Presumably that's 21% who didn't want to lynch them at dawn, rather than 21% who loved it and wanted to offer warm cuddles.
You'll be missed Kevin. Best of luck
I think it would be a shame to go 'GP only' as I think often the insight from other members of the practice team are just as valuable. I think an nhsmail account could be a prerequisite of gaining access, and discussions could be only visible to those with a login, to protect posters further. I think threads and logins (although with the freedom to have a meme, rather than your real name) is a really positive approach and encourages people to think before they post a little.
There is huge knowledge, experience and brain power in our collective thoughts. The challenge is to continue to harness and promote the best of that, whilst avoiding the animal farm excesses.
Anonymous | NHS Manager13 Jun 2016 11:17am - NO NO NO! The contract provides reimbursement, so no we can't do this. And the ROI on GMS is shrinking as it is, so we can't take this risk, and we can't be sure we can afford it for any long period.
The whole issue here is that the country is broke, and we're kidding ourselves we can still afford services like the NHS. Time for co-payment.
So true. It needs to be simple.
Why have we got here?
The GPC failed to challenge this at the procurement stage, and have actively endorsed it. I wrote to our LMC in Feb and the GPC in march (see below) asking that they fight it BEFORE it did harm, and instead they said 'it'll be alright chaps, do the work for free' or did not respond.
Why are we leaning casually on the recently closed stable door waving at a horse's arse again?
Tue 08/03/2016 12:35
FAO: All GPC Members, re Capita PCSE Contract
To all GPC Members,
Practices in our local area (North East Essex) have been hugely disappointed at the impositions involved in Capita’s PCSE contract, which predicate their ability to deliver the service on the unfunded transfer of huge volumes of workload onto General Practice at a time where workload saturation has been passed, and when workload remains a key issue in the retention of the inadequate number of GPs we have left.
Given that the consistent message through the LMCs has been that practices must focus on safety, and refuse unfunded work dump, I struggle to understand how the GPC can endorse this approach. Clearly there are additional steps which we are not currently taking, and it feels that the information governance risk is being placed squarely on practices who will be threatened with contract breach notices for such failures. The 40% reduction in cost to NHSE will be in addition to Capita’s profit margin on the contract (usually 12.5-15% for corporates in our sector) and as such we’re undergirding their contract approach with our unfunded and unnegotiated labour and the additional resources and process change this results in. The lack of clearly articulated plans at a date so close to implementation suggests further that this project will be an unmitigated disaster; further leaching valuable time and energy from practices.
As a patient I object to my personal medical history being carried by a jobbing courier and doubt that this will be safe and secure. And the fall back of a distant call centre in Leeds hardly fill me with faith and optimism, given the shambles that we saw with the transfer of practice payment management to Shared Business Services.
I ask that you urgently reconsider your support for this approach, and whether this would be a sensible beach-head on which to finally take a stand on behalf of practices overwhelmed with work, and underfunded to collapse. Such a call to arms might act as a rallying point for the profession, and both encourage the unity so essential to future negotiation, and demonstrate the collective might of a profession too long scorned. If ever there was an issue with the potential for practices to unite behind in saying no, without adversely impacting on patients, I would think this is it.
Anonymous | GP Partner09 May 2016 4:40pm
Surprisingly small actually.
Matthew Epton - Spot on as always.
They first announce the idea and allow us to pour our our rage (http://www.pulsetoday.co.uk/fury-over-plans-for-gp-call-centres-in-india/11049560.article) then gather our concerns, and find ways to excuse (not solve) them. They then introduce something worse, and agree to scale it back to our original horror to throw us a carrot (well done Shaba).
So - it will be India, and then scaled back to 111 with Capita et al as a 'concession'.
Robert Koefman | GP Partner23 Mar 2016 10:42am
£200? I think you'll find it needs to be about 3x that.
Anonymous | GP Partner11 Mar 2016 8:15am
Its called market forces. The day job is getting worse, so we're all looking at alternatives.
I trust taking actions on your pension being grabbed at by HMG will also be 'gold-loving', and attempts to keep yourself and your family from long term psychological harm will be 'self-serving'.
Whilst sad for the NHS, this is a way to survive.
The trend is even more worrying as much of QoF or the 'GP is ideally placed' nonsense is equally lacking in evidence. And when it comes to local CCG schemes of GP triage for opthalmology, or referral guidelines for X Y & Z....don't get me started.
But what this really shows us is this; Evidence is clear baseline requirement of medical care, whereas politics doesn't let something as trivial as evidence get in the way of a good-sounding policy. So do we really run a health service or a National Hocum Swap?
Has anyone actually bothered to justify these figures? Why £200?
Actually we have fallen from 11.5% of the NHS funding in 2004 to 6% of funding in 2014-15. So we have now half the funding we did a decade ago for double the consult rate, and considerably higher complexity, risk, and cost. Our costs have increased by 28% and net income down by 15%. So we have half the funding for twice as much work. We need to quadruple the funding to get back to where we were. Therefore it should be £564/patient. Clearly none of these people has ever bid for a contract.
By the time we get there the cost of services will have increased well past this. Health inflation is at roughly 15%/yr, and indemnity is at 26% currently. Incidentally, that's the whole 41% that this rise respresents in one mouthful.
Expect a huge wage hike with the National Living Wage reaching +£9 by 2020 with subsequent rises for all back office staff, cleaners, and then knock on rises for clinical staff who rightly expect to be paid proportionately more, not to mention growing supplier costs as a result. Add in the risks of pension change, CQC cost escalation, and you won't even standstill at £200. Supremely naive.
We'd be better off pushing them off the cliff. They are way behind schedule, and way over budget. We should all refuse the fees level. Continue to register, but refuse to increase payments by more than CPI (set to possibly be negative shortly). Essentially they'll go bust, and we'll crow in public that they are useless, and way behind and they'll get culled eventually.
Ivan does talk sense here, but it may well be too late by then. In Essex we are seeing whole towns hit the wall for GP provision, and its set to get very stormy very soon. I'm not sure 6 months will be soon enough to prevent the irrevocable loss of general practice in parts of the country. And without a nuclear option, you will simply be walked all over by the DH again. You have to be able to hit them so hard that the cost of what we demand looks like small fry. So you'll want to plan an exit folks. Too little too late.
I've offered to quote for FENO testing to our local CCG a number of times but they keep declining for some reason.
My recommendation - NICE should identify who pays as part of each nonsense exercise they undertake. We will then be happy to notify that party of our charges for additional activity. As the ABPI will tell you, there's no such thing as a free lunch.
Phlebotomy and cryo are additional services - which are paid extra under GMS, but you can opt out. Look at your statements to identify how much you are paid on them, or ask the payments team for a breakdown. Limit your work to what is paid, and include a % of all your costs for heat/light, CQC, uniforms etc. Happy to provide an excel calculator you can use to assess the true cost of services you do for free if you email me on email@example.com
We're just about to reduce our shared care prescribing, ear syringing etc as they are either not funded or can be self-cared. Then we just need to give notice on ECG and spirometry which are both unfunded and outside GMS.
Great list of unfunded work here.
Sessional/Locum Comdrade - Tell 'em again!
So about £324m/year, divided by 8000 practices gives a measly £400k, which after deductions, stupidity, commissioned nonsense and trivialities will give sweet FA at the cold face. Bravo
Anonymous | Military GP06 Jan 2016 12:52pm
We are looking at them - with envy. We just want him to be straight and say just that, rather than trying to crush us to prove the point. If its to remain public, pay us properly and tax accordingly so you can affort it. If not, be honest, and make it happen quickly. Currently the personal cost on so many in the NHS is enormous in order to hide his deceit.
Outstanding as always Tony. The issue to stike on is that they're killing us - literally.