So the networks will not reduce my workload. Neither will they increase my take home pay as I will have to subsidise the 30% shortfall of funding in employing staff that will not reduce my workload.
This sounds like a winner of a contract to me! And yet there is no mandate to remove the contract? Well done the LMC conference, NHS England will be quaking in their boots with such staunch robust inaction.
Cholera likewise I believe tends to spread rapidly in impoverished populations with inadequate resources.
I may be bucking the trend here, but I think the CQC is in some way correct.
If something is brown and smelly, no matter what you dress it up as, it will remain brown and smelly. Calling it good or outstanding will not make it any less brown or any less smelly.
I believe we are all trying to do our best for patients with inadequate resources and growing demand, but if we are calling a 3 to 4 week wait for an appointment, 10 minutes per consultation when we need 15, probably 20 minutes, and 40 to 60 patient contacts daily, a good or excellent service, then we are deluded and complicit.
This is not what I want to offer, but this is the level we have been funded to. Sorry.
Couldn’t the boffins at Capita be sent in to swiftly sort it all out?
Or will they recalculate contribution as if in the old scheme & then land everyone with a large tax bill?
And there was me thinking federating was the answer, or was that super-practices, or was that networks? I’m sure the boffins at NHSE will come up with something before it’s all too late! Or maybe not.
Surely charging for a service not given needs reporting to NHS fraud team?
It is difficult to get involved when working 12 and 13 hour days with a 10 minute sandwich break.
Sorry wrong article
What are they scared of by putting it to a vote if it’s that good a deal?
Totally agree about the 30% shortfall in funding. I believe our network will eventually get a £1,400,000 budget. If that represents 70% of the true costs, the practices will have to contribute £600,000 as the 30% contribution. That is either a big pay cut for partners, a lot of new work that has to be done in new contracts, or a lot of partners leaving. Probably the latter.
As a partner in a small 7.5k practice, I personally feel that the introduction of networks will hasten the demise of small practices. Only those practices that constitute a network in their own right will be able to survive.
The whole premise of a network is so legally and corporately complicated that any benefits will only be seen by super-practices which do not have to legally or corporately interact with another practice. Taking indemnification of risks of practices in a network as an example, the problems and risks are significant.
We either have to take a broad approach as essentially we are all going into partnership with each other in respect of the network responsibilities. We therefore take it on in a "partnership" approach and become joint and severally liable for the network. That is we are all in it together and share ALL the risk no matter what.
For example an employing practice discriminates against a network employee, the employee claims against the employing practice and is successful. With a broad approach to indemnifying the risk-holding employing practice, all the other practices would chip in to cover the practice that has been deemed to have been discriminatory.
However in a more narrow approach, one could say that an employing practice should act legally and in a non-discriminatory manner and hence if the practice acts contrary to this, why should the other indemnifying practices extend the indemnity to illegal or discriminatory actions?
The situation gets even more complicated and convoluted when network employees will presumably work across different practices. What indemnities are we happy to give or receive as the partnership where a network employee works? Would we expect to be indemnified for any breaches of Health and Safety legislation that befall the network employee whilst on our premises or any claims of discriminatory behaviour? Likewise are we happy to indemnify other non employing practices for potential breaches of Health and Safety law, or any of the other myriad of legislation and guidance that have to be adhered to when the employee is on their premises?
What indemnities are needed and how far do they go in relation to issues with the network employee working on non-employing practices' premises? What happens if a network employee significantly breaches GDPR? Where does the risk/responsibility lie? When GDPR breaches can result in fines of up to 4% of annual revenues or 20 million Euros, non-compliance with rules can have significant effects on a practice. I would therefor want to know exactly what risks I am running or offering to cover for others.
Similar complications appear to arise in a "bank" practice. If a "bank" practice fails to make a network payment on time and that practice makes a larger on paper profit for that year, then there is a risk the "bank" practice partners can be personally liable for tax and pension contributions on that network "profit". Would the indemnity for financial matters extend to that practice if there were reasonable explanation, or if it were due to an inaction of a practice employee, or if it were due to a negligent act of that practice? There is a similar risk with falling foul of VAT rules.
Agreements on interdependent indemnification are not the only complicated facet. In relation to corporate governance, legal agreements similar to articles and memoranda of association for companies will have to be generated and the networks run by them, each defining what powers and responsibilities individuals and organisations have in the network.
In addition the running of networks will have to be set up so as to minimise the potential impact of VAT on the supply of services.
There appear to be a myriad of complicating legal tax and accounting pitfalls in all this. I am sure the magic porridge pot £1-50 per head set up funding will cover all this, and all the meetings, and all the 30% funding deficit of network employees. Or possibly not?
Three cheers to the boffins who thought this was a good idea!
Which contract is he talking about? The only one I have seen is full of smoke & mirrors & reduces extended hours DES funding, reduces practice funding if we chose to make up the 30% new staff deficit in funding, and gives a below inflation rise in global sum. I will get my practice manager to send me the real one as I must have been given the fake news one.
With inflation at a 23 month LOW at 2% last month, a 1.4% rise in global sum every year is still a pay cut in real terms every year. Hmmm! That is a real incentive to stay!
With the amount of coffee we must drink to get through the usual 12 to 14 hr day I have wondered about fitting a conveen, £1-26 each, a leg bag £2-25, so £3-51 per day based on NHS tariff cost. Must surely cut out at least 5 comfort breaks per day, at what 5 minutes each. 25 extra minutes per day at a cost of £3-51. Or £8-42 per hour saved. This compares favourably to the 120,000 hrs clinical time saved a cost of £8m which works out at £66.66/hour saved. Why have none of the boffins at NHSE thought of this before?
Sadly that’s Plan b if
doesn’t work out favourably. I’ll be applying for the Barneville-Carteret job where the mayor is throwing in a free flat, yacht and Michelin starred food to attract a GP to work in a beautiful French seaside town. Ou est mon passport?
Which is why
is important not just for practices but also for patient choice.
Before I call it quits and head off to a career abroad, i am hoping to legally challenge the bar on charging our own patients for private additional services, just as hospital consultants, nhs dentists and nhs pharmacies can. Our contract is only 08-00 to 18-30 so why cant we see our own patients out of core hours. The bar is also potentially a restraint of trade and unenforceable and also potentially contrary to the Competition Act.
My practice is about to launch a crowd-funding website to fund the legal challenge to private practice bar. Website coming soon.
If we don't help ourselves, do not expect anyone else to.
My practice is instructing solicitors to challenge the bar on private practice charges to our patients. Pharmacists, dentists and consultants can do it so why can't we. The present bar is potentially a restraint of trade, anticompetitive and why is it enforced out of hours when the contract is only for core hours?
We have to take our own destiny in our own hands and look for funding elsewhere than government. Especially small practices like my own. If the government want to close me down, the only way is to introduce private practice to generate funding not from an effective monopoly customer that is the NHS. Crowd-funding website coming soon.
My practice is just instructing solicitors to challenge the bar on charging our patients. Our contract is for core hours so why are we restricted out of hours? The bar is potentially also a restraint of trade and is also potentially anti-competitive. We will also seek a definitive answer on whether the formation of a company and supply of services through that company avoids the bar on the partnership itself. Crowd-funding website coming soon.