"Please do not go to A&E for things that your GP could help with"
"If you come to A&E you can see a GP"
I may need the help of Big Brother to think both of these things at the same time.
The wording of the indicator is "The percentage of patients with non-diabetic hyperglycaemia who have had an HbA1c or FPG test in the preceding 12 months" with 18 points available. Thresholds are 50-90%.
We don't yet know how non-diabetic hyperglucaemia will be defined or how (or whether) this will be prevalence adjusted.
I had to take a few minutes to get my head around all of these statements.
What I think they are saying:
1. As extended hours is only at 76% of the population then extending it to 100% with the same money will cut the rate from £1.90 per head to £1.45
2. To compensate for this £30m is going into the global sum. This could have been added to extended hours to keep the rate at £1.90 but this was not done for some reason.
3. That £30m also covers the 111 appointment booking. We are spending this twice.
4. If you are in a network then 100% coverage is mandated (probably, yet to see the DES). If only some practices in your network provide the service they are likely to be miffed at only getting £1.45 and might ask for a bit of the other practices global sums, although that is also for 111. This will ensure networks start with bicking about money.
5. If you are not part of a network pratices that are in a network will get £1.45 for extended hours for your patients. They are unlikely to be able to persuade you to chip in and you can keep your share of the £30m (about 45p/patient)
There is also the time involved. The clinical lead at .25 WTE will mean about 300 fewer WTE GPs. It seems unlikely that there will be meetings that will require partners. This is not GP time that we can afford to lose.
There is another defeat - the fight against the paperwork. Previous QOF indicators, whilst not exactly the most popular thing in the world, at least involved patients.
The new QI indicators turn out not to be Quite Interesting at all but look rather the old QP indicators dusted off and re-arranged by the RCGP.
Each network will also require a clinical director working quarter time. That could be almost 400 WTE GPs managing the networks, not seeing patients. It also seems likely that the network itself will take some time from practices.
The killer for me is the new services that the Networks will provide. Med reviews, nursing homes etc. There will be loads of new pharmacists and NHSE will chip in 70%.
So I will be paying for 30% of these, which seems to be bloody generous of me. Presumably this is paid for by cutting other services in the practice.
PHE seem to labour under the impression that it is impossible to know who is obese and who is not without measuring weight and height.
Sometimes I think they might spend too long with their spreadsheets.
It is a rather odd calculation on page 12 of https://www.cqc.org.uk/sites/default/files/20180328_2018-19%20fees_scheme.pdf
It seems to suggest that the list size element will cover the "current full chargeable budgeted cost of regulating
providers of NHS primary medical services" and then another £509, presumable in addition to the cost recovery.
However any new locations will be much, much cheaper - aparently because the CQC can't tell the difference between division and multiplication.
I don't think that there is a specific requirement to run approved systems in the contract, although funding is not likely to be available. Do EMIS plan to market to practices on a "self pay" model?
The current setup is grossly skewed towards people who have illness or other health needs. It is about time that we had a service for the large number of healthy people who have previously been neglected by the NHS.
It will create some perverse incentives. If you have to pay for your paracetamol or cocodamol 8/500 but the stronger 30/500 co-codamol is free on prescription which will you ask for?
The Trusts accounts are worth a read.
All but one of the trustees were changed on 1st April 2016. The majority of their outgoings in 2015-16 were for strategy and research, although it is not clear what they were researching.
And patients can get access to the full medical record of anyone of roughly the same age/gender simply by registering with a practice with no documentation.
On indemnity it says:
"Some GPs have called for general practice to have Crown indemnity. This would mean it is not possible to sue for damages
and that the small minority of patients who had suffered harm as a result of clinical negligence would not have recourse to any financial compensation. We do not believe that this is the intent
of the profession, and this form of immunity does not apply to other health services."
Somebody did not understand the question. Muddling indemnity with immunity. Hospitals have a scheme and patients can sue. Who did not spot this?
Nobody seems to have asked the patients if they were in pain or not.
£750 million divided by 30 thousand GPs is 25k - a rather more signficant sum.
Dumping QOF into the global sum will benefit practices with fit elderly and take away cash from practices with younger and iller populations.
My favourite bit was the prescription charge fraud figures, the only source of which was something the author had once read in the Daily Mail and the government had not denied.
On the brighter side, if we take just his quote in the article, practices will be allowed to outsource it to a Skype call centre anywhere in the world.
I suspect that the full data is pretty terrible. If you look at http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/ all of the F&F data is published for maternity, inpatients, outpatients etc. The latests data is for June.
Despite seven months of plugging data into the system there is nothing for GPs. How bad is the data quality?
Can we start selling shampoo and condoms?
Whilst I think that we would all agree that we should adopt a holistic approach this certainly is not it.
The indicator as approved says that you must prescribe statins. You can exception report but it is quite clear that many comissioners reporting exception reporting as a form of cheating. Also if you don't persuade anyone to take the things (perhaps put off but 100,000 tablets it will take to prevent one event) you will get no points at all.
The other indicator is fairly bizarre as well as it suggests that if you have a risk of less than ten percent, even with a new diagnosis of hypertension or diabetes, you don't need lifestyle advice.
This is NICE as its most paternalistic and least holistic.