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CAMHS won't see you now

Adjusting profit share calculations

Quids in with my billing agency

The health service is now obsessed by money, contracts and performance. I'm sure that GPs up and down the country with responsibility for monopoly money spend more time in their counting houses than visiting patients.

I often feel I know more about economics than dermatology. Other careers will soon beckon ­ we could all become travel agents offering choose and book services around hairdressing appointments and our beloved friends the dentist.

Next month, a lucky few will have a good kick in the wallet every time they let a patient near a big bad hospital, in a version of proper 'go for broke'.

As a senior colleague pointed out to me, it is our job to keep patients away from hospitals.

But the point is money is pouring into the health service like never before. You might discount the cynical view that most has been spent by prior allocation on pensions, staff NI and central commandments. I can't see pots of gold on my desk but at least it is full of paperwork from departments or positions that didn't exist before.

Bananas expectations

The result of all this invisible cash of course is that patient expectation has gone bananas. The option of saying 'no, sod off' has been written out of everyone's contracts. Demand now reflects the hype rather than the changes on the ground. The powers that be always report that focus groups say patients want to be stakeholders in their local care organisations (if you understood that sentence in its entirety it is probably time for a holiday).

All well and good, but it is time for a reality check, which is after all why we are all about to ration, oops, no commission our secondary care services.

My latest idea is to set up an NHS billing agency. I've called it 'Big Bill'. I reckon we need another agency or quango to do this justice. I know this sounds expensive, but these ideas always go down well in Whitehall. Lots of cash and absolutely nothing to do with hands-on quality care, what could go wrong?

Big Bill will send out random pretend bills to patients for selected procedures to highlight how much their foray into the health service has just cost. Hope you have recovered from your MRSA and DVT following your hip surgery, please find enclosed imaginary invoice for

£28,000. It was a pleasure to see Johnny and his tonsils (again), hope you can swallow this £150 invoice faster than he was managing the crisps in the waiting area. I was just passing the house with a spare hour to come and look at your swollen legs: £400 should cover it.

Information overload

You get the gist? It's not about recovering cash; it's about information. We are supposed to be telling our regulars a little more. Time for the punters to tot up their health expenses. Patients will soon be quick to realise that the old chestnut of paying their stamps all their lives doesn't go far to meet the health costs in a modern economy.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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