So for those not in the room, a retired consultant with a history of believing any change is about privatisation/an American take over, presents a motion that demands the immediate withdrawal of a contract whilst also asking for a ballot on the same contract, and then confuses multiple different organisations demonstrating a complete disregard and lack of knowledge about both the contract and the current structure of the NHS supported only by a GP who declares they are the leader of their local Labour Party.
The debate was robust but only logical on one side, it was always going to go the way it did.
Not strictly accurate... they rejected part (iv), which read...
(iv) calls upon him to ensure that existing software used by GPs works appropriately first before continuing to promote GP at Hand
Because we didn't want it uttered into him thinking we would approve of his promotion of gp at hand were current software to be sorted...
I spoke to this at the England LMC conference, this is just the beginning, the integrated urgent care agenda, driven by an A/E consultant has plans for us eventually to be first responders and to deal with most urgent care requests in the community.
It is driven by a desire to stop people getting ambulances and going to A/E, seems to be based on the belief we have lots of capacity to do this and is being introduced without consultation at STP level - no one is resisting it because the speed of introduction means it is being missed. It will fundamentally change day to day practice and will come in without resource to us (it's all going to 111 won will simply signpost to general practice).
The ongoing plan is to allow 111 to book 8-8 7 days a week, and to agree and demand home visits without local triage...
I have a friend who has worked several levels higher than yourself in NHSE for many years, they categorically define that there has been a conspiracy by the treasury to defund and impoverish general practice since 2005, this is completely intentional with no thought to the consequences for the NHS, despite warnings from NHSE - and not something that NHSE has been able to alter, the same individual states categorically "We know general practice and the partnership model is dying, its not that we are letting it happen, we're just not saving it".
I trust this individual to be honest with me as I've known them for years and they have nothing to gain from this disclosure.
So if NHSE are standing by and watching general practice die, they are guilty of neglect, and if they publicly have accepted the treasury stance on gp income and resource, they are guilty of colluding in the demise of a profession, and possibly ultimately the NHS.
This only goes to 2015, there are another 2 years of significant falls to add to that, and potentially a further 3 to come...
It's not the name of General Practitioners we need to change.
We simply need to change the title of "Specialist" to "Doctors with a limited scope of practice".
Oxford medical school director: 'The variation in GP numbers between medical schools is not undesirable'
"There is strong evidence that the GP recruitment crisis is related to deterioration in funding and working conditions in the specialty, and much less to what goes on in medical school."
"If general practice is to compete with other specialities in attracting the best doctors, conditions and funding need to improve. Fix the job and the recruitment crisis will fix itself."
He's absolutely right, why is anyone disagreeing with him?
And here, in a single article, is the reason GPs as members of a CCG should NEVER agree to co-commissioning, if your CCG is advocating it and promoting it, go back and read the article again, look at where their priorities lie, ask yourself when they control a system with block contracts (General Practice) on one side of the equation and piecework (PBR) on the other side, where they will push the work, and which side will lack investment monies in favour of the other.
Co-commissioning will be the final nail in the coffin of General Practice, the lack of funding in the system generally will see primary care stripped back even more in favour of secondary care over-performance.
re the 8.58 comment - Hospitals have not even begun to feel the pain of primary care, 9 years of decreasing resources -go back to your acute trust accounts, and look at your turnover for 2003, and imagine living on the same income now, but with 30-40% greater throughput, that's the reality of General Practice today.
I have no problem telling Dr Porter where the money should come from - the NHS is again overspent, £2 billion less is being spent in primary care, that £2 Billion has gone somewhere, take a look at where budgets have increased and funding has increased, and cut it from all the areas that were happy to increase their resource at the cost of primary care - they've has a few good years out of it, now they can live as primary care has lived, in penury due to their greed and failure to committ to maintaining or reducing their costs!
Actually back to SHA sized units, while they're at it, perhaps they could rename CCGs "Practice Commissioning Groups" and when the inevitable "economies of scale" force CCG/PCG mergers, we could then call them PCTs, or Primary care Trusts, as they develop co-commissioning.
So several hundreds of millions of pounds disappear into administrative changes, lots more millions spent on redundancies for managers who will be re-employed within months, and we end up back where we were years ago, still with dysfunctional NHS management, still without enough clinicians, and still without enough resource allocation to provide even the basic stuff we were able to do 5-10 years ago, and they wonder why there is a morale and recruitment problem in Primary Care?
The bottom line re peanuts and monkeys, and pay vs workload, is that while GPs continue to take the pay cuts, and continue to absorb the work, and continue to race to meet the targets, for decreasing income and increasing media bile and ridicule, HMG are laughing all the way to the bank, until Partners actually start to walk away and hand contracts back, until GPs genuinely demonstrate there is no future in the current funding mechanism and that current pay
is no longer sustainable, why on earth would the DOH and HMG do anything different?
Just complaining will never get us anywhere, leaving practices and moving the problem of provision onto the shoulders of NHS England is what will get us results.
Out of hours in North Yorkshire is expensive because it covers an area the size of Belgium, most of the PCCs cover areas of hundreds of square miles,rates of pay are unchanged since 2004, and staffing levels around 70% of the same date.
We could have fewer Doctors, or fewer PCCs (though patients already travel up to 20 miles at times), and benchmark at lower costs, but we would then simply not perform to target, and more visits would need more staff.
The procurement was suspended because the impact of NHS111 was uncertain, the Urgent Care Review is anticipated soon, and the 4 CCGs want further information and analysis as to whether they should commission jointly or independently, all of this meant it was impossible to define an accurate service specification, and the CCGs could have been liable for significant penalties if they had to change spec mid-contract.
Rates of pay are significantly lower than daytime locum rates in North Yorks, hence the effect of market forces leading to local GPs declining to take up the work (DOI I am one of those that DO work in the system!).