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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)

  • 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!

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

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  • 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.

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  • £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!

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  • 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'

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  • '£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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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