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Health boards go into deficit to sustain directly-managed GP practices

Some health boards in Wales are running up large overspends as a result of running managed practices, the BMA has warned.

In 2017/18, Betsi Cadwaladr University Health Board in North Wales – a region with by far the highest number of managed practices at 13 - overspent by £1.3 million compared with a deficit the previous year when they only had seven managed practices, BMA Wales reported.

And Hywel Dda University Health Board who were responsible for three managed practices in 2017/18, had an overspend of £1.1 million.

Figures from both these health boards show they relied heavily on locum sessional GPs and salaried GPs backing the BMAs long-argued view that such practices are much more expensive to run than those with a GMS contract.

Data included in a briefing paper for Welsh Assembly Members confirm that managed practices do not provide value for money for the health board and the taxpayer, BMA Wales said.

Betsi Cadwaladr allocated £8.89 million of its total budget to managed practices in 2017-18 but ended up spending £10.19m the data shows.

The average overspend of each of the managed practices in last year was £100,355 with one practice reporting busting the budget by £599,296.

And it spent an average of £226,851 per practice on GP sessional locums.

Hywel Dda – which attributed the overspend to increased use of locums – spent which £3.2 million on its managed practices in 2017/18 compared with 2.1 million the previous year.

BMA Wales pointed out that health boards were starting to realise that the cost of directly managing a practice is not sustainable and are actively trying to return them to GMS status.

The latest ‘heat map’ shows 29 health board managed practices across Wales and 82 practices deemed ‘at risk’.

BMA Wales is currently in the process of negotiating a new GP contract with the Welsh government.

Dr Charlotte Jones, chair of the BMA’s Welsh GP committee said: ‘BMA Cymru Wales has always been clear that the most cost-effective way of providing primary care services is via the independent contractor model providing GMS services.

‘It is better for patients, providing them with the continuity of care they deserve and provides better value-for-money to Health Boards and ultimately the taxpayer.’

She added she welcomed moves to return managed practices to GMS status but it could not be overlooked that there are still practices at risk and considering handing back their contract who need more support.

‘We will continue to encourage Health Board’s to support practices, all of whom are facing challenging times across Wales.

‘This would include addressing last person standing issues through active intervention on premises by taking over or guaranteeing leases, as well as addressing additional challenges and pressures to make partnership an attractive option for GPs now and in the future.’

But Betsi Cadwaladr executive director for primary care, Chris Stockport said there were a number of factors that had not been included in the BMA report, including a reducing in prescribing costs due a quality scheme they had introduced.

He added: ‘There a number of reimbursements that the Health Board makes to GP practices such as for staff cover and costs associated with building improvements that were not included in this data for our managed practices, this data will be included in the future.'

Costs related to training and raising staff wages should also be taken into account he said.

‘We continue to look at all areas of our operation to ensure we make appropriate savings whilst also ensuring patients in North Wales receive the highest quality care.’

Jill Paterson, director of primary care, community and long-term care at Hywel Dda University Health Board said: 'The health board is currently reviewing service provision across all managed practices, looking at skill mix in line with the primary care model for Wales to deliver safe and effective patient services. Wherever possible, we are seeking to return managed practices back to independent status with a GMS contract and the first of these is due to complete in early 2019.

'We are currently reviewing all locum costs and have proposed a locum cap to reduce costs to support our ambition to build robust high quality multi-disciplinary teams.' 

 

Readers' comments (15)

  • ‘Proposed a locus cap’

    Lol classic communist playbook.

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  • So managed primary care costs more! Good luck with capping locum pay when there is a scarcity of GPs.

    I bet the overspend is somewhat comparable to the loss of income among GMS partners.

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  • National Hopeless Service

    'We are currently reviewing all locum costs and have proposed a locum cap to reduce costs to support our ambition to build robust high quality multi-disciplinary teams.'

    Twat statement of the year.

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  • Good luck trying to control the free market, it doesn't work!Supply vs demand, and how much are your multi disciplinary teams going to cost!Delusional and idiotic.

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  • The BMA is clear,the cheapest way to provide services,is GP's who are represented by the BMA.

    And they're proud of it !

    You would think they would hang their heads in shame,

    Who pays a subscription to ensure their fees are as low as possible

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  • Locum cap = no locums
    Free market, had the chance to do it right, didn’t take it, cannot blame the free market that has developed aa a result.

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  • Tantalus

    So running general practice costs more than allowed for in the global sum ....... who knew?!

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  • I really hope the BMA plays hard ball with them. Locum costs are projected to increase as salaried GPs will realise there is more to gain financially.

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  • Locum cap- Haha, its needed but for those MANAGERS SITTING IN CCG SIPPING COFFEE

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  • The rest of the UK NHS needs to wake up and smell the coffee, get rid of partnerships push a salaried service with multidisciplinary teams your service will cost a lot more to run.We will not just slip into salaried roles like good surfs, all you "health leaders" miles from the front riding around on your white horses from meeting to meeting.

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  • Just Your Average Joe

    The DOH and the politicians are slowing destroying the partnership model - and siphoning funding to far more expensive models of care.

    We all know walk in centres are black holes, and APMS contracts were paid at a huge premium to the baseline funding for GMS practices with around 50% extra funding in their money per patient often around £120 per patient.

    Running practices with cheaper Noctors is not cost effective when you try and foist partners work, and heavy patient loads on salaried doctors. Once the simpler cases have been cherry picked by the Noctors, the remaining work can be back breaking and complex.

    Locums are a valuable resource when supply is outstripped by demand. The amount of work partners swallow out of good will, and do above the baseline hours expected, would never be done unfunded by salaried or locum colleagues.

    Rightly so, all those hours extra will be chargeable and will unsurprisingly push up costs.

    It is not too late to put a smaller amount to make Primary care work effectively, than the poison pill to come if the plan to destroy partnerships is continued.

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  • very interesting article. May be of interest to policy makers.

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  • Well, I think the politicians will stick with partnerships, since they know they cost less. Going to a salaried workforce will actually cost more and a locum chambers type system will cost even more (rightly so - driven by market forces).

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  • Not a surprise that (1) managed practices cost more and (2) that in Wales GMS is even cheaper as the practices are underfunded by 12% compared to identical English practices.
    (1) https://bjgp.org/content/67/664/e792
    (2) https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-10-156

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  • The BMA had a chance to resign and negotiate a new Contract, was mandated to do so by the LMC, but they chose not to do so.
    GP land is so unjust and unfair. Neighbouring practices earn vastly differing patient year payments from 100 to 250 and in rare cases, 500 pounds. Really, it should collapse. It is like slavery in its Contract. Here in NI, even if you cannot cope with current workloads you have to take on more patients. The last time this happened was slavery. This Contract is crap and it is time it shut down.

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