In the same way that tomorrow never comes, it seems that the View to which we have all been looking Forward is, in fact, the horizon: a destination we’ll never get to.
Yes, OK, the ‘Time for Care’ scheme from NHS England’s GP Forward View has borne fruit, apparently freeing up 121,000 hours of clinical time, although this neatly overlooks the 121,001 hours of box-ticking it took for GPs to negotiate the scheme.
And, true, it briefly felt like we really could bounce back bouncebacks and deflect the DNA letters showered on us by hospitals using the rough, tough BMA template letters. Until, that is, the hospitals decided to laugh collectively in our face and CCGs decided to ignore the whole thing, since when it’s been workload-dumping business as usual.
But there was one Forward View pledge that really got my juices flowing and which, unless I’ve somehow been in a coma for the past two years, seems to have been filed quietly under ‘Let’s pretend it never happened’.
This neatly overlooks the 121,001 hours of box-ticking it took to negotiate the scheme
I’ll give you a clue. This past couple of weeks, a number of things happened, and here are some highlights:
• We’ve just heard that, because of a ‘software issue’, the CQRS system is not picking up codes for flu jabs given to certain at-risk groups. The solution is: a) we have to do a retrospective system search to ‘prove’ what we’ve done thus far to validate payment for any shortfall; and b) we will have to do some extra prospective coding for these patients to justify payments we’d otherwise miss in the future.
• Because of a ‘software issue’, our electronically transmitted lab results are not being coded properly, thereby screwing QOF targets for cholesterol and HbA1c. The solution is that we will have to search for all patients affected, then enter the data manually, otherwise we lose mega QOF bucks.
• The alignment of QOF with SNOMED codes, which we were previously told would cause no QOF problems, is very likely to cause QOF problems. I don’t know the reason for this, though my guess is it will be a ‘software issue’ and I don’t know the solution, either, but I do know it will involve GPs, time and pain.
You’ve possibly guessed what I’m driving at but just in case, here’s what the Forward View had to say about ‘streamlining of payment processes for practices’ and the ‘feasibility of a single payment vehicle’: ‘It is unacceptable for hard-pressed practices to have to waste time chasing or recording payments.’
Unless the current view is that the 121,000 hours of freed-up time means we’re no longer hard-pressed – and therefore wasting time chasing or recording payments is now, in fact, completely acceptable (and I wouldn’t put it past them) – then, yes, it is indeed unacceptable. It’s also unfair, time-consuming and demeaning.
This leaves us with two certainties. One being that, by the time I finish this sentence suggesting that by the time I finish this sentence something else will have gone wrong with the payment system, something else will have gone wrong with the payment system. And the other being that absolutely sod-all is being done about it.
Dr Tony Copperfield is a GP in Essex
