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At the heart of general practice since 1960

CCG admits to spending £2.5m earmarked for GP practices on propping up A&E

A CCG has admitted spending funding that was identified for primary care to spend on the care of vulnerable patients on plugging gaps in its urgent care budget.

NHS Coventry and Rugby CCG said it had planned to spend its £5 per head of population earmarked by NHS England in support of the named GP scheme for the over 75s as specified, but had to instead put the money into the acute trust after ‘experiencing activity levels that are much higher than we jointly planned for’.

It said it was ‘committed’ to working with member GP practices to work up ‘robust’ plans for the £5 per head money - which, based on the CCG’s population, equates to around £2.5m - but added that it had to ensure it had thoroughly appraised options before going ahead.

Last year, NHS England announced that practices should be given £5 per patient to help them plan for the care of vulnerable patients as part of the Government’s plans for all elderly patient to have a ‘named GP’.

But Pulse reported earlier in the year that many CCGs had not allocated the funding to GP practices, while a GPC found that fewer than one in three GPs had been consulted on how their CCGs were spending the £5 per head of funding.

NHS Coventry and Rugby CCG had admitted to Pulse that it is allocating the money to the local acute trust.

A spokesperson told Pulse: ‘[A]s with any NHS monies, it is essential that we undertake a rigorous appraisal to ensure resources are invested in a way that will secure the maximum health impact. Given this need for a thorough appraisal of available options, and the subsequent commissioning and recruitment processes, any service developments agreed with practices using this money will not be operationalised until late in the year so there will be some non-recurrent slippage against the £5 per head investment budget.

‘Since April, our local acute trust has been experiencing activity levels that are much higher than we jointly planned for, e.g. A&E attendances are 8% higher than for the same period last year. This is a situation replicated across many parts of the country.’

He added: ‘We are confident that the £5 per head spending plans that we are developing with our member GPs will, once fully implemented, help address these emergency pressures. In the meantime, we are inevitably having to utilise the investment slippage to reimburse our acute provider for the additional work that is being undertaken.

‘This does not detract from the CCG’s commitment to enhancing out of hospital care. We will be working closely with our member practices to finalise investment cases as soon as is practicable.’

But Dr Grant Ingrams, a member of the GPC and GP in Coventry, said the CCG’s statement was ‘misleading’.

He said: ‘The CCG has had extra, unexpected activity within the A&E department at our local hospital and they therefore told us that there was less money available for the £5 per head of population, that they wouldn’t do that.

‘My understanding was that this money was supposed to go to general practice for providing care for over 75s. In this case they have said “we are going to spend the money elsewhere therefore don’t even bother putting in your applications”.’

As part of the 2014/15 contract deal, the plan was for CCGs to identify and ringfence £5 per head of population to support GPs in their work to reduce pressure on hospitals by caring more efficiently for vulnerable elderly people via the avoiding unplanned admissions DES and the new ‘named GP’ for all over-75s contractual responsibility.

When the funding was announced in December last year, an NHS England planning paper said: ‘[CCGs] will be expected to provide additional funding to commission additional services which practices, individually or collectively, have identified will further support the accountable GP in improving quality of care for older people.’

Readers' comments (16)

  • CAB ANYONE BEAT THIS FOR BUREAUSPEAK:
    ‘"[A]s with any NHS monies, it is essential that we undertake a rigorous appraisal to ensure resources are invested in a way that will secure the maximum health impact. Given this need for a thorough appraisal of available options, and the subsequent commissioning and recruitment processes, any service developments agreed with practices using this money will not be operationalised until late in the year so there will be some non-recurrent slippage against the £5 per head investment budget."

    Utterly meaningless, avoiding the fact that, maybe, this was not a local decision but orders from above "not to upset the local economy" ie :
    ‘The CCG is taking money from general practice to put into hospital’

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  • Exactly same in my local area. I asked what's happened to the £5/head money and I was told it's a money CCG is not required to give personally to each practice and instead they are planning to use the money for wider service. Except there are no planned out existing service to help manage this named GP responsibility. By the way, the CCG had just discovered they are >£1m in the red as secondary care "increased" their activity.

    Any guesses as to where this money is disappearing?

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  • There just isn't enough money in the system. All the Trusts are bankrupt too - please don't blame us for the mess we are all in.

    The unplanned admission DES had totally failed, as everyone knew it would, and our admissions have actually risen instead. I'm afraid the CCG has to pay us something for that (at 20% of tariff, a small fraction of what it cost us to deliver the care) and there just isn't enough money in the pot.

    If you think morale is low in GP-land, come and visit the hospital. Everyone inspects us and moves the goalposts further and further away, whilst criticising everything we do: the CQC, Monitor, NHSe, and CCGs do this with relentless enthusiasm.

    The winter bed crisis lasted all year, and caused failure of surgery RTT and ED waiting times, so the CCG fined many of us hundreds of thousands of pounds, for what was ultimately their own failure to control demand. Thanks for that guys.

    Community nurses tell us the DES has identified unmet need, and even directly caused additional admissions, where an acutely unwell patient has been found on a routine visit!!

    Pretty soon, the true extent of the financial crisis will be visible to everyone, and we can either try and fix it, or crumble. Blaming each other will get us nowhere.

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  • Has anyone ever found a CCG that took money earmarked for hospitals and instead spent it on General Practice because GP is overworked and underfunded?
    No? I thought so.

    Poor hospital, it only gets 92% of the funding already.
    Once again the bureaucrats only think of hospitals.

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  • 8:58pm,

    I can sympathize with your problem (ish) but you are missing a point here. If CCG has taken away CQUIN funding to balance over spend in primary care, would you accept it?

    p.s. You might want to consider the difference between general practice as independent contractor and hospital. If we go into administration, the partners of the practice will not only loose their jobs but will also be personally liable for redundancy of the staff, as well as any money the business owes. If a hospital goes into administration, you might loose your job but nothing more. Which is why the GPs constantly "moan" about the money - the threat is very real to us.

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  • "Anonymous | Work for health provider | 16 October 2014 8:58pm"

    Here in GP land we do sympathise, but we are in terrible trouble too. Taking money from us to prop up a hospital department has no justification as GP land has serious problems as well. As the previous comment pointed out, no hospital manager risks any more than his job, in GP land the partners risk everything including their family home, personal bankruptcy etc.

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  • Thanks for the comments. My point was not to underestimate the crisis in General Practice, but was simply to highlight that there is an equally huge one in hospitals, many of which are on the verge of bankruptcy.

    It saddens me to read the responses that assume that the hospitals are wallowing in cash at the expense if primary care, and the degree if rancour expresses by some GPs.

    Whilst the Trusts employees would 'only' lost their jobs if that happened, it is the wider implication of quality of care when you and I become ill one day that really worries me.

    We have a common enemy, and should not fight each other.

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  • And here, in a single article, is the reason GPs as members of a CCG should NEVER agree to co-commissioning, if your CCG is advocating it and promoting it, go back and read the article again, look at where their priorities lie, ask yourself when they control a system with block contracts (General Practice) on one side of the equation and piecework (PBR) on the other side, where they will push the work, and which side will lack investment monies in favour of the other.
    Co-commissioning will be the final nail in the coffin of General Practice, the lack of funding in the system generally will see primary care stripped back even more in favour of secondary care over-performance.

    re the 8.58 comment - Hospitals have not even begun to feel the pain of primary care, 9 years of decreasing resources -go back to your acute trust accounts, and look at your turnover for 2003, and imagine living on the same income now, but with 30-40% greater throughput, that's the reality of General Practice today.

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  • I'm sorry, it is difficult to understand the "crisis" in secondary care.

    You might know GPs has taken a pay cut year on year despite doubling as both clinician and senior management team. How many of your clinicians and senior managers has taken a pay cut? My partner is a senior clinician in secondary care and I know most have taken a pay rise, never mid cuts. y staff hasn't had any pay rise (not even 1% which NHS staff gets) for a couple of years and we are finding this difficult to do in face of decreasing income.

    Our work load has increased tremendously and we now work >50+ hours/week (despite the pay cut) - I know your employee cannot work more then EWTD hours. So work done by individual has not increased, though I don't disagree trust as a whole is seeing increased activities (for which you'd get paid, we don't get paid for ANY increased activities, not even 20%)

    You may not like us saying you'd "only" loose your job - but have a go at putting your house, cars, saving in the same risk pot and see if you still think it's unjust to make that comment. By the way, wider implications for the quality of care will suffer just the same if a GP practice closed, that privilege isn't confined to secondary care.

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  • Vinci Ho

    Even devious Mao once said ,' unite with the lesser enemy to combat the single , common enemy'
    But I would still say the teeth are to be exposed cold when the lips die away.

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