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Gold, incentives and meh

GP leaders to vote on whether to support patient charges for appointments

Exclusive GP leaders are set to vote on whether the GPC should ‘explore national charging for GP services’ at the LMCs Conference later this month.

The motion, put to conference by the agenda committee and set to be proposed by Wiltshire LMC on the day, suggests general practice is ‘unsustainable in its current format’ and that ‘it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery’.

The motion concludes: ‘That conference… calls on GPC to explore national charging for general practice services with the UK governments.’

A Pulse survey of 440 GPs last July showed that just over half of GPs are in favour of the NHS charging a small fee for routine appointments, with many believing it is the only way of managing their workload and curbing rising patient demand.

Other topics scheduled for debate at the annual policy meeting, set to be held 22-23 May in York, include whether or not CCGs should commission primary care, with several LMCs arguing that this will ‘fatally damage relations between CCGs and their constituents’.

However, in a counter motion, Merton, Sutton and Wandsworth LMCs will argue in favour of CCGs commissioning primary care. This comes as NHS England invited CCGs to bid to commission primary care last week.

GP leaders will also be voting on a motion to ‘reject the concept of routine general practice care 8-8 seven days a week’, a concept that has been heavily pushed by Prime Minister David Cameron over the past six months and which is likely to form part of Conservative policy ahead of next year’s general election.

The agenda document also highlighted LMC concerns over the Government’s care.data scheme, which is now set for a delayed rollout in the autumn. An agenda committee motion, to be proposed by Bedfordshire LMC will say that ‘the introduction of care.data has been nothing short of a disaster’ and call for a patient ‘opt-in’ system to replace the current process of patients having to opt out if they disapprove of their records being shared.

The motion says: ‘That conference believes the introduction of care.data has been nothing short of a disaster and.. asserts that extraction should only take place with the explicit and informed consent of patients opting-in.’

The conference will also see LMCs debating the ‘unsustainable workload in general practice’; deplore ‘the CQC’s plans for a simplistic rating system for practices’; and condemn the ‘disorganised mess’ resulting from the NHS reorganisation, including delayed payments to GP practices.

Highlights from the 2014 LMC conference agenda

AGENDA COMMITTEE to be proposed by WILTSHIRE That conference:
(i) believes that general practice is unsustainable in its current format
(ii) believes that it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery
(iii) urges the UK governments to define the services that can and cannot be accessed in the NHS
(iv) calls on GPC to consider alternative funding mechanisms for general practice
(v) calls on GPC to explore national charging for general practice services with the UK governments.

AGENDA COMMITTEE to be proposed by NOTTINGHAMSHIRE: That conference views with alarm proposals contained in NHS England’s (NHSE) interim response to the ‘call for action for general practice’ to make CCGs co-commissioners of GP contracts and
(i) believes that this will fatally damage relations between CCGs and their constituents
(ii) warns that this will undermine CCGs’ chances of success in other areas of commissioning
(iii) predicts this will undermine the credibility of CCGs
(iv) asserts that conflicts of interests would be unacceptable
(v) insists that GP core contracts should not be held by CCGs.

AGENDA COMMITTEE to be proposed by WIRRAL That conference:
(i) rejects the concept of routine general practice care 8-8 seven days a week
(ii) believes that GPs will only provide routine planned care 8-8 seven days a week if resources are provided to the satisfaction of the profession
(iii) commends GPs for already providing unscheduled general practice care for 24 hours every day, seven days every week.

Source: BMA

Readers' comments (57)

  • If something is free, we accept what we are given, if we have to pay, folk demand more. Charging patients will make them more demanding of time and care.
    Too many folk are trying to change too many things once! We need very many more GP's, only when they are in place, can you look at extended hours.
    If you charge for appointments and someone turns up obviously very unwell, or collapses in your surgery with suspected heart attack / stoke, to you demand the payment before you care ... I hope not!
    What happens when patients consistently refuse to pay, do you start incurring court cost to recover the fees?
    We pay National insurance contributions, do they stop when the charge is imposed?
    What about benefit claimants, they are always the winners, everything comes free of charge!
    I fee GP's will lose the support of their patients and start demanding much better care as and when they need it.
    Far too many problems are being tackled at once which throws everything into chaos, let's hope the next election comes quickly so that trust and respect in our GP's can be restored!

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  • How many times are we going to fall into the traps set by our political masters? Increased workload and patient demand is largely as a result of government policy of hospital closures and privatisation. GP income is falling by design. There needs to be some reimbursement which reflects our activity, but there won't be.
    Patient charges are NOT the answer. User charges deter the sick and poor as much as the 'worried well', expensive and bureaucratic to collect. Evidence shows patients delaying seeking medical advice when user charges are introduced. Delay in diagnosis can cause significant harm. If we know this to be fact, to introduce charges appears to suggest that our incomes are more important than any potential harm to the patients. Is this ethical?
    The current crisis in Primary care has been manufactured to create a pressure from GPs for charges. It seems to have worked in Wiltshire or perhaps they have been brainwashed by McKinsey & Co. We set ourselves up as scapegoats, yet again, as over OOH and commissioning, for the Governments agenda.
    We should be demanding increased resource from Government and not our patients. The NHS returned £5bn underspend to the treasury in the last 3 years.
    The cost of the purchaser-provider split exceeds £10bn pa yet delivers absolutely no patient gain at roughly the entire cost of primary care!
    There is vast resource being squandered on PFI debt servicing, management consultants, internal market and commissioning. This needs to be re-directed to the frontline.
    Funding delivery of care is being deliberately and unnecessarily restricted.
    We need to stop jumping on command, to every stupid policy the DoH dreams up such as remote monitoring (for the benefit of IT companies), pre-dementia screening (for the benefit of Big Pharma), Health checks (poor cost-effectiveness) etc, etc.
    At danger is the Dr-Pt relationship, our respect in the eyes of the public and our professional integrity.
    We need to identify the correct target and demand our representative bodies are more effective rather than the incompetence/collusion with Government we have seen in recent past.
    The minority of pro-privatisation GPs leading the call for charges need to be recognised for what they are. We must not be persuaded by the 'greedy and dims' amongst us.

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  • @6.00pm, your analysis of the current crisis in GP is interesting though I feel flawed on multiple levels.

    Workload and patient demand has been increasing exponentially since before the 2004 contract, when the same arguments at present were being made for a crisis in GP land. Workload has increased BECAUSE of patient demand not as well as, which has come about by worsening demographics - aging population kept alive longer by improvements in healthcare, ever expanding natural population thru immigration and higher birth rates. Add to this wholesale consumerism within society with perceived expectations from public services being comparable to what would be delivered (and appropriately funded) by a private service. These demographics and mind-sets are not changing any time soon useless it is proposed government introduces policies of enforced euthanasia on over 80s, ending all immigration and restricting births to 1 child per family. (Government policies which I pray would never see the light of day in the UK). If government policies have had any contribution to increased patient demand it has been an inadvertent one as it has to tried firefight this tidal of demand due to demographic change by introducing structural changes not compatible with a static budget. In fact the national, and hence the NHS, budget is dwindling, and will continue to dwindle in the years ahead given demographic changes outlined above, technological advances in healthcare such as gene therapies and nano-bio technologies which will cost more than the most expensive drugs currently available. Why do you think big pharma is rushing to buy up all these biotech and nano-tech start ups on the hush hush. Its got nothing to do with altruism. Its about profit for them. You might not like it, but guess what their shareholders will. Not commendable notions of duty and benevolence but do they care?. They will charge the NHS cost price, and the NHS will have to pay up, or really be considered a 3rd rate service if it cannot provide life saving treatment for their patients.

    Of course there is one way to reverse the funding trend and keep up with demand. government could just raise income tax across the board to levels last seen in the 70's under Callaghan. That worked out well didn't it?
    No the only way to get sufficient, SUSTAINED funding for the NHS going forward is to be realistic about how we as a society go about raising these funds. Yes it was founded on the principle of free at the point of delivery, but sadly founding principles of any kind are not by definition set in stone, not even the NHS. It may be that if as a society we decide we want to continue honouring this principle then the only way is to pare current NHS services down to the bare bones, enabling the continued funding of a universally minimal service free at the point of delivery for all but overtly recognising it will be lacking in quality and range of services that had previously been enjoyed by earlier generations. But still free.
    Or alternatively we could consider other options such as co-payments, insurance, or full privatisation as alternative models of funding, models of healthcare funding I would point out that seem to work reasonable well in most of the rest of the advance western nations. This would have the benefit of maintaining quality and range of service provision, whilst keeping funding at levels that enable the continued affordability of perpetual advances in medical and life sciences- so we don't get scenarios such as NICE blocking life saving drugs for hep C patients (as reported this week) due to costs not sufficient to past its notorious QALY test. Or lets talk about Prescribing Incentive Schemes aka 'lets not give them' schemes which operate only to assist boost CCG budgets, and have nothing to do with patient care or safety.

    The argument that the doctor-patient relationship would be harmed by charging is both ludicrous and condescending. Are people implying that currently private patients in the UK are receiving a second rate service from a doctor they secretly despise whilst handing over the notes/cheque/card? Does this apply to all other doctors in other western nation where alternate funding methods are in operation? Doctors who feel this way need to get a grip- the strength or otherwise of the doctor-patient relationship is, and will always be down to the quality, training and personality of the doctor involved, developed through years of training and experience.

    As for the 'greedy and dim' among us, it may just be that they save the rest of us from the 'sweetly but sad saints and never going get it naïve' savants who threaten the existence of GP let alone the NHS with their head-in-the-sand approach to medico-economics, behavioural economics & psychology and motivation theories.

    Disillusioned GP Partner (1yr)

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  • BMA leaders seems to have lost sight of a unions reason to exist - protecting the interests of the members. FATPOD is killing us, and is killing General Practice.

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  • Dr Gill 6pm, Patient charges are the only logical answer, a solution in fact favored by most of the western world who are neither greedy nor dim. Models relying on mixed funding streams do not fail the poor who are offered concessionary rates. You may consider this unethical but some might say its more unethical to allow catastrophic disorderly failure of the NHS or let it limp on as quality plummets due to a serious lack of GPs. I agree the current crisis is squandering billions on the useless internal market and that the GPC should take a far tougher stand with HMG but in order to do so we need a bigger bargaining chip. Ultimately the only sane option is to take back control of our profession by relinquishing the GMS contract and releasing ourselves as much as possible from political control.

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  • These are selected motions for debate not yet policy.
    The topics are all sentiments that I have seen expressed in the discussion threads at Pulse.
    LMC conference agenda does identify the crushing workload , recruitment and retention crisis.
    The Pulse item lists the most contentious (and therefore newsworthy) items.
    I think NHS Medical Practice and our profession is approaching a
    " stand together united or all fall" point.
    Its not a good start if we cannot agree it is benefical to have a debate on the differences and resolve our variances by a democratic process.

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  • Bob Hodges

    Anon @9:52pm hit it squarely on the nail-shaped bit.

    The system is crashing and WILL crash in a disorderly fashion unless SOMETHING changes radically and in the near fuure.

    MANY more people will come to harm under this scenario than will under a system with some form of access charges.

    The alternative of gradually reducing quality as overworked GPs are worked to death actually ends in collapse as well, but with dead GPs as well as patients and no capacity to provide ANY system, even pay-as-you-go, at the end of it becasue there are even fewer GPs left to build a new system around.

    Ethically - it's not preferable to free at the point of use I grant you. To say it's a 'moral' issue is trite and condesends to EVERY OTHER developed nation in the world.

    Logically, the main attraction of ANY anlternative system is the reduced influence of the SoS for Health and politicians in general. THAT is probably the single most powerful advantage to the patient AND the doctor.

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