（1） Perhaps , the Carr-Hill formula was not that ‘wrong’ as far as ethos and telos are concerned . At least the small practices were funded more numerically . Problem is that shortage of resources carries a different meaning . In fact , it goes with my philosophy of time , manpower , expertise and then money being one for all , all for one . The smaller practices in more deprived areas as well as rural practices suffer seriously from recruitment crisis , whether the money is there or not . Without the expertise of senior partners (many took early exit) and actual manpower , the task to meet ever increasing demands from all directions for those surviving staff in a practice, would be even more onerous morale-defeating .
(2) APMS practices , not surprisingly, were funded more . But then , it begs the question for NHS England of why did these practices frequently end up in closing down their businesses? I think that was the same old nightmare stories of Carillion and Capita once again .The desperation of winning contracts at all levels by these private companies precluded honest and astute recognition of what they were really up against in primary care . They would just say yes to all questions laid upon on them in their procurement process . ‘Cheaper the better ‘ was undoubtedly the biggest temptation for the commissioners during the austerity period seen in the last decade . Thanks to the Health and Social Care Bill bestowed by the coalition government. The rest is history .
(3) The truth is even though we now have a government , led by the most egregious prime minister in history ( my opinion ) which is willing to ‘lavish’ voters with money spent in public sectors including NHS , the crisis in general practice continues to escalate. Whether you genuinely believe that austerity is really over , it only serves as a good subject for cathartic experience in a coffee morning debate . The reality is NHS England is exerting its autocracy on CCGs in making more savings , as we read news in various parts of the country . More CCGs are to be merged into bigger ones as the swinging blades from NHSE are over their heads . My suspicion of NHSE’s draconian ploy to end direct and individual practice funding has never been more acute .
(4) Then you have PCNs which are the ‘new kid on the block’ and supposed to become the portal for direct future investment in primary care from NHS England . Notwithstanding that CCG is , by default , an organisation of GP membership , the parody is PCNs(also made of GP practices ) became an inevitable caricature of CCGs. GPs are forced away to attend various meetings engaging CCGs . Clinical directors are inundated with all sorts of stipulations and politically correct tasks (while many still have clinical commitments in own practices). Integrated Care Team in the system requires a GP lead from each PCN . OoThere is no clear indication where is the funding for these ‘additional’ engagements with various big providers in STPs . Everybody seems to have ‘high hope’ for this new kid on the block to be the next crusade to get us out of this mess .
(5) Then we have a health secretary who is so upfront about technology and smartphone apps to deliver general practice that he virtually gave free passes to these private companies cherrypicking relatively younger , healthier ,mobile and obviously internet bound patients from swathes of the country, even though they live miles away or in a different city. The inequality created by this two tier system further complicates the big picture . It has now become apparent that these companies were ‘awarded’ simply because they provide the government free technologies to satisfy this obsession of a 21st century digital general practice underpinned by apps , algorithms , video consultations and eventually AI . I smell the word cronyism.
After all , no matter which figures , high or low , one would like to pick from this study kindly conducted by Pulse ( my full gratitude to the editor and his hard working team), the funding rate per patient was still way below what was necessary to cope with this current level of demands in general practice. Pulse used to compare this rate with the annual subscription of Sky TV (especially if you are a football fan) . I suppose these days one can argue Netflix is offering a cheaper , better deal for entertainment. But seriously , are we , general practitioners on NHS , only merely something there to provide ‘entertainments’ for patients ??
One of my all time favourite songs is ‘Sometimes love just ain’t enough ‘. Read the lyrics if you think many of your patients ‘love’ you (and you still love general practice) .
But I must draw a conclusion using this song title for this funding data study :
Sometimes money just ain’t enough .........