Where are the Royal Colleges on this why are they not lobbying Parliament about how unsafe the whole service is? More concerned about gongs than patients! Where is the media outcry? Too common to make it a story!(unless it is a foreign doctor!) The NHS is being systematically run into the ground and will not be able to be resuscitated as the goodwill has gone.
Public Health is hamstrung by the vested interests of the commercial supply of alcohol food soft drinks etc. Anything that could harm profits outweigh any health benefits. Public health budgets have always been raided as the returns take too long to be delivered. It also points a finger at the inadequacies in policies for joined up thinking on health and wellbeing. Now that Public Health is back in Councils there is hope that true provision is made for prevention not just headline grabbing promises that never materialise.
Two years ago at the Health and Care conference at the Excel I suggested that there should be a local health and care tax like there is for the police. I was shot down in flames by nearly everyone for my audacity ! With the way the allocation formula works for both health and social care a possible solution is to get the public to be able to determine how much they want to spend on their health and care . It may focus their attention on preventing illness and keeping healthy . It would make everyone responsible to maintain the health and wellbeing of the public. Then all the blame games can stop and we can wake up to the reality of the growing burden of care.
"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 Democracy 2005.
The system cannot survive unless the hospitals can make money via elective work. Stopping it to meet winter demands would lead them to go bankrupt unless they are bailed out by commissioners who in turn go into debt and the cycle continues. Long waiting lists lead to people demanding to go privately within 18 weeks adding to the costs, once they find the private sector very difficult to persuade them back to the NHS. Those non viable trusts will be forced to close and the care model radically changed as in Christchurch Canterbury New Zealand but that was as a result of an earthquake!!
To entertain ourselves at PCT meetings we used to play bullsh*t bingo, where you had to tick off all the overused and well rehearsed jargon that came out every time. Terms like granularity, waterfalls, ice climbs, recovery plans etc etc. You could always tell who had just been to an expensive management consultancy course as there would be the new phrase of the day!
It is not the CCG that drives the demand but is charged with controlling it after it has occurred. The rules mean providers must be paid for activity unless on a block contract. Why we persist in this bureaucratic nonsense of giving everyone a different allocation and expect the same outcomes I don't know. The only measure that counts in the NHS is financial balance. Where is the quality of care measure?? We need to be honest with the public about how much it costs to deliver the healthcare they need.
Carr Hill was introduced twelve years ago to try and improve the funding to General practice to reflect the differences in workload because of population variation. MPIG was also used to prevent surgeries collapsing. Since then there has been attempts to resolve the issues but there are so many variables that are so confusing with winners and losers that it is almost impossible to get unanimous agreement. What is clear is the lack of investment in primary care is destroying it. The penny pinching slicing of PMS and GMS contracts proves that NHSE does not value Primary Care below the fine words of the Five Year Forward view. The all you can have smorgasbord cannot continue at less than £2 per patient per week. Tweaking a formula is dereliction of duty to solve the problem once and for all.
There is never any transparency on exactly how much more it costs to deliver the contracts. I tried an FOI to NHSE and got back this response.
"However, we consider that this information is exempt under Section 43 of the FOI Act (FOIA), which exempts from the general duty to release information which would, or would be likely to, prejudice the commercial interests of any entity, including the public authority holding the information.
Section 43 is a qualified exemption and, as such, we are required to assess the public interest in withholding this information against that of its release. We recognise a general public interest in public (particularly health) sector spending. Further, NHS England is committed to openness and transparency, and seeks to release information wherever possible.
However, we also take into account the fact that this information is commercially sensitive as APMS contract terms are for a year only and paid at a caretaker premium to ensure continuation of patient services whilst a formal permanent procurement process is undertaken. This is a local contract and commercial terms will vary depending on circumstances. The terms of the contract are commercially sensitive as this type of contract is awarded based on competition of price and quality.
Therefore, we consider that releasing this information would not be in the public interest, as disclosing the commercial terms of this contract in advance of the full competitive procurement could encourage providers/suppliers to raise their prices for any bid they may make for the permanent APMS contract, thus it could be seen as though NHS England is disclosing its annual budget for the service in advance of procurement.
This is not in the public interest as it would negatively impact on NHS England’s ability to secure value for money, potentially leading to an aborted procurement as all bids being out with national policy which is seeking equity of funding for all contract types. This scenario would not be good for patients as no permanent solution would be secured and another more costly caretaking period or at worse no medical provision in the locality.
As such, we consider that the public interest in withholding this information outweighs the general public interest in health sector spend."
I have to display my earnings on my website. Why can NHSE hide behind Section 43?
The Government won't act! Their ambition is to de-nationalise the NHS and you have to stop the heart to kill the beast! There is too much to do to resuscitate primary care and not enough time.
All three of my teenage children have contemplated joining their parents in the profession. I never encouraged those thoughts but they are all bright and would get the grades. Sadly both my wife and I have counselled them to look at alternative careers as the profession has lost its way. The slow steady denigration has worked.
What we as GP's need is direct access to investigations such as MRI CT etc. There are so many protocols in place to be able to decide which and when. After that decide with the patient where to go for best treatment. If NHS can't provide and the money following the patient use the private sector. They are the same doctors!
STP's are an oxymoron as you can't have transformation and sustainability in the same sentence. Something has to give in order for there to be change. The drivers of the plans have too many conflicted interests about preservation of their own organisations. The reason GP's have been omitted is because there is the expectation they will just absorb all the unfunded work in the spirit of collaboration after it is a done deal! The ultimate goal is to make general practice a fully salaried scheme as part of larger accountable care organisations. The role of the Dr Findlay family doctor will go to be replaced by an American style pile them high all you can eat faceless financially driven heartless business.
Why we try and copy the US is beyond me other than to open the door through the TTIP to denationalising the NHS, oh that's right Jeremy supports that ideology as he wrote it in Direct Democracy!!
The public need to be asked what they are willing to pay for their NHS and fund it properly. Every decision is made for short term in year savings that have lasting effects on moral and services. You can't provide a 21st Century service by 20th Century tax funded cash strapped inequitable annual allocation.
“… That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.”
Preface on Doctors by George Bernard Shaw 1909
“Supply creates own demand when care givers make more money by providing more care”
Jean Baptiste Say 1804
Excellent letter! This is a societal problem that is being medicalised. The root cause is not being addressed which is education on healthy living. The schools should teach it and employers should promote it via schemes to encourage activity. There is no quick fix or we would have done it already.
The mistake the founding fathers of the NHS made was not to Nationalise GP's. They thought people will be so well they won't need a GP and they would wither and die as a profession. 90% of NHS contacts are in primary care for less than 10%(not sure of number could have made it up like everyone else). It is a false economy to salary GP's as John Glasspool rightly points out. In partnerships going off sick puts so much pressure on the others and takes money out of profit to backfill so people don't. I'm not criticizing salaried doctors but there is a different priority as a partner. I met one who said in his partnership the only acceptable certificate to miss work was a death one!! What needs to happen is a sense check with the public about what their GP is for and how much they are willing to fund it. Cutting the rewards means people vote with their feet and the world renowned British primary care will disappear into accountable care organisations driven by financial targets and not care.
With the revelation by Danny Boyle that those in power wanted the NHS pulled from the opening ceremony of the 2012 Olympics, I doubt there are many in the party who wish it to remain Nationalised. The NHS is seen as an employment service that does a bit of illness. Because it is such an emotive subject for the nation it is far better to let the NHS die by slow strangulation of resources, which leads to industrial action. Then the blame can be squarely on those greedy agency staff and immigrants who bleed the NHS dry. So sad that the honesty about how much it costs to run the service is lost in that rhetoric. The demise of the independent contractor status is playing into the hands of large corporate groups to offer quick fix solutions that will end up costing more in the long run. The personal responsibility for a registered list will go and with it the ingenuity and autonomy of primary care.
What needs to be addressed is the inexorable rise in demand without the resources to meet it. It could be an opportunity to finally break down the divisions between primary and secondary care and just provide proper care for people in the best setting be that at home or in hospital and stop passing the buck and blame for why the system is not working. CCG's were meant to be the vehicle but have never been given enough time or resources equitably to make the necessary changes. STP's are yet another top down must do to fix the perennial problem. At Excel last week everyone who is as long in the tooth as me had been involved in STP like plans since they started work. A plan is only a plan but it ticks a box somewhere up the chain. Implementing the plan is the difficult bit because the plan is obsolete even before the ink is dry.
The ACO model could work if people could be honest about surplus/profit and deficit/loss and where that has to happen in the system. It is an oxymoron to have sustainability and transformation in the same sentence because one means keep status quo and the other is change!
It will be a summer of discontent spilling into a worse winter than in the 70's! GP's are still waiting for our ballot about our contract and new deal. The denationalisation of the NHS is closer than anyone could predict as there won't be a workforce soon! Playing into the Governments hands and carrying the can when it happens!
Ah the old Delusional Entitlement disorder or DED. It thrives in Surrey as well where parents aren't responsible for how their children turn out it is because we didn't diagnose the latent ADHD Dyslexia oppositional defiant disorder or Autistic spectrum in time to make a difference to their exam results!
If only the nanny had a PhD things would have been so different!