This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

Extra 'named GP' funding in doubt as CCGs struggle to stump up cash

Exclusive Some GPs may not receive the additional £5 per patient funding supposed to support the new contractual responsibility to be a ‘named GP’ - and those that do may have to undertake additional work - a Pulse investigation reveals.

As many as a third of CCGs have yet to decide if they will offer GPs the extra money, which has been promised by NHS England and the health secretary and is due to begin in April, with one CCG admitting it is waiting on uncertain ‘quality premium’ payments before committing to paying GPs.

Among those who are to offer the funding, meanwhile, many have yet to determine what extra work it may be tied to over and above the new named GP duties, with one CCG planning to commission ‘additional services’ and two others in the process of negotiating ‘baseline outcomes’.

LMC leaders warned that CCGs were likely to struggle to find additional cash to fund GPs’ new duties.

It is a new contractual requirement that practices in England ensure that from April there is a named, accountable GP assigned to every patient aged 75 years and over, with the GP responsible for coordinating and overseeing that patient’s care.

In its ‘Everyone Counts’ guidance, NHS England instructed CCGs to ‘support practices in transforming the care of patients aged 75 or older and reducing avoidable admissions by providing funding for practice plans to do so’. It said this funding ‘should be at around £5 per head of population for each practice, which broadly equates to £50 for patients aged 75 and over’, and said GPs could propose this funding pay for new general practice services or be invested in other community services such as district nursing or emergency response nursing teams.

In an interview with Pulse last month, health secretary Jeremy Hunt also explicitly promised the extra funding would be used to support the new ‘named GP’ responsibility.

He said: ‘It’s a very big change, and there’s a lot of extra work, but that’s why we’ve removed 40% of the QOF targets to help free up GPs’ time, and we’ve also put in extra resources. The extra £5 [per patient funding] is a reflection of the fact that we know that to deliver better care we need more capacity in the system.’

But of the 50 CCGs who responded to an enquiry from Pulse this week, 18 were unable to confirm that they would be able to provide the £5 per patient funding.

One CCG, NHS South Gloucestershire, even admitted it was waiting on whether it would receive the whole ‘quality premium’ funding before committing to the investment.

An NHS South Gloucestershire CCG spokesperson told Pulse: ‘There is no new money in the system to easily fund this requirement. If the CCG achieves the quality premium this will enable us to invest in the fund, which is based on £5 per head of the population.’

In other areas, CCGs were also unable to commit to providing the extra money.

A spokesperson for Cambridgeshire and Peterborough CCG said: ‘We are not in a position to answer questions on this, as the debate about this funding has not been completed.’

A spokesperson for all 12 CCGs in the North East said they were ‘working closely with NHS England to develop their detailed plans for the next financial year, including enhanced services for vulnerable patients and those with complex physical or mental health needs’.

Dr Ken Megson, medical secretary of Gateshead and South Tyneside LMC, predicted CCGs would struggle to find the funding.

He said: ‘There is no new money available. What CCGs will do is take money out of secondary care and slosh it into primary care. It’s not about giving GPs £5 a head to do things differently, but giving services such as district nursing some money to keep people in the community.’

Most of the 32 CCGs who said they would offer GPs an extra £5 per patient said they had yet to decide how the money would be offered. But a number did confirm that it would involve GPs taking on additional work over and above being a ‘named GP’.

A spokesperson for NHS Southampton City CCG said: ‘The funding will be used to commission additional services to support patients in line with our commissioning strategy on behalf of our practices. We are currently in discussions with all of our member practices on how best to invest this funding.’

NHS South Cheshire CCG and NHS Vale Royal CCG said the CCGs had taken an ‘innovative approach’ and were working with GP federations on ‘negotiating baseline outcomes’.

Dr Nigel Watson, chair of Wessex LMCs, said the £5 per patient funding could be used for positive change, but expressed fears that the promised money might not materialise.

He said: ‘There is a real opportunity to embed community nursing services with GP practices and provide integrated services. There could be primary health care teams led by GPs and supported by nurses working in partnership with practices. If you gave GPs £150,000 each and asked them to develop services there could be some imaginative schemes, but at the moment it seems like a lot of talk.’

Readers' comments (44)

  • NO FUNDING NO EXTRA WORK {{{:-(

    Unsuitable or offensive? Report this comment

  • There isn't enough time to do the extra work anyway . £1 per week per patient over 75 won't allow employing extra workers . This is a non-starter . 11% of NHS budget down to 8 % - is decreasing resources with increasing demand . Even with the good will to do the work there isn't the means. Do the maths .

    Unsuitable or offensive? Report this comment

  • I don't think maths is their strong point - 0.28 = 1 !

    Unsuitable or offensive? Report this comment

  • I deal with GPs regularly in my work (I am a consultant), and I think they are finally being pushed to earn their money for the 1st time. When you clear away all the endless whingeing clouding the issues you find nothing more than overpaid medical clerks and state sponsored drug pushers...and often incompetent ones at that. The public are no longer the adoring fans of yesteryear and are increasingly intolerant of the medical model being dispensed by blinkered and lethargic so called "doctors".

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Nobody is surprised here . On the matter of maths , I think even these maths teachers coming from China can save the day. Maths is only science-- politics always conquer science.......

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Apology
    ...cannot save the day .....

    Unsuitable or offensive? Report this comment

  • Consultant 1111 am
    Please identify your self to call us state sponsered drug pushers etc is insulting Why not have a mature discussion.

    Unsuitable or offensive? Report this comment

  • 11.11 - bet that is (nurse) consultant

    Unsuitable or offensive? Report this comment

  • Don't bite the bait, 11:11am isn't a consultant.

    On the issue of work - I think this is going to be in our GMS contract i.e. no choice but to do the work or risk bleaching the T&C of the contract.

    What I'm not sure is how the responsibility can be built into GMS contract but the payment seems to be optional (i.e. not embedded into global sum). This ineffect allows government (or it's delgate such as CCG) to withdraw the funding without the need to withdraw the responsibility.

    Another weak "negotiation" by the GPC I recon. I'm afraid they are so badly out maneuvered we might as well send in my gran to do the negotiation.

    Unsuitable or offensive? Report this comment

  • Consultant 11.11am
    Come and spend the day with me, go on - oh sorry, you will make sure you don't have time as you are so important.

    Unsuitable or offensive? Report this comment

  • Anonymous at 11.11am. Identify yourself or hide behind the moniker

    Unsuitable or offensive? Report this comment

  • This comment has been moderated

  • @ 11.11am
    I deal with consultants regularly in my work (I am a GP) and find most of them are overpaid lazy pompous twerps with a penchant for private work at the expense of doing their allocated NHS duties.
    Like many GPs, I am extremely well qualified with multiple postgraduate qualifications and consider myself an expert in many areas.
    You and your colleagues, however, know your own subject (a bit) and absolutely nothing else.
    You send us homework which you can't be bothered to do yourselves.
    You make multiple errors in your discharge letters, if we ever get them at all.
    Your clinic admin is awful resulting in missed and delayed appointments for my patients.
    Your arrogance is so striking it almost appears from a byegone age.
    It drives a further wedge between primary and secondary care and shows you to be what we all suspected anyway, a bunch of ludicrous tosspots.

    Unsuitable or offensive? Report this comment

  • @11.11.....probably financial consultant from nhs England ..not a proper one...ignore him!Obvious troll.

    Unsuitable or offensive? Report this comment

  • On the serious point, It'll be difficult to push this through as a contractual requirement. I suspect this is a leaked story to try and distract from other issues or they will try and pile a lot of work with this 'extra' funding.

    The GPC can only negotiate for us if we're behinf them, we're not - we are divided with mnay competing agendas. there are many GP's who effectively don't need to care about the pennies as many of us do. Especially those in academia or NHS england roles and they feel free to pontificate without any consequence

    Unsuitable or offensive? Report this comment

  • 11.44. Wow made my day!
    However just like the majority of GPs, the minority give us the bad name. Consultants are the same but can hide behind their 'employed by the trust, fulfiling my contract arguement.'
    I have a good relationship with a lot of consultants and they are as disillusioned as we are.
    We (the collective profession) have let the governments divide us, place idiotic contracts on us and we've rolled over and had our tummys tickled because of not wanting to upset or put patients safety at risk, as we know who'll get the blame. We may/should sacrifice goodwill now to protect the future patient from insurance based medicine. 46% of bankruptcies in the US have medical fees contributinng towards them; who only knows how many deaths or years would be saved it people could afford to see the doctor. Fight now to save this happening to us as a whole profession or we can carry on hiding behind the arguements as mentioned above.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Old Chinese saying:-
    When the lips die away ,the teeth are exposed cold.

    Unsuitable or offensive? Report this comment

  • I'll bet even 11 11 is registered with a GP. Not sure he would open any consultation with the balls he wrote annon.

    Unsuitable or offensive? Report this comment

  • Can we please just ignore the fool (11:11) that claims he is a consultant. He is not a consultant. Many consultants are wonderful people to work with.
    He is likely one of those people who think they know how it works in medical practice which is their way of covering their ignorance, regret and hatred for their inability to actually make something useful out of themselves.

    Unsuitable or offensive? Report this comment

  • NO PAY ELECTRIC BILL--->NO ELECTRIC
    NO PAY GAS BILL-->NO GAS
    NO PAY CAR TAX--->CRIMINAL RECORD

    DO YOU UNDERSTAND???

    Unsuitable or offensive? Report this comment

  • 11.11am---another DAILY MAIL JOURNALIST or some related Freelance nutter.
    P*** *** you ridiculous imposter.

    PULSE magazine....either barr this person's account for impersonation/misuse or you will end up with no readers because nobody trusts you anymore. I understand it stimulates debate but Newsnight do not stimulate debate by having fake politicians doing interviews, do they??

    Unsuitable or offensive? Report this comment

  • Anon 11.11 a.m. I feel much the same way about consultants, they use hospital theatres fro private work, making NHS patients wait longer, they work office hours and will always fit you in quickly for a handsome fee.

    My GP works 70+ hours per week, he is the very best, I couldn't ask more from him, and lazy is certainly not a word that comes to my mind! I am considered to have 'complex issues' with high demands on my GP time, my GP meets all my needs without opening extra hours or working weekends, but he looks shattered!

    There are times when as a patient, I am concerned for his wellbeing, I know not all GP's work as hard, but please don't tar all GP's with the same brush!

    As for the £5 for named GP's, is that £5 extra per hour, per day, per week ... oh no, please don't tell me it is £5 per year, somebody really has got to be joking!

    Unsuitable or offensive? Report this comment

  • 1111..obvious offensive fraud...bears strong resemblance to "111"....!

    Unsuitable or offensive? Report this comment

  • 11.11 consultant, if you are NHS consultant you should identify yourself and consider how you can criticise others when displaying such utter unprofessional behaviour/language. As per other response you are very welcome to spend the day with me! Grow up.

    Unsuitable or offensive? Report this comment

  • £5 per patient is an insult even if some CCG's cough up for the additional workload set to engulf practices from next month, come on <10 pence per week!

    Unsuitable or offensive? Report this comment

  • Hunt: it’s a very big change, and there’s a lot of extra work, but that’s why we’ve removed 40% of the QOF targets to help free up GPs’ time, and we’ve also put in extra resources.
    I used to work 11 hour days this time of year to mop up QOF targets. For the last year i have put in 11-12 hour days every day just to clear the admin generated by increasing amounts of stuff General practice expected to absorb for nothing. Looking at the 2014 qof , removing those qof targets won't free up much time and if you don't pay, don't expect anything extra as we have nothing more to give. Saying that, all our patients already have a 'usual' gp so I don't understand this 'enhanced service'

    Unsuitable or offensive? Report this comment

  • '£5 per patient is an insult even if some CCG's cough up for the additional workload set to engulf practices from next month, come on <10 pence per week!'

    This money will be taxed at the top rate of tax, and pension contributions will be taken off the top as it will eventually be considered as GP income.

    It will pay enough to possibly get me up from my chair, to my car, turn on the ignition, and the petrol needed as well as the time taken will have eaten up that 10p paid for the week. Anything you do after that is on your own time and good will.

    Typical DOH policy - smoke and mirrors.

    1 A&E admission hundreds of pounds spent, so lets give GPs £5 for a whole year to prevent this.

    If they were serious it would be half the money needed to prevent 1 admission as funding to help save money later, and would still lead to savings overall.

    Unsuitable or offensive? Report this comment

  • I posted the comment about GPs at 11.11. I note that some of those complaining I was posting anonymously are also posting anonymously. Why? I am not a troll nor a journalist but a Rheumatologist working in the South East and I have a right to my opinions which is borne out by experience. I am a woman and considering the vitriol spouted, was right to withhold my name. There was nothing abusive in my comment. It is a view held by many of my colleagues and increasingly, the public. For those so upset by my valid comment, look in the mirror. I have touched a nerve because deep down you know it is true. Stop trying to project and instead self reflect and own your shortcomings. Only then can you improve your performance and restore your reputations as doctors.

    Unsuitable or offensive? Report this comment

  • Anon 08:28- You are a rheumatologist? And you think you are working harder than me?
    You are a fool to think that. You do your 9-5 hour work, use hospital facilities for private work and anything outside rheumatology you are unable to see it. They you send patients to us on expensive medications with absolute disregard for health economics and you have the audacity to imply you work harder than I do?
    For me, I see all patients and treat them appropriately. It is because of the job I do that you are not inundated with patients while sitting in your 'Olympus'.
    I refuse to dignify your gross ignorance with any further reply. Have a good day.

    Unsuitable or offensive? Report this comment

  • I am a Nurse working in General Practice - with 3 extremely hard working GPs. Please instead of widening the divide between secondary and primary care - we need to find ways of working together to prevent Hospital admissions, when we are told 30% of elderly admissions are dead within a year - I think I heard 1:10 don't leave hospital alive , instead of petty bickering we need firmer stratergies to ensure our elderly population are cared for. None of the subscribers came in to the medical field for the money - you all had the same basic training and then made your own carreer choices. Belittling each other is worthless. Be proud and face your frustrations together. GPs work hard long hours - in my experience work far longer hours than the public imagine - openness, and appropriate funding - are the answers and we need to negogiate to that end.

    Unsuitable or offensive? Report this comment

  • Daniel Nlewedim. You do yourself no credit. I suggest you re-read my original post. The implication you refer to comes from your own mind and not mine and displays your own gross ignorance and foolishness to coin your language, rather than mine. I also suggest you follow the advice you gave in YOUR own previous comments held on Pulse not to insult those merely because they have a different opinion to yours. I also note that no-one has argued against my actual point regarding clerking and pushing prescriptions at all comers. This further validates my original point that when people cannot dispute the facts, they obfuscate and deflect through threats or abuse. I am bowing out of this thread now as a grown up intelligent exchange of views is clearly not possible.

    Unsuitable or offensive? Report this comment

  • This comment has been deleted by the moderator

    Unsuitable or offensive? Report this comment

  • 11.44. Stop. Enough. Cannot you see by this shocking comment and your previous one that you lose the argument straight away when you resort to playground language. I truly am shocked.

    Unsuitable or offensive? Report this comment

  • Dear colleagues we are doomed if we continue down this path where we cannot respect and appreciate our colleagues in both primary and secondary care. Perhaps the only way to resolve this is for all GPs to become salaried as Clare Gerada suggests so we all work to the EU work directive and consultants will then finally stop feeling that GP Partners pay is "greater" than theirs. At this point IF this happened then finally the true worth and added value that we GPs provide will finally be appreciated.. too late of course as the NHS will at that point become a much poorer place where extra patients will be sent to A and E and home visits will be a thing of the past. There are many consultants and GPs who are excellent but many who only work to rule. Let's try not to drag all of us down to the lowest denominator please.

    Unsuitable or offensive? Report this comment

  • Una Coales

    Tensions are running high for all state NHS workers, hospital consultants and GPs. Consultants are hounded by nurse managers where not rolling up your sleeves may result in a gross misconduct charge and where operations are cancelled as beds are being blocked by managers and clinics overbooked as consultants are left to stay late when juniors reach the limit of their EWTD hours. They try to deliver a safe patient service but are constantly being hampered by the system and interfering managers with clipboards and targets.

    GPs are being hounded and buried in paperwork targets, retenders for LES or DES, ie to write reams of pages as to why they should be handed back services they have always provided as a GP so they can have a source of income or why NHS England should provide them with clinic premises when their lease runs out. GPs are banging their heads against a brick wall trying to deliver safe patient care but are being hampered by meddling almost weekly changes to unreasonable and unworkable 'daft' government diktats.

    Salaried for APMS is NOT the answer! In my opinion it will be much much worse! In the US, salaried family physicians for HMOs start their day rounding on their own admitted patients in hospital, writing their own orders, managing their own heart attack and diabetic inpatients, delivering babies for their own patients, and then they start their morning list of GP patients. They order and review their own x rays and spend their lunches checking blood results and writing up reports before they start yet another session of seeing patients. This is followed by yet another visit to the local hospital to check on their patients before they head home and take any paperwork not dealt with, home to complete. One salaried doctor says she doesn't finish the paperwork until 10 pm each night. The pay is abyssmal $70,000 and the hours long with more responsibilities. This is the future that is coming our way. Just sit in with a BMA employment advisor and she will tell you how little rights salaried employees have as contracts may be changed unilaterally by the employer after you start work!

    As for hospital consultants, they face insurance companies only reimbursing £75 for a GA or paying the same fee for grommets to the ENT surgeon of 2014 as to the surgeon of 1994. They are discriminated against if they do a procedure in their own private practice. If the same procedure is done in a HMO hospital, the hospital will get more reimbursements. In the US, they handle this problem, by putting up a sign as to which insurance companies they accept or not. For consultants starting out, they have no choice but to accept pittance in insurance company reimbursements until they build their own private practice with self paying patients and some health insurance providers are now saying they will offer their patients a choice of their preferred consultants (meaning the cheaper and newer ones).

    What is the solution? Look at the Irish, Canadian and Australian models of healthcare. It asks for copayments. It is based on a system of semi private healthcare. Demand is controlled by subsidy. Pay first and get reimbursed as a patient on medicare. Until then, hospital doctors and GPs, locum at up to £100/h filling service provision gaps in the NHS as it becomes privatised and handed to large insurance companies and NHS GP managing directors, emigrate, go solely private as a St Thomas' psych consultant did despite receiving numerous clinical excellence awards for his exemplary NHS work and as young GPs are doing (google face clinics and dermadoc), or take voluntary early retirement.

    Unsuitable or offensive? Report this comment

  • D Niewedim -
    Well said.
    I see my earlier angry comment has now been removed.
    While I applaud my colleagues' more measured assessments, someone has to stick up for GPs as we are getting bashed from all corners. The last thing we need is a rheumatologist arrogantly denigrating all GPs.
    So, to 'shocked' at my comments (now removed), unless as GPs we fight from all corners we will continue to play the role of spineless victims, and the longer we do it, the more it will be perpetuated.
    Hence the anger.

    Unsuitable or offensive? Report this comment

  • Guys,

    Really, stop biting the bait. We should respond to a genuine comment designed to stimulate a discussion but ignore those that's come phishing. Why would a Rheumatology consultant with a hatred for GP be reading and commentating on Pulse? She wouldn't.

    Anyway, back to the original subject - I think this will become the norm in our contract without having 'extra' payment for it. So, as the QoF points are removed we stand to lose substantial asking of money - for my practice nearly the drawing of a part time partner.

    Unsuitable or offensive? Report this comment

  • Named GP role in question if CCG's don't stump up cash.

    Unsuitable or offensive? Report this comment

  • dear 11.11
    you must be a fraudulent troll.
    no nhs consultant could possibly hold such reactionary and backward views... gps and consultants in the modern nhs work as a team and do not make libellous non evidence based childish rants about their colleagues.
    ps ?what has being a woman to do with anything..opinions have worth intrinsically(not in your ignorant case)..and are not related to the gender of the intiator.
    if you are a consultant which i think extremely doubtful words fail me............resign.

    Unsuitable or offensive? Report this comment

  • dear 11.11 and 8.59 fraud
    you started the vitriol
    direct reply ..hardly state sponsored drug pushers..we do our best to reduce prescription costs in everyway and have been doing so for over 20 years.
    medical clerks..what on earth does that mean??
    all your posts are invalid pieces of evidence free abuse..i suspect your 'knowledge' comes from the childrens magazines..eg the daily mail.
    bye bye :)

    Unsuitable or offensive? Report this comment

  • Una Coales

    Once upon a time in the days of the Raj and under the rule of the British Empire, Indian workers toiled and harvested to pay 'taxes' in grain to the Raj who then took his share and paid the rest to the British who said they would protect them. That was 2 centuries ago.

    In 2014, Indian and UK NHS doctors (GPs and hospital doctors) toil and pay 40%+NI taxes to the British government and GP practices also pay levy+NI for their employees, doctors pay annual subs to Royal Colleges, medical defence orgs and the BMA who say they will protect them. Have we made much progress in history or is history repeating itself?

    And if you still have not mastered maths (perhaps a reason why A level in maths is NOT mandatory to be a doctor in the UK), then add on council tax, road tax, tv licence fee, inheritance tax, 20% VAT and ask yourself, why?

    Unsuitable or offensive? Report this comment

  • more lunatic top down micromanagement from an organisation of sick control freaks.

    Unsuitable or offensive? Report this comment

  • I have spent the day with 3 consultants over the last couple of years and found it really interesting and was impressed with what I saw, finished my VTS in 1987. Each consultant then spent a day in my practices, sitting in consultations, joining in the meetings.
    Each was surprised at what we did in there of quantity and quality as it was very different from the stereotypical view they and their colleagues have.
    Consultant 11.11am you comments are sad and frankly ill informed. We try hard but don't always get it right, we are not perfect but then neither are hospitals or your colleagues.
    I would suggest you do as I have and spend a day with one of your colleagues i.e. a GP and you might be surprised. Happy for you to come to my practice in the New Forest.

    Unsuitable or offensive? Report this comment

  • We need to work together. The lady rheumatologist maybe has had one too many fibromyalgia referrals. Let's bathe in the breadth of uncertainty and realise all were really here for is to have as good a life as possible for ourselves, our families and our patients. Pass the pen and I'll sign the prescription. Pass the old dear rheumy and I'll give her a hug. Pass the guidelines and ill light my living room fire with them. I love GP land!

    Unsuitable or offensive? Report this comment

  • Bob Hodges

    Those questions don't just apply to IMGs Una.

    That's the reasons that so many British GPs and doctors are now IMGs in OTHER countries.

    I suspect that India is now now a big enough attraction for Indian doctors, and who can blame them? The faintest hope of an opportunity to spend some of MY career as an IMG in India might improve my morale right now.

    Unsuitable or offensive? Report this comment

Have your say