The issue here is not that we do not want to do Home Visits it is that we lack the capacity to do them properly or safely.
Our GMS contract needs to evolve into one that is based primarily on activity. Then the more home vistits you do, the more you get paid, the more pts you see the more you get paid. In such a system you don't need the maligned Car-Hill Formula. This way when the next pressure group starts shouting about PSAs, we can welcome them will open arms and its beholden on the Govt to stem the flow not us evil doctors.
Payment by activity is the only solution. Till that happens there is no impetus for anyone to care about of consult General Practice.
Absolutely fine if the is activity based and it is optional via a LES/DES. Then if the numbers add up each individual practice can decide if to take this up.
This is nonsense as it will cap our earnings. What is needed is an acivity based contract and get rid of all QOF, GMS, PMS Car-Hill etc. This is easy to administer and there will be no arguments that Car-Hill favors the wealthy elderly population. This will promote access as with increased access comes increased revenue.
It's not the partnership model that is the problem it is the outdated capitation model of funding that needs to change to a model that better reflects activity. Then and only then will Primary Care be sustainable.
Thanks for your time and support Nigel. You have highlighted and championed numerous causes that have helped frontline GPs and you have our gratitude and thanks for this. I wish you every success in your next adventure. Bon Voyage!!!
Great writing Zoe. I personally would enter the GP into a destruction derby. That way at least I'll have fun on my last ride in the car and I may even be able to take down some of the NHSE sponsored cars.
There should be a set number of pt contacts that a practice should provide per 1000 pts. Once this level is breached for whatever reason be that poor discharges, GP to do more post discharge etc then it is the responsibility of the CCG to provide the extra capacity which can be in the form of a LES so that practices themselves can provide it if able. Until there is cost attached to the wider health economy of work coming our way it will keep coming.
There needs to be an element of activity-based pay in our contract otherwise where is the incentive to change anything.
As Shaba has said and I have repeatedly said on SOME...we need to move to a contract that pays us by acitvity. This will then shut the public and media who say we are lazy as the harder your work the more you get paid. This linear relationship is easy to understand for public and also this an activity based contract will relegate the often criticised Car-Hill formla as no forumla is needed. Then if you drive a Porsche it's cause you work hard end off.
Could not agree more with Turn out the lights. There needs to be a way to recover costs and counter sue when vexatious claims are made.
Until our contracts change and there is a cost attached to the dumping of extra workload this will continue.....why would a CCG stop it as currently the dumping costs the CCG nothing. Only when our contracts move to a payment by activity model will this stop as the increased activity will then cost the CCG and money and money only will change behaviour.
Interesting comments and article. The reason pts are turning upto A&Es and WICs is due to service provision and funding outstripping pt demand especially in Primary Care and General Practice. If this can be addressed then there would be no need to have a GP in A&E.
Treat the disease of underfunded General Practice not the symptoms if you want lasting solutions.
Ask them to leave or charge them commercial rates for the rent which should be enough to cover the loss in notional rent as a bare minimum but I would charge more if the local rental rates are higher. The practice is not a charity and they should not have to pay to prop up an underfunded service.
Could such GPs not be employed centrally by a GP federation with HR/Visa expertise. These GPs can then be placed in GP practices and the GP practices pay the federation the cost of employing these GPs.