NHSE Directive = beatings will continue until morale (and output) improve
Primary care networks have been ‘operating’ for a month, and yet HSL attributes fewer practices capping their list in the last year to this? PCNs haven’t done anything yet! Perhaps we should have a competition attributing various implausible successes to PCNs apparent magical powers. The sun is shining outside my window this morning - well done, PCN!
HSL shouldn’t be so keen to hitch her credibility to another bandwagon, the wheels having fallen off the GP 5 year forward view.
So, General Practice gets roughly 1/18th of the ‘new’ funding - except it doesn’t look like it is coming to general practice at all. Huge sums of money appear to be being given to a small handful of CCGs for a few pet projects. Most of this will no doubt be diverted, top-sliced or just wasted. It would be interesting to hear the opinions of GPs in these areas. Meanwhile the rest of us just struggle on in the vain hope something will rescue us.
completely absurd, and likely to be a bubble company. its It consists of video calling - nothing new there; and decision trees like the ones 111 use. There is nothing worth £2billion there. It has been dressed up by extensive marketing (which is the really clever thing here) as AI (it's not), cutting edge (it's not) and revolutionary (it might be, in that it will destabilise healthcare provision if it is allowed to, ending the values of the NHS). The unfortunate thing is that it has another £450 million to throw at bringing an end to the NHS.
I suggest we all insist on a vote, and we all vote against it. If they want this major change, let them put it through the appropriate legislation. If they really want to avoid that, let’s negotiate a decent settlement for general practice, MH and community services before we hand back all our influence/control.
‘Reinvest the savings in care’ = pay off a small chunk of the hospital overspend.
Merged CCGs mean an end to any grassroot GP involvement in commissioning - though that has has really been minimal due to obstruction and sabotage and misdirection by CCG management and NEDs.
Merged CCGs mean an end to real accountability - not that commissioners are ever held to account for poor decisions and the top-slicing and redirection of funds meant for frontline general practice.
Merged CCGs mean an end to localism, and a new wave of cosy commissioner-hospital sub-dom relationships, with general practice, mental health and community services left on the outside.
PCNs? They have two years before practices start quitting when the money and resources no longer match the expectations placed on them.
You want more access, you need more doctors and nurses.
You want more doctors and nurses, you need to get the terms and conditions right.
No other solution will work.
- Online algorithms: likely to have minimal effect. Studies suggest patients will game the system to get what they perceive they want.
- Noctors using algorithms: the persistent worried well will get though to a doctor eventually, the actually sick probably won’t. A&E will be overwhelmed with sore fingers.
- Video consultations: won’t make a positive difference to workload, might make a negative one as expectations will drive demand. Likely to open another door to trivia.
- Online booking: in my practice has a very high DNA rate compared to other modalities; and many online bookings are made for trivial illnesses.
Build another road and you get more cars, and yet another traffic jam.
This is simply passing the buck.
The failure of the partnership model and approaching collapse of general practice is nothing to do with PCNs, and everything to do with years of neglect and underfunding.
This is either very cowardly, or just confused thinking at the heart of NHSE.
So, only 6% achieved - 94% short of the target. Isn't this a total failure?
But they don't need to re-examine this too deeply: it all comes down to the same thing - the terms and conditions we work under are so appalling no one wants to work as a GP in the UK.
Until this is addressed, all other attempted solutions are pointless.
Set the number at ‘1’ - it’s the only logical thing to do in order to preserve patient access to face to face consultations etc.
The problem - and solution - is simple.
In the private world, if business costs go up, providers raise prices to consumers to cover those increased costs.
But we are unable to do that.
So, if NHSP want to massively increase service charges, NHSE need to massively increase funding to GPs to cover those costs, or we will all go out of business. Perhaps the could simply reimburse service charges in the same way they do rent.
If they don’t do that, we will need to change our business model to one which enables us to raise our prices appropriately - like the dentists.
No it won't.
You cannot allow one rule for practices and another for Babylon.
This is either driven by management fear of Babylon's lawyers (which is cowardly, because the regulations are clearly on the CCG's side if it refuses to allow it); or DOH intervention because they don't believe in either general practice or PCNs and want to break the system; or perhaps someone somewhere stands to benefit somehow, perhaps with a nice cushy job or sinecure directorship in digital health in a couple of years.
GPC, BMA, and RCGP should be very visibly opposing this - so where are they?
Refuse to sign up and boot it upstairs to NHSE's national team for resolution. They are likely to be more sensible and pragmatic. Two functional PCNs - even if one is smaller than 30K - are better than one larger dysfunctional one.
CCGs typically offer support, but not proper funding, courtesy of a poor core contract and secondary care that can not control spend.
The market should be allowed to determine this, surely. The provider can’t provide the service, the commissioner must find another provider. If no provider can provide the service at the price advertised, the CCG will have to spend more. This will enable the provider to spend more money to actually recruit staff and run a service.
Of course, the reverse is done in hospitals: they spend the money to run the service then the CCG or NHSE has to stump up the cash no matter how far over a nominal budget they have gone.
This is why commissioners have battened down and failed to invest or cut investment in the only part of the system they can actually influence spend in. This is why community services, OOH and general practice have suffered so much.
Compare: accountant/solicitor quote to advise on TUPE matters... £350 (plus VAT) per hour.
‘Not willing to work’ - a shocking, shameful thing to say. It’s the lowest form of manipulation, to try to use our guilt to make us work for peanuts in a broken and unsafe system.
The solution to the workforce crisis has always been obvious: it’s the terms and conditions. Simple, basic free market economics.
The problem is that PCNs are being touted as the solution to every possible problem. But they are not. Practice resilience isn't a question of lashing struggling practices together in the hope they weather the storm - its about negotiating a fair core contract that enables us to deliver safe and effective care from appropriate estates while offering decent terms and conditions (including pay) to our staff. Anything else is either a stopgap, a desperation measure, a fantasy, or just plain stupidity. And the fair core contract is what the GPC is responsible for negotiating, and it has failed. And the GPC is led by 'portfolio GPs' who do very little actual general practice and generally don't hold partnerships.
This is a major NHS reorganisation - at least as big as the 2012 HSCA. It triggers the end of genuine localism and local accountability, and an end to the clinical voice, whatever guff the ICS leaders spout.
It should have gone as an Act through Parliament. To do otherwise is a profound subversion of democracy.
CCG executives should be forced to go to the GP memberships for a vote, as it involves a fundamental change to the constitution of each CCG, and we should vote against it. If the Governing Body decides to agree without a vote, the membership should put in a vote of no-confidence in their governing body.
'We will encourage doctors to do more general practice by finding new and multiple ways for them to do less general practice.'
Words fail me.
So many young doctors I meet put in a day of GP and four days of CCG/PCN/OH/OOH/LMC/something else: that seems to be their aspiration and their/our future.
This doesn't get better until they make the Ts and Cs we work under better.
Yes, let’s move increasingly rare GPs away from frontline care of the unwell and instead get them to pander to the immediate access demands of the worried well and those with trivial illnesses. It’s not as if there is a workforce crisis.
More idiocy, that is likely to sink the whole system.