Working to 65 hits pensions
Would you have taken on your current job if your pay depended on patient care markers? Don't answer that just yet. In the future, would you take on extra staff or give current staff a pay rise, based on last year's performance-related profits? That's certainly more difficult to get your head round. But these are the realities of general practice today.
Implications of some of the latest NHS changes are only just becoming apparent. Performance-related pay hit me like a subarachnoid headache when I was trying to fine-tune next year's practice budget. A good budget should have very little variance from the plan. But my efforts were curtailed because future changes to practice cash flow are as predictable as the weather.
The simple problem is that just about every budgeted item has more uncertainty than ever before. Minor changes to cash flow can lurch apparent cosy surpluses into the red. Keen attention is paramount for the first 30 seconds of any accountants' meeting, but drumming up enthusiasm to go through enhanced service specifications or PCT budget reconciliations is a bit trickier.
Bureaucracy is king
The big picture is clear. More money is finding its way to the front line. GPs are all going to earn more money. QOF money, like the cavalry, has finally started to arrive. But bureaucracy has become king. The new contract has made things so complicated that most budgets are only a little more stable than uranium.
Put simply, whether you are PMS or GMS, it doesn't matter. The core pots of money are shrinking in real terms. The basic items of the past will diminish over the next few years. PMS baselines have only gone up by 1 per cent and GMS global sums have remained static for this financial year. Doh! We are all supposed to be using QOF money and profit to bolster local care. Anyone remember that at the start? No, I'm not surprised, because this has just been made up.
If you think this through, it's bad news the last people to have call on any profit are the partners. Partnership, in simple terms, means sharing the profits (or potentially dividing liabilities). Increasingly, partner drawings will come from the performance-related parts of
the business. If you assume that core baselines pay for staff, amenities and chocolate biscuits, then the partnership drawings are fuelled by locally enhanced nonsense and quality outlook fudging.
Read the questions at the top again and you will realise that GPs are the first sector in the NHS to have direct performance-related contracts. If you wait five years, I reckon most GP earnings will be performance-driven, just because of margins. Some will feel threatened by this, but I'm not so sure. I think this will be the one instance where Government targets hurt they are really going to hurt the Exchequer's wallet.
I'm off to screen some local nursing homes for hypertension, hypothyroidism and asthma while I think through this some more.
Dr Andy Jones is a GP in Stamford, Lincolnshire