Primary care has never been commissioned properly. We are supposed to have a National contract yet there are so many variations depending on local circumstances. Every contract attracts different funding and it has always been divide and rule with a push to the lowest denominator. Value for money test is how little will someone accept to provide the care. APMS providers are leaving across the country because the funding is inadequate. Partnerships will fold for the same reasons but that has always been the plan. Make everyone salaried and employed so that they can be controlled and do as they are told!
As an active MP what is he doing to make it better? This denigration of the profession is deliberate to make it easier to denationalise the NHS and lay the blame at the feet of disgruntled doctors.
Fundamentally it is about patient safety and quality of care. Demand for access is increasing and the workforce is struggling to cope. Primary Care commissioning is so varied there are great differences in what is expected to be provided. Interpretation of the guidance is dependant on how much funding is available. Buy cheap buy twice!
We are in this "post truth" era where no-one is trusted and everyone lies but cannot be held to account. Even statins are getting a kicking!! STP's are the new game yet a Chair has resigned before the plans are published? Must be really bad?
The truth is that the NHS is being denationalised by a plan with origins in 1982 under Margaret Thatcher. A long slow burn but getting there!Brilliant political move to make Doctors responsible for commissioning then claim to have given the NHS all the money it asked for but in fact withhold it. Get doctors pissed off with imposition of new contract then sit back and wait for winter to hit! The NHS will struggle so much that waiting times grow so long people will be forced to grasp at the proffered private straw, and denationalisation complete!
"Our ambition should
be to break down the barriers between private and public provision,
in effect denationalising the provision of health care in Britain" direct quote from page 78 of Direct Democracy. It has always been the goal of the reforms to push the NHS to the brink and then offer a Knight on a white horse of private provision. The Business model of the NHS is unworkable and not fit for purpose. The problem is untangling the internal market and PBR etc. There is no solution other than honesty about how much it costs then ask the public what they are willing to pay. Politicians will say and do anything to be re-elected as proved with Brexit and Trump so we cannot allow the NHS to collapse because of political interference in the funding.
Practices are closing despite the fund! The red tape to access the fund is beyond most to navigate let alone those that are struggling to keep going. Since 2004 there has been the steady decline in any support for primary care without multiple strings being attached. Hospitals get bailed out by hundreds of millions of pounds that originally earmarked for care in the community and that is done on the back of an envelope calculation. Too big to fail. GP's are expected to just absorb work without funding to help the system. As they are closing the business model must be wrong and not fit for purpose. Having the sound bite of a support fund helps with the press but unless it is properly utilised it remains hot air!
Even working at scale they need to be funded appropriately for the work expected.
No-one has asked patients what they want from their primary care. If they did it would not be what is being proposed. The business model is no longer fit for purpose and is unattractive to any sane doctor. The move is towards a fully salaried system so that everyone is employed and controllable. It won't be by NHS bodies either as the move is away from the state to a private denationalised system. It will still be "free" at the point of delivery but very much more restricted by virtue of limited supply.
"NHS funding comes from the tax revenues in the economy" Simon Stevens said if the economy sneezes the NHS catches a cold! We need to change the business model because it is unsustainable with the coffin of demographics showing a bulge of over 65's (not paying much tax) and not enough taxpayers left to fund the whole health and care system. There needs to be a local health and care tax to fund what each area requires and that would very soon focus the minds of the taxpayers and local politicians. The blame game of who is meant to pay for what and what is free and what is means tested has to stop! Winter is upon us all soon and we have to spend the public pound wisely!
The business model for primary care is not fit for purpose. Salaried doctors need paying irrespective of the profit a practice can make so either change the model or pay more.
The business model for General Practice is not fit for purpose. It is impossible to make a profit when income is essentially fixed and costs and demand rise inexorably. The corner shop model is no longer attractive financially to anyone but has been the backbone of the NHS. Our Pharmacy colleagues are facing even great cuts and many more will fold than GP's. People have forgotten that the taxpayer is meant to pay for their care. If the people controlling the tax funds don't value the provision and aren't willing to pay, market forces means it will disappear only to be replaced by a much more expensive alternative.
The business model is all wrong. You can't run a socialist ideology with capitalist business models. The public expect care free at the point of delivery but someone has to pay. The taxpayer funds the Government and hopes the Government spends it wisely and would pay more if it was guaranteed it would be spent on health. Costs only ever go up so trying to make efficiency savings when there is ever increasing demand is pointless. Accept how much it costs and agree what will be funded and be honest with the public.
Great initiative and proof that working together improves patient care. Pity the Government is blind to that and want 3000+ small community pharmacies to close after the swinging cuts to their budgets!
‘This Government was the first to ensure that doctors, not politicians, make decisions about who provides care. In fact, the rate of growth in use of the private sector as a proportion of the NHS budget remains slower than it was before 2010.
‘On the back of a strong economy, we are giving the NHS the £10bn it asked for to fund its own plan for the future.’
It is not whether you win or lose it is where you place the blame!
Fantastic hospital pass from Government to doctors about how the funds are spent so doctors can be responsible for rationing. Sound bites on how much money is being spent placates the public who will then either pay up or complain and wait. Once the NHS can no longer be sustained because of relentless demand in the health and care system the doctors will be held responsible as they see their private patients ahead of the NHS ones. Back to pre 1948! I would not want to be a councillor now as the STP's are making plans to rescue NHS finances and not social care and woe betide them if they go against saving NHS services. The denationalisation is almost complete!!
Why do persist with the charade of private versus NHS provision? It is the same doctors and nurses providing the care just in different settings being paid by different methods. The question should be WHY after nearly 70 years of a publicly funded universal care system do we still need private providers?
Great article Nigel!
I have just seen a patient with a verruca who is fed up paying his chiropodist £35 per time (8 minutes approx.) to sort out his wart and wanted me to "cure" him for free. I just had my cat immunised and de-wormed at the vet in 10 minutes for £130 and overheard someone else paying £1500 for their pet to be treated. Gone are the days where people valued the NHS and doctors because no money changes hand. It is perceived as free and as such valued as worthless. So much is made of the founding principles of care irrespective of the ability to pay. It is used to ethically challenge doctors to provide for free because we have forgotten the tax payer was meant to pay the doctors to provide. We don't value the care system and then blame it when it lets people down. It is always blamed on evil private providers cherry picking and putting profits before patients, that argument has worn so thin. The profession I joined 26 years ago has been so denigrated that it is no longer attractive to the high calibre students who used to compete for places at undergraduate or post graduate. We have slept walked into the next evolution of care. A two tier system of those that can pay and those who have to take their chances. Sadly it will take a generation to get the best back.
What does the Competition and Markets Authority have to say about capping rates unilaterally? What rights do NHSE have to impose an indicative rate if it is only after information on where locums are needed. The practices are the ones paying so unless NHSE are planning to pay the backfill is it really any of their business?
Vulnerable practice fund only of any use if it is accessible and to date has anyone managed to penetrate the criteria to get any money?
It is as a result of ten years of underinvestment in Primary and Community care that has led to this point and a quick injection of cash won't solve the problem. Social care underfunding drives people to the health service which then cannot cope with the numbers and complexity of care needs and not sufficient funding to match. 80% of hospitals deemed unsafe and only 4% of GP practices found wanting yet NHSE want to let practices wither?
If you use the same tools to do the same job you will get the same outcomes! My old CCG has the second biggest reduction in admissions last year in the South Coast after Torbay but without the support. The local trust however has had the highest increase in its billing and coding and is top in the country! How is that working as a sustainable and transformational plan?
There are so many assumptions and extrapolations in all the plans that don't take into account the real world. There are expectations without discussion that one part of the system will just do the bidding of another part with no resource changing hands. I asked the Chair of the STP how he planned to move 25% of care out into the community when there is no capacity and he assumed he would retrain hospital staff to fill the void. Everyone's health is far too important to be playing these political games to appease here today gone tomorrow politicians with the faint hope of being appreciated enough to get a gong!
Very little political capital keeping practices open. What will happen is mounting pressure on other practices then overflow into the A+E sector. Patients only know two places to get help GP or A+E if one is not there the other will always be. Targets get missed before the winter and the NHS as an organisation starts the finger pointing blame game. Junior Doctors going on strike will have upset waiting lists and subsequent funding flows so will be blamed for the failing finances. Long waits will allow the politicians to offer tax breaks to go private then the £10 charge for GP's will be introduced. That will have to be extended to OOH and A+E to prevent gaming and then we have private providers offering services to compete with NHS. Training out the window. Patients voting with their feet and the NHS as a whole allowed to wither on the vine and not just primary care. Denationalisation complete!
There has never been any real understanding from anyone other than primary care exactly how primary care works. The drivers are not financial but money is important to pay the bills. I have had many instances where senior NHS people and politicians believe GP's are on huge salaries as they believe the media rhetoric. There is little reward for good practice nor for long service. With the introduction of the £10 per patient per contact as described by the Kings Fund discussion paper there may be some respite from the relentless demand. There certainly won't be any help from NHSE before the cards come tumbling down.