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A faulty production line

James Kelly

  • GPC concerned over practice funding following NHS England's PMS review

    James Kelly's comment 03 Feb 2014 7:06pm

    The reason General Practice is at breaking point is that core funding is straight-jacketed by a formula which means you get paid the same no matter how much activity takes place. Even if the "formula" is accurate enough to account for "need" it certainly doesn't take account of the exponential increase in "demand" (ratcheted up by successive governments promising more for less as a means to win votes). Though people are living longer with ever increasingly complex needs the real growth in workload comes from the expectations around access. Its time the government owned up about what the NHS can afford to provide. If we are to offer such access there needs to be an incentive to expand workforce and premises to cope. This can only be achieved through an activity based (PBR) core contract!

  • PMS practices face £260m losses as NHS England announces two-year review of all contracts

    James Kelly's comment 03 Feb 2014 7:01pm

    The reason General Practice is at breaking point is that core funding is straight-jacketed by a formula which means you get paid the same no matter how much activity takes place. Even if the "formula" is accurate enough to account for "need" it certainly doesn't take account of the exponential increase in "demand" (ratcheted up by successive governments promising more for less as a means to win votes). Though people are living longer with ever increasingly complex needs the real growth in workload comes from the expectations around access. Its time the government owned up about what the NHS can afford to provide. If we are to offer such access there needs to be an incentive to expand workforce and premises to cope. This can only be achieved through an activity based (PBR) core contract!

  • NHS England to commission new services from practices hit by MPIG withdrawal

    James Kelly's comment 13 Dec 2013 12:22pm

    It does seem arbitrary and therefore unfair, particularly if you happen to be the 101st worst affected practice! The basic issue is that Carr hill (and any formula) is imperfect and does not truly reward workload or more importantly activity. If the government want GP's to rise to meet the ever increasing demand for access to core services, then we need to be paid for the actual work we do (not the potential demand on services, which may or may not be met). The current formula based funding straight-jackets the necessary investment/expansion in Primary care workforce and premises. The time has come to redress the balance by incentivising the most cost efficient part of the NHS by allowing GP's to be paid by PBR!

  • Trusts allowed 'open cheque book' while GP budgets are dwindling, warns NHS Alliance chief

    James Kelly's comment 03 Dec 2013 0:16am

    Michael Dixon is correct. The system is perversely encouraging more activity in the sector it wants to shrink and straight jacketing primary care with a formula based contract which provides no incentive to rise to the demands for growth in activity!
    Something drastic needs to happen to primary care contracting... and quick!

  • The 2014 GP contract deal: what we know so far

    James Kelly's comment 15 Nov 2013 0:06am

    These look like radical changes but in reality this will do nothing to address the real crisis facing general practice. The fundamental issue is that we are being swamped by ever increasing demand (both access and clinical complexity). Global sum doesn't incentivise increased activity or growth. PBR does! It's obvious that, for the NHS to be sustainable, even more activity needs to take place in Primary care. At present the most expensive part of the system gets paid for every bit of work it does whilst the most efficient is straight jacketed by an underfunded block contract! Give GP's the tools to save the NHS and watch us rise to meet the challenge!

  • In full: BMA response to GP contract offer

    James Kelly's comment 25 Oct 2012 1:38pm

    I've got an original idea....

    Why don't we get paid for the ACTUAL work we do (consultations), ACTUAL services we provide and ACTUAL quality we deliver!

    After all it IS the way every other small business in the world is resourced.

    Why the GPC insist on flogging a flawed formula based of the POTENTIAL workload POSSIBLY generated by a VIRTUAL weighted patient, is beyond me.

    The GP's posting above are concerned about spiraling demand and workload.

    Would any other small business moan about having too much work?

    NO, because they'd get paid for doing it!!!

    The insistence on funding a core contract based on potential rather than actual workload is ludicrous in the extreme, and actually creates perverse incentives which have the potential to drive down quality and access. Even QoF rewards the achievement of targets, no matter who does the work.

    If the government want GP's to do more, they have a funny way of showing it!

    Primary care is the most cost effective way of delivering health services, the DH know it (Commissioning excellence in Primary Care) and so do we. Even the Kings Fund have recognized the benefits of enhancing Quality in primary Care and suggests government pay special attention to incentivizing this.

    Why not then, facilitate growth, innovation and leadership by ensuring GP’s can rest assured they’ll be paid for the work they (or their staff) do.

    Dame Barbara Hakin’s recent letter charts the destruction of all the above objectives.

    General Practice will be in decline and the NHS and, more importantly, our patients will be worse off for it!

    I use the NHS income my practice receives to deliver ACTUAL services not to compensate me for POTENTIAL demand.

    Come on DH/GPC……GIVE US AN ACTIVITY BASED CONTRACT!