not often enough that I try to change.
Mr Z is the exact opposite. He conducts a minute-by-minute threat-level analysis of the medium term, as if he has one of those angled dental mirrors into the future. Consequently, he is extremely worried about gas prices and very worried indeed about food shortages. He also has some ambient concerns about nuclear submarines.
The Brazilian president wanted a popular uprising against the supreme court, but the underwhelming response was telling
There is something pathetic about a leader who cannot recognise his limitations. For months, Brazil’s president, Jair Bolsonaro, has insisted that he could bend democracy in Latin America’s largest nation to his will if he so desired. Brazil’s independence day, 7 September, was supposed to be a watershed moment, as the president mobilised his supporters to take to the streets. Instead, it revealed the distance between Bolsonaro’s perception of the popular support that he enjoys and reality. Sinking in the polls and with mounting obstacles in the way of broadening his political alliances, the president bet that he could compel enough of a grassroots backing to intimidate the political establishment, and the supreme court in particular. Unsurprisingly, to quote Gabriel García Márquez’s novel The General in His Labyrinth, the president “could not renounce his infinite capacity for illusion at the very moment he needed it most”.
Bolsonaro backers and dispassionate analysts alike predicted a massive public outpouring of support for the president’s ongoing efforts to undermine democratic processes. It was thought that 7 September might even culminate in a takeover of the supreme court building akin to the raucous invasion of the US Capitol building on 6 January. Days before independence day, Bolsonaro called the planned demonstration an “ultimatum” for supreme court judges, and declared ominously that “if you want peace, prepare for war”. He even hinted at a constitutional “rupture that neither I nor the people want”.
The architects of the proposed 150,000-acre project are scouting the American south-west. They’re already predicting the first residents can move in by 2030
Welcome to Telosa, a $400bn “city of the future,” according to its founder, the billionaire Marc Lore. The city doesn’t exist yet, nor is it clear which state will house the experiment, but the architects of the proposed 150,000-acre project are scouting the American south-west. They’re already predicting the first residents can move in by 2030.
Telosa will eventually house 5 million people, according to its website, and benefit from a halo of utopian promises: avant-garde architecture, drought resistance, minimal environmental impact, communal resources. This hypothetical metropolis promises to take some of the most cutting-edge ideas about sustainability and urban design and make them reality.
Rising gas prices in a climate emergency is not the time for the rigid application of free-market principles
There is a level of government complacency about energy price shocks. Ministers think the best course of action is to just accept them. Wholesale gas prices are now more than five times their level two years ago, raising the prospect that household bills will rise by 12% next month. Shoppers could also face empty supermarket shelves as it becomes unprofitable to produce the dry ice and carbon dioxide needed to store meat products. If the energy crunch continues, industry warns, a 1970s-style three-day week might have to be introduced.
The government response has been familiar: deny the problem, deflect responsibility for failure and delay taking action. This strategy is a reminder of the importance of perceptions in a crisis. If something feels like a crisis, it is effectively a crisis. That is why perhaps Kwasi Kwarteng, the business secretary, says there is “no question of the lights going out, of people being unable to heat their homes”. But what if people cannot afford the energy costs to heat and light their homes? About 85% of the UK’s domestic heating comes from natural gas. Fuel poverty is a real issue, especially when millions of workers are facing cuts to universal credit and a hike in national insurance. Price caps help poorer people afford necessities of life such as gas – but there’s no sign that ministers think the hardship merits more generous help.
Pronatalist policies seem beside the point when existing families’ needs are ignored
There are not many things that most people agree on. But one is that it is a good thing if adults who want children are able to have them. This is the simple idea at the heart of a new report from the Social Market Foundation thinktank, which examines the case for pronatalist policymaking in the UK in the context of a falling birthrate, and recommends more research. The Scottish government, the report says, already has a population taskforce.
So far so uncontroversial. The birthrate in England and Wales stood at 1.58 in 2020, well below the 2.1 required to replace the population (in Scotland, the birthrate was 1.29). More than a quarter of the world’s countries have explicitly pronatal policies, usually entailing financial incentives designed to encourage people to have babies. While often associated with anti-immigrant rightwingers, such policies include birth grants in Finland and variable tax rates in France, as well as housing subsidies and other rewards in Hungary and Poland. Pronatalism need not be the exclusive concern of nativist politicians seeking to reverse population declines.
Readers respond to the new pact between the UK, Australia and the US, and its implications
The Aukus pact is not a “new global order” (17 September) but very much an old order; it is colonial gunboats. I do not expect politicians to have read history such as the first Anglo-Afghan war of 1839, but I do expect them to be aware of history in their own lifetimes. Eton may not teach the failures of empire, but China has been very clear about Taiwan since 1950.
When Biden said, “This decision about Afghanistan is not just about Afghanistan. It’s about ending an era of major military operations to remake other countries”, he was committing to another battle in the Pacific. The global dominance of China has been clear for more than 20 years, and yet we are unwillingly signed up to face this new empire?
St Albans, Hertfordshire
Dr Kate Cabot says there is nothing ‘tiny’ about medical professionals’ compassion and wisdom, while Bernadette Sanders misses routine preventive healthcare
As a GP who retired at the end of last year, having worked the last nine months of my career in primary care in London, I have been despairing when I hear repeated criticism aimed at GPs. So thank you, Zoe Williams, for your kindness (GPs are full of kindness and wisdom – so why do they face constant criticism?, 14 September). I would only like to question the words “usually quite tiny” used to describe their acts of kindness and wisdom, which caused me to reflect.
As a GP, you need to use enormous amounts of kindness and mental energy to generate empathy, and to enable the full use of your knowledge and experience to deal with a vast variety of problems. Working remotely for patient safety means you often have to plumb new depths of your psychological resources to maintain standards. Mistakes can cause medical errors, or misunderstandings and upset.
- Men’s and women’s trips cancelled due to security fears
- ECB has failed member of cricket fraternity, says PCB chair
England have been accused of “failing a member of their cricket fraternity” and “making excuses” after cancelling next month’s tour of Pakistan and citing mental wellbeing as one of the driving factors behind the decision.
The short trip was to be England’s first visit to Pakistan since 2005, featuring two double-header men’s and women’s Twenty20s in Rawalpindi on 14 and 15 October before Heather Knight’s women’s side stayed on for three one-day internationals. But it was plunged into doubt on Friday when New Zealand withdrew their men’s team from the country in response to a “specific” and “credible” security threat that was relayed to their government by intelligence services.
The Northern Irishman expects a partisan home crowd with Europe’s lack of fans in Wisconsin increasing the scale of their task
When Rory McIlroy used a devilish pre-Masters question about voting rights to call the United States “the best country in the world” it was easy to sense another blow to the once-ferocious rivalry that existed in the Ryder Cup. How could McIlroy and the other residents of Florida who represent Europe for a week every two years possibly feel antipathy towards their adopted home?
Perfectly easily, as it transpires. McIlroy expanded on his “best country” remark by pointing to the convenience of life for someone in his “fortunate” sporting position. McIlroy admires this “land of opportunity.” Yet one glance at his face upon his singles defeat to Justin Thomas at Le Golf National in 2018 or his hulk-like demeanour when losing narrowly to Patrick Reed in the same format two years earlier reveals someone who can very easily turn against the star-spangled banner. The Ryder Cup is not the cosy domain of those who frequent the coffee shops of West Palm Beach.
David Gower is pulling for his old club Hampshire as they look to pip Lancs, Warks and Notts in the final set of matches
David Gower was at Scarborough this month, when Yorkshire thrashed Somerset to end, yet again, their hopes of winning the County Championship. He was giving an after-dinner speech on the second day – the last as it turned out – and managed to escape the handshakes and small talk for long enough to squeeze in some time to sit in a deckchair and let it all soak in, watching some of the younger players have their day in the sun.
Gower was not always known for his dedication to the county grind but – with one round left to decide the winners, and four clubs in hot pursuit – his old club Hampshire are top of the table and in with a shout of their first Championship title since 1973.
- Advice will ‘prioritise inclusion’ and ‘avoidance of harm’
- Guidelines will also ‘separate gender from eligibility’
The International Olympic Committee’s new transgender guidelines for sports have been delayed again because of “very conflicting opinions” and are now unlikely to be published until after next February’s Beijing Winter Olympics, three years later than originally planned.
The news was revealed by the IOC’s science and medical director, Dr Richard Budgett, who said the forthcoming advice for international sports federations would “prioritise inclusion” and “avoidance of harm”.
- Vunipola would be shock omission from three-day camp
- Jones free to select England’s British & Irish Lions contingent
Eddie Jones is set to usher in the next stage of England’s 2023 World Cup preparations when he names his first squad of the new season on Tuesday with Billy Vunipola believed to be among the senior players whose places are in jeopardy.
Related: Wallabies can dare to dream two years out from next World Cup | Bret Harris
Rayo Vallecano’s top-flight return was a miracle and now they have signed Radamel Falcao. But all is not well with the club
This was the kind of moment you didn’t want to miss and on the corner of Avenida Albufera and Payaso Fofó street, down in the People’s Republic of Vallecas, the opening bars of the Final Countdown boomed out. Inside, in the front row of seats on the eastern side of the ground where Colombian flags joined tricolours and the smoke smells sickly sweet, the fan in the tiger onesie roared and sang along. Around him, they did the same. Or just laughed. There were 3,280 people, plus a dozen or so gathered in the tower blocks overlooking the wall at one end, all going slightly mad while their striker wore a smile the size of the city he had returned to.
None of this made much sense, but things rarely do down there. The smallest team in the first division, and by a very long way, one that shouldn’t even be there but was somehow promoted through the play-offs, a crumbling club in perpetual conflict and crisis where many of the fans that make the place unique had chosen to stay away, was 3-0 up. Two home games, two wins, seven goals scored, none conceded. And out in the sunshine, that really was Radamel Falcao kissing their badge. He had played 10 minutes and 24 seconds for them and he already had a goal.
The warmth, or otherwise, of the response after his next Festival winner will be a key moment for disgraced trainer
As one of the biggest names in jumping officially departed the stage last week, two more returned to action as a National Hunt campaign that officially started in May slowly works its way through the gears. Farewell Altior, one of the outstanding two-milers of recent decades. Hello again, Davy Russell and Gordon Elliott, after many months on the sidelines for very different reasons.
In the last two seasons of his career, much more time was expended on speculation about where Altior would run next, and then forensic analysis of the reasons why he had not, than in watching him in action on the track.
Training-ground visit shows thoroughness, fun and humility as ‘awesome’ Carabao Cup trip draws nears for League One club
It is 10.30am on Thursday, the morning after Manchester City put six goals past RB Leipzig, but at Wycombe Wanderers’ training ground the focus is not on their glamour trip to the Etihad Stadium on Tuesday but their next League One opponents. Downstairs the kit man, Steve Vaux, is applying the Carabao Cup logo to the sleeves of the away kits but upstairs Gareth Ainsworth has the attention of his players as he runs through some clips of Charlton Athletic.
An hour later Ainsworth drags a goal into place in preparation for an XI v XI game, which he occasionally halts to make a point. “If you let him turn on the ball there, bloody hell we’ll be in all sorts,” he says, urging the centre-backs Anthony Stewart and Ryan Tafazoli to get tight when on halfway. Making mental notes from the sidelines is Dr Misia Gervis, the sports psychologist, while the analyst Josh Hart films from a scaffold tower. Gone are the days of Hart and David Wates, the head of sports science, making up the numbers as defenders in practice matches, as they did on the eve of promotion to the Championship.
Region’s leaders make joint declaration vowing to step up efforts to address extreme weather
With the catastrophic effects of this summer’s unprecedented wildfires still being counted, leaders from around the Mediterranean – the European region most at risk from climate breakdown – have vowed to intensify their efforts to tackle the challenges posed by extreme weather.
A joint declaration, signed in Athens, has fired the starting shot on what is hoped will bring groundbreaking change in how the neighbouring states shore up their defences against natural disasters.
PM admits he used to be a climate sceptic and says Anne-Marie Trevelyan will do ‘outstanding’ job
Boris Johnson has acknowledged that he has altered his views about the climate crisis over recent years, saying, “the facts change and people change their minds”.
As he travelled to the US in a bid to accelerate progress towards an agreement at the Cop26 climate summit, the prime minister was asked about the views of his new international trade secretary, Anne-Marie Trevelyan.
CMA issues ‘green claims code’ and says too many businesses falsely taking credit to woo customers
The UK competition watchdog has given companies that make misleading claims about their environmental credentials until the end of the year to stop the practice, which is known as “greenwashing”.
Too many businesses were “falsely taking credit for being green” in order to woo environmentally minded consumers, the Competition and Markets Authority said.
Man arrested on suspicion of murder after Derbyshire police were called to property in Killamarsh
Tributes have been paid to three children and a woman who are suspected to have been killed at a house near Sheffield at the weekend.
A man, 31, was arrested on suspicion of murder after Derbyshire police were called to a property in Killamarsh, Derbyshire, at 7.25am on Sunday.
Insiders reject inference of division among EU members on Northern Ireland issue
Boris Johnson has walked into a diplomatic row with one of the UK’s closest allies after claiming the prime minister of the Netherlands had been seeking to “mediate” between Brussels and London over the post-Brexit arrangements for Northern Ireland.
Speaking to reporters on a plane to New York for a meeting of the UN general assembly, the prime minister suggested the Dutch government was looking to act as a mediator between the European Commission and London on the differences that have arisen in recent months.
Canterbury MP, who will not attend party conference, says meeting with leader could help find way forward
Rosie Duffield has called for Keir Starmer to meet her and other female Labour MPs to discuss the party’s policy on transgender issues, confirming she will not attend Labour’s annual conference over worries she could face abuse because of her views on the subject.
“I took the decision a few weeks ago not to go,” the Canterbury MP told BBC Radio 4’s Today programme.
Firefighting equipment was available that ‘might have made the difference’, inquiry hears
London fire brigade (LFB) did not know how to properly deploy water equipment that could have doused flames all the way to the top of Grenfell tower and potentially saved lives, the inquiry into the disaster has heard.
In what a lawyer for bereaved people and survivors said was “an extraordinary possibility to have to contemplate four years after the fire”, an expert witness has found that water from a ground monitor – a nozzle on a fixed base – beside the tower was capable of reaching the 15th floor and that all the available aerial pumps were capable of launching water to the top of the building.
Officials look at emergency funding to help large energy firms rescue customers of suppliers that have gone bust
Energy companies willing to rescue the customers of rival suppliers that go bust amid the gas and electricity market crisis could get state-backed loans in a scheme under government consideration.
The Guardian understands that officials are looking at the emergency funding to help the UK’s large suppliers pick up potentially millions of unprofitable customers this winter as record prices threaten to decimate the energy market.
Role will alarm those who accuse Boris Johnson’s government of stacking cultural institutions with supporters
A venture capital investor who donated more than £200,000 to the Tory party in 2017 has been appointed chair of the National Gallery.
John Booth will succeed Tony Hall, the former director general of the BBC who stood down as chair in May during the fallout over Martin Bashir and the Diana, Princess of Wales interview.
Barnsley Central MP, who was elected to mayoralty in 2018, said he was never planning to stay in dual role
Dan Jarvis, who has spent the last three years as a Labour MP and the mayor of South Yorkshire, will not seek another term in the latter job, he has announced, saying he had never planned to carry out the dual role in the long term.
The Barnsley Central MP had to battle initial Labour party opposition to his staying on in parliament when he was selected in 2018 to fight for the mayoralty, which at the time had no powers or funding due to a dispute about devolution arrangements.
British company known for its Golf Clash franchise is latest to be snapped up by the California-based firm
Electronic Arts has completed the $1.4bn (£1.04bn) deal to buy Playdemic, the mobile games maker known for its Golf Clash franchise, the latest British video games maker to be snapped up by the California-based giant.
For EA, the maker of titles including Battlefield and The Sims, the all-cash deal struck with Playdemic-owner AT&T’s Warner Bros Games division marks the latest move to expand its sports and mobile gaming business.
Arooj Shah, town’s first female Muslim leader, says she forced herself to go to council meeting the day after the attack
The leader of Oldham council has spoken out about the firebomb attack on her car, and her determination that whoever was behind it would not stop her doing her job.
Arooj Shah, who became the town’s first female Muslim leader in May, said her mother initially thought she was in the car when it was firebombed on 13 July in what the police described as a “reckless, abhorrent act”.
Charity that has helped 340 homeless veterans at Catterick garrison says it will soon run out of money for service
Vulnerable veterans of wars in Afghanistan and Iraq living in supported housing at the UK’s largest barracks are set to lose help with mental health problems, triggering fears of a return to homelessness and lost lives.
A charity that has helped 340 homeless veterans at Catterick garrison has said it will run out of money at the end of the month for the service, which is dedicated to tackling issues including post-traumatic stress disorder and substance misuse.
Exclusive: in the first piece in a new Guardian series on China and tensions in the Indo-Pacific, Japan’s defence minister says the international community must bolster deterrence efforts against Beijing’s military
Japan has urged European countries to speak out against China’s aggression, warning that the international community must bolster deterrence efforts against Beijing’s military and territorial expansion amid a growing risk of a hot conflict.
In an interview with the Guardian, Japan’s defence minister, Nobuo Kishi, said China had become increasingly powerful politically, economically and militarily and was “attempting to use its power to unilaterally change the status quo in the East and South China Seas”, which are crucial to global shipping and include waters and islands claimed by several other nations.