'Dramatic' changes to GP contract by next April as Hunt spells out detail of general practice reform
No decision about me, without me..? Is Hunt asking GPs what they think needs to be done or is the profession reliant on his wisdom?
If we accept that GP access is the key to A&E attendance (a big IF), surely, unless GP funding per patient is increased then the total number of GP appointments will remain relatively static despite rising demand. Ergo, it won't make any great difference how many hours a practice is open, its overall access that's the problem, not spreading the same size spoonful of jam on an ever bigger piece of toast. If funding for greater opening includes a significant element for GP funding (i.e. pay for a GP to see the patient rather than paying A&E, not the GP for free and save the A&E cost) then great, if not, I fail to see how opening GP surgeries 24/7 will make ant material difference with the same funding for the same number of appointments.
FF sake - is it April 1st again?
I’m not sure how rising practice staff pay is calculated but it may not just be rising rates of pay, it might be more hours employed that contributes to the rising cost. If so, this deal will negatively impact on patients more than practice staff as practices will become increasingly unable to meet rising demand. It sounds like a recipe for disaster.
I cannot help but feel that making the case 'GPs are being treated unfairly' is going to achieve anything. DH know it, that's why they are doing it, and the public won't listen to relatively well paid GPs bleating being treated unfairly when they, the public, are being hammered too. The only argument I can see that has merit is the impact on GP delivered NHS services to the public. A cut is a cut to the NHS in their eyes, and that's not on. Frame that argument properly and give it to the public and they might, just might, fight the corner for GPs. If BMA provide us with the materials to support such a campaign, we’ll even do the leg work. Too obvious?
I'm inclined to disagree with your analysis of starting from scratch Dr Moss, although I do agree Whitehall has been trying to unravel the GP model almost since inception. An army of cloned salaried GPs would not achieve the continuity of care resulting from the independent status traditional partnership model, as no half decent salaried GP would spend 30 yrs in one practice serving one community. The current model of General Practice is highly cost effective in real terms and the NHS, much maligned at the moment, has one of the highest value for money ratings of any health system in the world on evidence based research. It’s a shame that in the midst of argument and rhetoric both sides seem to increasingly blind to some of the most obvious truths.
PS: I consider my avatar both unsuitable and offensive. David Cameron should be removed forthwith.
Ha, there was no need to assess impact of Health & Social Bill either and DH blocked release of the risk assessment. With hindsight, earlier and honest consultation, shared understanding of the imposed changes and assessment of the likely outcomes might have been very useful indeed. I imagine DH don't want an impact assessment of the GP contract changes because then the profession and the public would see what the changes are intended to achieve. If DH don't do an impact assessment, perhaps the BMA should commission the work to be done independently?
The only winners will be practices that don't use locums so get a SA gift. We are a large practice and have quite a high locum usage so our choices will be to; suffer another net increase in costs and/or employ fewer locums and/or pay less to those we use. Whichever way you look at it, it's yet more work when it seems like change for change sake just keeps generating more and more work.
This makes bleak reading for General Practice as GPs could well be linked (if not blamed) for cuts in service and privatisation of the NHS. Trust and reputation in the profession may become a serious issue if public are not aware of what is forcing the changes (67% admitted they know little or nothing about the way the NHS is changing).
Remember the billboards before election: Cameron said no cuts to the NHS and no more top down reorganisation: the public will only see GPs running the show as it slips into decline. It might take all GPs on a CCG board to walk away before the public understand the profession is a conscripted messenger, not the architect.
Does Dr Dixon have any suggestions has how GPs should avoid being blamed when resources and services are less than patients expect, their relationship with patients is compomised as a result and we see widespread fragmentation and privatisation, for example through enforced AQP?
Ignoring all the troll comments here, surely the one thing that is being overlooked is that the GP partnership model has produced one, if not the most, cost effective primary care systems in the world.
One of the reasons for this is the continuity generated between a GP who has likely committed to 30 years service in the same practice and the patient. The benefits of this are too easily overlooked by the profession itself, not understood by NHS/PCT managers and ignored by those in Whitehall seemingly hell bent on fracturing the profession to achieve either a salaried workforce (who move around frequently in search of better terms or pay, so breaking continuity) or a private provider agenda.
If general practice was just about condition management, you could have call centers in India, with a common easy to remember number that everyone should call (111 perhaps?) and be triaged into A&E, pharmacy or a GP practice determined by a trained algorithm operator and seen by any GP or prescribing nurse in a corporate white coat. Hey, how about this system but everyone uses the internet for Skype consultations – then the clinician can be anywhere in the world too. Frighteningly close to what I’m seeing emerging which ignores that general practice is about so much more than ticking boxes and adhering to coarse algorithms.
I despair of the constant attacks on general practice without some rational defence either by the profession or better still by the bodies that represent it. Come on BMA, get your act together before you oversee the retirement of the NHS at 65.
PS: I’m an MBA manager not a GP and I know good value when I see it
65 complaints upheld following formal investigation from 300m consultations is not bad; something to think about when GPs are being urged to be more customer focused like Sainsbury's (Kings Fund, Pulse yesterday).
However, what I particulary like is the opening paragraph about GPs being unfit to take on commissioning responsibilities as a reult of removing patients from their lists.
1. I recall it was this government that decided to dismantle the NHS and put GPs in charge of a large amount of funding and not something that most GPs wanted, then or now.
2. Is this the government realising too late that it wasn't really very well thought through and looking for an excuse to blame GPs as to why they have to u-turn?
3. If GPs are discouraged from removing abusive patients from their lists, is this at odds with a zero tolerance policy?
While I agree with making practices very patient centric, and review what they do and how they do it to ensure they are meeting the primary care needs of their community, there are lots of reasons not to call patients 'customers', not least that customers pay directly for a service - for GPs the customer is the organisation that pays them, unless (or until..!) patients start paying over the counter for their consultations. And, as Anon 11:07 says, greater activity doesn't generate greater income - in these financially restrained times, such an approach seems self defeating?