you can have the test but you can't have the test. If you have the test it might be useful but it might not. Hmrc says it may be a benefit in kind so you might have to pay more tax for the test even though Secretary of state for health has said the test is available for nhs staff so test, test test.Now the bma says weeks later, no practices should arrange the test even though most practices have been doing just that the last 3 weeks! sounds like bo Jo's lock down rules! Shambolic!
I really dont know where to start. The key point of GMS is that practices are expected to provide for the REASONABLE needs of their patients and the current pandemic is not a REASONABLE situation. It is clearly exceptional and should be funded outside GMS as stated by BBO LMCs. Should NHSE decide to impose Hot hub work onto GP practices, NHSE should remember that a significant number of primary care workers are BAME and there would be a good case for breach of health and safety should there be any deaths as a result of any such imposition as in Northern Ireland. I find the BMAs position in NI relating to hot hub work for NI GP staff and colleagues shocking.
Ed waller has a surprising lack of knowledge and insight into practice and employment contracts given his position hence his absurd statements. If a member of staff is ill and unable to come to work, an employer cannot force them to work and would be in breach of the employment contract. Despite this, if by some sense of loyalty, an ill colleague decided to work from home, it would not be at the capacity of a fully fit worker and limited in scope due to remote working and as result there would still be impairment of a practices ability to provide an adequate usual service. Hence the need for supplementary locums. Agree that practices are responsible for the first 2 weeks of employee sick leave before getting reimbursement but we are in an exceptional situation due to national isolation rules regarding COVID. The ability of self isolating clinically well staff to return to work was also seriously hampered by NHSE failings in healthcare worker testing in the early stages of the COVID pandemic. This gives rise to increased expenses for practice above the agreed guarantee of core GMS funding during the COVID pandemic. IE practices would be out of pocket. Regarding the comment on staffing hot hubs, I really dont know where to start. The key point of GMS is that practices are expected to provide for the REASONABLE needs of their patients and the current pandemic is not a REASONABLE situation. It is clearly exceptional and should be funded outside GMS as stated by BBO LMCs. Should NHSE decide to impose Hot hub work onto GP practices, NHSE should remember that a significant number of primary care workers are BAME and there would be a good case for breach of health and safety should there be any deaths as a result of any such imposition as in Northern Ireland. I find the BMAs position in NI relating to hot hub work for NI GP staff and colleagues shocking.
The constantly changing shielding goalposts have caused unnecessary confusion and distress among patients and practices. I agree, enough is enough and if the correct message (despite the confusion) has not got to the appropriate patients yet, it never will.In fact the mismanagement of shielding by NHSE has added to the problem. In the early stages, we were asked to contact all patients at risk based on flu elegibility for shielding and we did. Then the goal posts changed to a more specific cohort needing shielding only with everyone else we had contact needing onky social distancing vigilance. Now I have to call all splenectomy patients who i have advised don't meet the criteria again to tell them they now do? Patients will think we are incompetent when it is quite obviously clear NHSE is the cause of this farce. Waste of time.
Not sure where this central dictat has come from suddenly and shows complete disjointed thinking and a lack of understanding of local arrangements and developments.Most practices had stopped patient and nhs111 direct bookings early in the pandemic to avoid the risk of symptomatic patients turning up at practices. I assume these are face to face requests as the CAS is clinician led so if triage on phone has been done properly, these patients may need f2f. Locally, most areas have set up hot Hubs for covid suspected cases (often run by the same nhs111 providers) at specific sites and most individual practices are beening used to see shielded and cold patients. This makes sense to avoid exposure to a larger cohort of the gp workforce to Covid, reduces ppe use (which the government thinks is a "scarce resource") and also for shielded patient safety. Now the suggestion is to bounce back to practices after a clinician triage? Pointless duplication and makes no sense putting GP staff and other patients especially the high risk at more risk. Better option would be direct booking into the local hot hubs. The point made above about doing this work, in addition to review of shielded patients (another total NHSE farce) and the suggested proactive monitoring of suspected covid cases in addition to business as usual is also a valid concern. NHSE thinks we are sitting in our practices twiddling our thumbs. I also find it very concerning that unilateral contractual changes to the Gms contract are being made on a weekly basis on a whim. Where is the Bma in all this? Hiding as usual. GP Practices are being completely unsupported in the whole situation, being used to mop up failures of other services with the only resource give so far being a pack of surgical masks and a roll of flimsy plastic aprons!
The government knows there is no ppe. The UK has no manufacturing and is totally reliant on imports. These are going to the highest bidders and that in not the NHS.The government position is to keep calm and carry on despite the risk to NHS staff. The bigging up of NHS staff serves to cojole us into continuing care despite the risks. The ppe is not coming. Lots of patients are going to get infected and many will die. We are going to have to make hard choices in a few weeks and even now. Do we see asymptomatic possible covid patients with possible other urgent conditions without appropriate ppe putting ourselves and our families at risk or sign post them to a stretched secondary care where there might be a better chance of staff with appropriate ppe? If we do the latter,I am sure the GMC would be breathing down our neck very quickly stating we are neglecting our duty of care to patients like they did during the pensions strikes.
additional roles reimbursement scheme= (ARRS). LOL. NHSE really taking the mickey!
This sounds like a politically motivated backhander for our health secs favourite medical digital business. Guess which established primary care disruptor (guess... begins with a B and rhymes with London) has been mass recruiting and working on AI and will likely get a chunk of this "competition" funding?
this mess has been caused by the ideological move to get rid of faxes and paper referrals when the e referral system has always been inadequate. To not have an agreed analogue back up system for urgent referrals when the move to e referrals only was implemented was stupid and clear safety issue. This work is now being picked up inappropriately by GPs. Simply madness! This issue can be solved in a day if there was any common sense! Allow faxed referrals till the e referral system is workable in circumstances such as these and stop over burdening GPs!
the winter pensions tax "scheme" was an election bluff. It was never real and all those who worked additional sessions out of the hope it was and the GPC who took this "back of the envelop" idea as genuine have been gullible suckers. I can understand the nativity of some colleagues but for the GPC to fall for the same trick over and over again demonstrates a remarkable wish for recurrent self flagellation.
Good on the GPs who did the shift. The rates they were paid are what we deserve every day. We are highly trained professionals doing an excellent high risk job in a extremely horrible environment. The cardigans stating "what a waste" are deluded. These are market forces at work as they should be. We have over the last 15 years allowed ourself to be bullied and deprofessionalised to such a degree, we now believe we don't deserve better. There is also a sense of fear of change with all GPs especially the leadership in the BMA and RCGP. NO ONE should put up with the sh*t we put up with every day. We have totally lost our sense of self worth and seem happy with bondage and abuse from all angles. Time for major change. Anything less will make no difference as it is the same cycle of hope followed by dispair we have had every year since 2008.
The goalposts have changed and rather than a pragmatic balanced look to see if a practice is safe and effective, we have moved towards a comparison with an impossible ideal standard which no practice can adhere too. There are fortunate practices getting outstanding by the cqc on any given day but scratch the surface and you will find issues which could result in them being adequate too and give current standards anyone can fall foul of the inspection regime.The solution is to reduce the daywork of seeing patients and provide a miminal actual service in order to spend time pandering to achieve the stupid standards, work within limits and not take on any work which is potentially unsafe especially non contractual work. Ifthe government realises that as a result of this we are unable to provide sufficient appointments and waiting lists rise to months with increase in Ed attendances and patients complaining of practices not offering some services, change might happen. Otherwise you could leave it to the BMA, listen to their waffle and see no change.
@matthew Davies. Actually the opposite is true. The pension accrual rate for the 2015 scheme is much higher (1/54) than either the 1995 scheme (1/80) and 2008 (1/60) main difference being the age at which you can take a full pension without actuarial reduction and how the lump sum is managed. So the taxation for both the annual allowance and the lifetime allowance comes quicker and is higher under the 2015 scheme. I think more likely, colleague who have paid large sums of tax related to breaches in annual allowance might be due a refund if annual allowance calculations are redone!
This approval and expansion is a concern for all UK gp practices with the potential to defund and destabilise primary care to its end. I echo the comments as to why a London CCG already in financial difficulties would be allowed to approve this expansion outside of its Jurisdiction. No doubt there has been discussions with NHSE around future unfair bailouts for the ccg being contingent on this approval in order to distrupt gp practices nationally. The absence of both the BMA and the RCGP whilst this is happening also stinks a d is suspicious. There is clearly a greater plan at work and watch the dominoes fall. The only way to fight back is for local practices to offer remote consulting however the tools (including the intentional non development of the NHS app for this purpose recently highlighted in the hsj) are not there. Practices don't have the ability to compete with GP at hand so watch the rush for a select selfish few practices to join the this disruptor service to safeguard their own survival. This with PCNs as a pointless distraction is going to irreversibly destroy UK general practice. But there is no concerted resistance from anywhere. V sad.
"A BMA spokesman said: ‘This is no different to practices looking for legal advice on partnership agreements, leases and other areas that require a legal input". It is COMPLETELY different and the fact the bma does not recognise nice this shows they are soooo out of touch. The GPC negotiated this farce of a contract change which provides nothing of benefit to primary care (including funding if you do the figures over 5 years and not just the indemnity sweetener for this year). They are responsible for this appalling mess and then to have the nerve to charge practices to sort the mess out? defies belief. No GP should be a BMA member.
This is all being made up on the hoof! 88% of practices are part of a network according to CCG? I am sure CCGs assumed this was part of a federation when asked rather than the new "definition" of PCNs. I know of very few practices working in small groups in my CCG. Having looked at the funding coming through (and the already shifting goal posts on what was agreed financially as well as finding the staff and the 30% to employ allied staff) and what is being expected (changes to QOF, care home services, enhanced medication reviews etc), the contract changes seem like a dud. There are also wider risks in PCNs with the loss of practice autonomy and the need to support PCN members who may be struggling or about to fold. It will make the CCGs job easier when a practice gives up its contract or there is a single hander retirement as the responsibility will be pushed to the network. Overall, this is a contractual herding exercise prior to setting up ACOs as the federation experiment has been a failure in most areas of the UK and will be the death knell for small and medium size practices. Going forward, it will also herald the end of the GP independent contractor status; what control do we or will we really have in a few years time? Very little to none so we are heading towards a controlled salaried workforce with pay restraint. General practice will cease to be a profession and will be no more than a technically skilled job. Pretty sad that the BMA has been complicit in this.
The narrow consultation period seems to suggest its a done deal with token consultation.
Impact for general practice would be devastating. Even if there are increases to GMS funding to account for this, I doubt (as with previous experience in 2008 when contributions were increased and when GP practices took on responsibility for employers contributions I think in 2005) any uplift would fully compensate for the increase; as an example, recent GP earning figures show that the 3.3% uplift given last year only translated into a 0.4% increase in GP funding no doubt eaten into by expenses so in essence a paycut. This increase probably brings the NHS Pension scheme employer contribution rates on a par with the civil service and judiciary but their employee contributions are far lower that senior NHS staff. So maybe negotiating a reduction in employee contributions would be an option?
For GP partners this is a double whammy, as we pay both employees and employers on our pensionable pay so this will amount to paying 35.6% into the scheme! I.e over 1/3 of income. That doesn't include additional tax from exceeding the tapered annual allowance which would make the cost even higher.
Being the cynical type, i would say the Government does not want an NHS pension scheme! Senior staff will probably stop contributions and as existing contributions are used for current pensions, the scheme could fall apart. I also don't think the NHS pension scheme is as "government backed " as we assume it is. BMA as usual will be impotent.
Technically not correct. The NHS pensions annual allowance is not based on the contributions made but the growth in the pension value from one year to the next as the scheme is a defined benefits scheme. So growth can be in excess of contributions made if you have a large pot and more so if cpi is high in any given year. So in effect you are paying tax now on money you may never get in the future if you happen to die!
No protection. No reflection!
This verdict and the farce leading to the appeal demonstrates that the profession has no confidence in the Gmc. It is time for change in one of 2 direction; if the Gmc wishes to continue to victimise rather support doctors and wants to be an advocate for patient safety at doctors expense, then the profession should not be funding it. If however, heads roll and the Gmc becomes a responsible profession led self regulatory body balancing public protection, patient safety and doctors support, I would be happy to continue funding the organisation. I doubt the latter will occur however and neither will the lame BMA take a firm position on this.