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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)

  • This comment has been deleted by the moderator

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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

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  • 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.

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  • 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 :)

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  • 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?

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