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GPs go forth

Just maybe general practice should get money for nothing

Editor’s blog

Our February issue's two big articles sum up where general practice is at the moment. Our cover feature shows the probable fate of the health secretary’s efforts to increase the number of GPs, with the exodus of mid-career GPs unlikely to be offset by younger doctors or overseas recruits.

Meanwhile our analysis of the primary care network DES specifications confirms that any extra funding stumped up by the Government always has significant strings attached.

I’d love a senior official to sit health ministers down and spell out the obvious: that the only way through the general practice crisis is to give practices no-strings funding to spend as they see fit.

Basic supply and demand economics dictate that the funding on offer is not enough for what GPs are expected to do: if it were, we wouldn’t be set to lose almost 2,000 GPs by 2024, as our analysis predicts.

But I’d suggest that – in the equation of available funding vs what GPs must do to get it – the funding is not the major problem. The cash on offer now is more than at any time over the previous decade of stagnation. True, it is still not enough, but at least it’s something for GPs to work with.

No, the problem is what GPs are expected to do for it. Because Government policy seems to incorporate two ills: first, no funding without more workload, such as fortnightly care home visits by GPs (unless you can find a community geriatrician ha ha); second, you can have the money, but we decide how you spend it – ie, within a network and a significant portion on precisely defined new staff. And have a look at Matt Hancock's recent comments for proof.

GPs are ‘best placed’ to decide where funding should be spent

It feels as though GPs aren’t trusted to use their professional judgement on how to spend the money. But this needs to change, because one area where GPs really are ‘best placed’ is in deciding how to alleviate their own workload and therefore keep GPs in the profession.

GPs know how to use their funding – they’ve been doing so successfully for the past 70 years. With the necessary funding over a sustained period, GPs could turn around the crisis. They are in the best position to incentivise leavers to stay within the profession, they are the best people to choose their own staffing skill mix, and they know the best configurations of practices for GPs and patients.

They are also best placed to decide whether the funding on offer is fair for what they are expected to do. And our latest Pulse survey reveals 80% of GP partners in England are willing for their practice to give up Network DES funding – which incorporated the majority of last year’s funding uplift – rather than shoulder the extra workload it would bring.

I get that money for nothing for ‘high earning’ GPs would risk the tabloids’ wrath. But if the Government is worried about this, it should consider what patients want. And I can pretty much guarantee it is not enhanced care home visits, medication reviews, personalised care plans, etc. What they want is not to wait three weeks to see their GP – something Boris Johnson acknowledged in his very first speech as PM.

With no-strings funding, GPs could achieve this. Without it, ministers can’t hope to recruit and retain new GPs – you don’t get chicks (or guys) for free.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

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Readers' comments (12)

  • GPs 'best placed' yet again, but at least someone got it right this time!
    Jaimie for Health Minister!
    NO : Jaimie for PM!!
    otherwise, there will come a time when the directed expenditure of the pCNs will actually match the funding provided - leaving GPs to pay for their own lighting and heating! (though that might actually reduce number of patients wanting to sit in the waiting room??)

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  • Spot on Jaime.stabilise the ship, get access sorted. Then all this other stuff

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  • Common sense...... if only we had it in our leaders.....

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  • Common sense indeed. Is anybody at NHSE or other government agency listening?

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  • I couldn't agree more with this piece!

    It's strange that commissioners are happy to 'trust' us with all the work that hospital doctors are told they can't do anymore, including following up their patients, complex prescribing and monitoring, making diagnoses etc, yet we can't be trusted with some extra cash to pay for all the work already transferred/dumped to us over the past decade!

    Given the severe lack of funding and explosion of work to do we should be cutting back on extended access (at least 1.5x the cost of a daytime gp appt by my conservative calculations) and ditching care plans, whilst keeping the money to pay for core services.

    Institutional distrust of GPs is endemic in commissioner land, yet they look to us for answers!

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  • Spot on. If only NHSE is as sensible.

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  • I'm going to buck the trend and say DREAM ON. FANTASYLAND stuff. It will NEVER happen. Putting your hand out and begging for more money, Jaimie? Where is that money coming from?

    1. We're broke. Are YOU happy to pay more than your current approx. 40% tax to the state to (hopefully) spend on this (and other projects one might deem a waste/misuse)? I'm not and I suspect I'm not alone.

    2. Power corrupts, and absolute power corrupts absolutely. If the govt provides the funding for it, you think they will give up the 'power of regulation/quality control'?

    3. There is only one way to improve the lot of 'most'. To decentralise control. And only one way to do this. To convince the mind of the majority that the state itself/power is the problem, until such a point that a democratic choice is made to shift towards individual liberty and responsibility.

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  • Hi Dr Ho,

    Just to respond to this briefly, because I may not have made the point clear enough (if this is the case, I apologise) - the money is there. It has already been committed to general practice (as I said, not enough, but it is a start). I'm simply arguing that there is no need to attach demands to it, such as those in the service specifications.

    And I am not sure whether this rather modest proposal is more 'fantasyland' than, it seems, a move to privatise the whole of general practice.

    Many thanks,

    Jaimie

  • Plenty of high earning GPs had a business model of 3 week waits for an appointment during the more prosperous times pre-2010.

    Without an 'access' KPI we've bugger all chance of open-ended extra funding.

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  • Ah, my bad Jaimie, but pt 2 remains. Asking the govt to NOT attach demands to money? I suppose they do that with foreign aid so its worth a shot :)

    And pt 3 is not suggesting a move to privatise the WHOLE of general practice. But certainly the entirety of 'healthcare' should not be socialised. It isn't now anyways, covertly, e.g. some places in the UK, the dermatology services have 'declined treating benign skin lesions'... I simply suggest that we're honest with the public, put the facts before them, and broaden what falls into the realm of individual responsibility.

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  • Hi Christopher,

    As I said: "I get that money for nothing for ‘high earning’ GPs would risk the tabloids’ wrath. But if the Government is worried about this, it should consider what patients want. And I can pretty much guarantee it is not enhanced care home visits, medication reviews, personalised care plans, etc. What they want is not to wait three weeks to see their GP – something Boris Johnson acknowledged in his very first speech as PM."

    I think I understand your other point - that the thing the Government needs to do most is inform the public that the NHS cannot treat everything. Something I have argued over and over again:

    http://www.pulsetoday.co.uk/views/editors-blog/nhs-leaders-are-complicit-in-stoking-patient-demand/20037543.article

    http://www.pulsetoday.co.uk/views/editors-blog/ministers-will-never-give-up-unofficial-screening/20038324.article

    http://www.pulsetoday.co.uk/views/editors-blog/artificial-intelligence-blunts-any-residual-patient-intelligence/20039330.article

  • " I can pretty much guarantee it is not enhanced care home visits, medication reviews, personalised care plans, etc. What they want is not to wait three weeks to see their GP"
    "Government needs to do most is inform the public that the NHS cannot treat everything"

    - I am with you with these. Just a wee step further for the state to simply cover the essentials (emergency treatment +/- primary/social care), to reduce its expenditure as such, to reduce taxation accordingly and leave the public the liberty to choose for everything else e.g. insurance/co-payments/etc.

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