Funding must separate GP pay from service provision
Dr Naureen Bhatti writes
From Dr Naureen Bhatti, Tower Hamlets, east London
My practice, The Limehouse Practice, is a long established, large teaching practice that, like the rest of Tower Hamlets, provides high quality care, despite serving a highly deprived population of nearly 11,000 patients. Like all inner city GPs we are utterly committed to the work we do, often in very challenging circumstances, working beyond contractual demands to make a difference to the health and wellbeing of the local population. High workloads caused by deprivation in practices like ours were not recognised by the Carr-Hill funding formula, introduced in 2004, so we were then and have continued to be heavily dependent on the Minimum Practice Income Guarantee (MPIG), which gives us nearly 20% of our income. The removal of MPIG without any thought on how to reimburse practices fairly has had a devastating effect on our practice where we had losses close to £3/patient but did not qualify for Section 96 reprieve money.
It has taken 18 months of negotiations with NHS England (NHSE), writing regularly to local MPs and the press, as well as demonstrations and petitions to finally have a solution. We are lucky to be in a forward thinking CCG that, having taken full primary care delegation, has negotiated funding for a ‘Locally Commissioned Service (LCS): meeting local patient need beyond Essential and Additional Services’. This is an appreciation that deprivation impacts on our workload and needs to be funded. It gives us two years of reprieve taking us to March 2017. There is no recognition for either our losses for 2014/15, or the time and energy we have diverted from patient care to fight for this additional funding.
We are delighted to have a solution. We hope the funding is enough for us to remain viable and retain the excellent and committed partners and other staff we have. I hope that we can work with the CCG to develop a primary care strategy with a longer-term solution. Still, we have to highlight the accountability of NHSE and the DoH in the development and implementation of such a devastating national review to the distribution of GP funding, without evidence on the distribution of workload and need, resulting in the destabilisation of primary care, particularly in the inner cities across England.
It has highlighted the inequity of GP funding and remuneration, with numerous different contracts, all relating to historic funding and spending. This has resulted in very different £/patient/practice and unrelated to workload and need. We need to ensure investment in primary care delivers the best outcomes everywhere. This can be done only with increased primary care funding overall and, going forward, new models of care that separate GP remuneration from that for patient services.