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Behind the headlines: do Barclay’s GP claims stand up to scrutiny? 

Behind the headlines: do Barclay’s GP claims stand up to scrutiny? 

Rachel Carter analyses whether or not the new health secretary’s previous pronouncements on general practice were fair

It was a short-lived first stint as health secretary for Steve Barclay, who was replaced by Dr Therese Coffey in September after Liz Truss won the vote to become the next UK prime minister.  

Mr Barclay took on the role earlier this summer, after July saw a series of dramatic developments for UK politics, including the resignation of former health secretary Sajid Javid. He was not without experience in the department, with a brief tenure as a junior health minister from January to November 2018.

But while Mr Barclay had little time to make his mark on the NHS, Pulse did have time to analyse his history with GPs. Here we take a look at some of his previous comments about the profession…

These bonuses are worthy of an episode of Yes Minister… If it wasn’t so serious it really would be funny. The reason for highlighting this is to show up a culture of a lack of accountability within the NHS.

These comments from Mr Barclay were included in an article in The Times in 2013, which reported that GPs had been paid ‘a taxpayer-funded bonus of £1.6m for having neat handwriting’. The article was based on a report from the Public Accounts Committee – of which Mr Barclay was a member. 

The finding was based on an indicator from the QOF, included in the original 2004 contract, on records and information for patients, with one point related to ensuring that ‘entries in the records are legible’. And a QOF point around the time of the article was worth around £1.6m. 

However, Mr Barclay’s remarks were a misrepresentation of what the QOF is. The framework is a way of incentivising good practice, and, even at the time, many GPs thought this money should have been part of core funding. So this was not a ‘bonus’ as Mr Barclay claimed, but money that many believed could and should have been given to practices without requiring boxes to be ticked. Furthermore, the ‘legible writing’ requirement related to one single point out of a total of 1,050.

Former BMA GP Committee chair, Leeds GP Dr Richard Vautrey, says there were good reasons for the addition of this point. He explains: ‘You need to remember it was at a time when computerised records were not universal, and an important safety issue was the ability to read the entries recorded by individual practitioners – so it was actually an important issue to address.

‘But having said that, it was a single point out of 1,050 so it was not material in terms of the scheme as a whole. It was included along with a whole range of those types of indicators in the original QOF.’

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Of Mr Barclay’s comments, Dr Vautrey says: ‘It was just more point scoring and playing to a particular gallery, rather than actually understanding what the indicator was trying to address, which was a serious point of quality and patient safety.’ 

There is a systemic failure in the disciplinary process that applies to doctors, which gives insufficient weight to patients and their families. Voluntary erasure enables GPs to play for time, delay disciplinary hearings and then to walk away before they have concluded.’ 

In the 2014 Telegraph article where these quotes first appeared, Mr Barclay claimed that a loophole in the process for voluntary erasure from the medical register meant GPs were removing themselves instead of facing the outcome of a fitness-to-practise investigation.

He added: ‘There is a culture of secrecy because names are routinely not made public. In other cases, where doctors have been named, they are able to call a halt to their own disciplinary case.’ 

According to GMC guidance1, a doctor may submit an application for voluntary erasure ‘at any time’ and there is ‘no requirement to wait until the conclusion of fitness-to-practise proceedings’. 

However, Mr Barclay’s statement that GPs were able to ‘walk away’ was another mischaracterisation. First, this cannot happen in the most serious cases. Such applications will be referred to a case examiner, who must determine whether the doctor’s erasure from the register is in the public interest. The GMC guidance advises that in any cases involving a conviction for a serious criminal offence, or where the allegation carries a presumption of impaired fitness to practise, voluntary erasure should not be allowed.  

Second, his claim was predicated on a misunderstanding of the fitness-to-practise process, whose remit is to protect the public. ‘Voluntary erasure’, therefore, replicates the most serious punishment the fitness-to-practise process can mete out – removal from the register. In the same article, former GMC chief executive Niall Dickson pointed out that any doctor who takes voluntary erasure while subject to fitness-to-practise procedures cannot practise medicine in the UK. ‘There is no better way to protect the public than stopping them from practising as a doctor’, he said. 

Reference

  1.  GMC. Guidance on making decisions on voluntary erasure applications and advising on administrative erasure. Link


          

READERS' COMMENTS [2]

Please note, only GPs are permitted to add comments to articles

David Church 14 September, 2022 7:08 pm

If an MP does not understand GP pay system, they should be forced to learn it in their own time without pay until they can pass an exam in it.

Dave Haddock 26 October, 2022 11:30 am

Whilst some is useful, a lot of QOF is utter Qrap.