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Behind enemy lines

In the third instalment of the PBC diaries, our protagonist has moved over to the dark side and now works for the PCT

In the third instalment of the PBC diaries, our protagonist has moved over to the dark side and now works for the PCT

The story so far

Dr Peter Weaving, a full-time GP in north Cumbria, was previously chair for one year of a consortium comprising 38 practices. But his PCT, which has one of the largest deficits in the country, has instigated a massive programme of investment and reorganisation in community services and felt the consortium was too big a partner. So the consortium has been split and Dr Weaving has crossed over to the PCT side...

Did I tell you the one about the woman who was pregnant for a year?

I'll come back to that later. In my last diary entry, I wrote about our PBC consortium being dismantled and morphed into the six localities of Cumbria. I have swapped the role of independent consortium lead for that of PCT locality lead. I am now a company man. Although I have taken the king's shilling of a Blackberry, I am not influenced by a nice office, a laptop, hot and cold running PCT staff, telephone conferencing and trips to see how the Finns do it. I remain as clear as Einstein that to continue acting in the same way and expect a different outcome is madness. If we want to improve our health economy we need to manage it differently.

So I find it a little frustrating to look around, halfway through the second financial year of PBC, and see no practice in possession of a prescribing or activity budget. We've only just crunched the data on last year. Finance and information departments tell me the figures are sound – by which they mean the activity the hospitals say they've done equals the bill they've given us. Nobody has looked at a single bit of billed activity and verified that it took place. Nobody has checked that we have no bills for 12-month pregnancies as we had before. Nobody finds it even a little intriguing that a big and well-organised practice with its own business manager could be ticking along in the black at halfway through the year and end up £330,000 in the red. We have accepted bills for activity of £500,000 that the hospital cannot attribute to individual practices. Does this sound like robust financial handling of a deficit health economy?

It put me in mind of the mantra coined by Barbara Hakin, the former GP who led negotiations for the Government side on the new GMS contract. I want to shout it at my PCT (and I have): ‘Hey, guys! It's your docs who spend your money – they refer the patients, write the prescriptions and admit the emergencies.' If you don't give them the data how do they know how they're doing? How can they do things differently if they don't know what they're doing now?

So what are my new bosses in the PCT doing while all this is going on? Well, I have to say, they have kicked ass at high level in the most successful way – not only has our millstone of historic debt been written off but we've secured £80m to rebuild and renew our community health services and there's a separate £300m pot for rebuilding a hospital in one of the most deprived parts of the patch. It's reminiscent of a certain superpower's post-invasion strategy – overwhelming victory has been achieved but in the trenches it's still mayhem and confusion. In the past I could have railed against the PCT and its inefficiency but I have a dawning realisation that the buck now stops here… with me!

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