Secondary care cuts to ‘overwhelm’ GPs with work

By Andrew McNicoll | 16 Nov 2011

GP practices are threatened with being ‘overwhelmed' with workload after a major north-east hospital launched a £40m cost-cutting drive.

Cleveland LMC warned the pressure to shift work into primary care and community services was already causing ‘significant issues'. Announcing the cost-cutting programme in a letter sent to all local GPs, Alan Foster, chief executive of North Tees and Hartlepool NHS Trust, warned the trust faced ‘the most difficult financial position' in its history.

‘We will need around £40m-worth of savings in the next three years if we are to stay solvent as an NHS foundation trust,' Mr Foster wrote. ‘This is the most difficult financial position we have ever faced and will mean difficult and unpopular decisions will have to be made.'

Board minutes from Cleveland LMC state: ‘Significant issues [are] arising with work moving from secondary care into primary care without any associated funding – £40m is being cut from North Tees's secondary care budget.'

Dr John Canning, a GP in Middlesbrough and chair of the GPC contracts and regulation sub-committee, said: ‘We are concerned a lot is being cut from secondary care and shifted to primary and community care. We simply do not have the capacity – practices are threatened with being overwhelmed.'

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READERS' COMMENTS

Peter Bennett, GP Partner,

16 Nov 2011

As long as secondary care is paid fee for service (which is what pBR really is) and primary care is capitation any movement of work is a savings to the NHS.....this is what will happen in the next yrs of savings/cuts call it what you want. So in effect primary care will be doing more for less whilst secondary care will do less (with associated cuts in jobs etc)... happy days????

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RANJAN Pruthi, Sessional/Locum GP,

16 Nov 2011

Peter
Would you be able to explain your statement to me and others who may not understand the implications of this? Thanks

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Anonymous, PCT,

17 Nov 2011

In many respects this is very similar to the story about reductions in follow up outpatient appointments. PBR rules mean that you only get paid for what you do. More recently Acutes haven't even been getting paid in full as a response the perceived gaming up.

The DH direction of travel for a few years now has been to encourage new out of hospital services and allow choice of provider. For an Acute this means reduction in income whichever way you look at it. It can only respond by either gaming up its income (an old FT trick from 2005) or slashing it's costs. This isn't easy as Acutes have lots of fixed costs and smaller Acutes have buildings/staff etc that carry out multiple activitiy types. So - its difficult to reduce costs to the level of the income lost.

The PBR system challenges both Providers and Commissioners to balance their books, hence both parties are often at loggerheads. Acutes/FTs are now responding to Choice/PBR/AQP in the only way possible. It isn't what the NHS needs but it is the direct consequence of the bad system.

PCT Finance Manager

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Andrew Bamji, Consultant,

17 Nov 2011

How refreshing it is to see that all the problems afflicting secondary care in the South are at last being visited on the North which, thanks to money redistribution 10 years ago, have been relatlvely immune. The economics are simple; if GPs refer less (much has already been written on this vis-a-vis referral management and rationing) hospitals get less. If follow-ups are then cut back to meet stupid ratio targets then income from thse diminishes (and makes achieving N/FU targets even harder). Then on top of that PCTs start refusung to pay for work done, whether in- or outpatient. So the hospital is squeezed, and has to downsize, and more work goes back to general practice which cannot cope with it.

I predicted all of this in 2004. Nobody listened.

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