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Why £68 an hour to commission services is unsatisfactory

Blogger, Dr Clive Henderson, wants better pay for commissioning duties because ‘he’s worth it’

HR issues are holding back the development of effective consortia.

By and large this translates to who gets paid what for doing what and what allowances have to be made for job seekers facing redundancy.

Locally, we have just started a round of quantifying GP pay for commissioning roles. A rather uncomfortable process of offer and rejection followed by counter offer has begun. Let me dare to be specific and put the debate out in the open. The initial offer was for £67.50 per hour.

My rather reflex and not wholeheartedly professional reply was – ‘I don’t think commissioning will be as successful if only run by the following: hair-shirt altruists; hobbyists; semi-retired; non commercially-minded; patsies; poor negotiators; status-hunters; egotists; GP partner-alienators; the hidden other-agenda led; resentful de-motivated compliers and non-pragmatists.’

I had some very supportive colleague comments but from others I had a tumble weed experience.

Further, more orthodox discussion made the point that GPs would not be able to get adequate locum cover at that cost and anyway, a locum does not do the same work as the missing partner or indeed regular salaried doctor. Patients have to cope with unfamiliar doctors, working in unfamiliar geography, on different computer systems whilst all the admin from running a small business backs up and needs sorting once the GP commissioner returns to base.

The current offer on the table sounded better at £45 plus receipted locum bills for board/CLE work, or £35 plus locum for ‘transition group’ work. That was until we found locum costs were thought to be £35/hr ! But it got worse. The fee for chairing or attending the monthly locality commissioning forum meetings was suggested at £30/hr and any reading and preparation time at £25/hr.

Oh dear. Some responses were unprintable but suffice it to say that my locality felt unable to continue meeting at that rate.

The other debate is about paying for travelling time to regional meetings.

So what are we worth ?

I know my plumber cost me £69.50 per half hour this winter. I know ball-kickers ( ) and investment masturbators get paid rather more.

It is churlish to be arguing for more pay with considerably less well remunerated PCT staff with uncertain prospects.

What are we allowed to pay ourselves ?

I am sure the Daily Mail has the articles already drawn up and is just waiting to insert some quasi factual figures.

Are there any national guidelines on this ?

I don’t think so.

The LMC was unable to suggest a specific rate for fear of creating a cartel. Though average GP salaries could be used as a guide. Suppose that begs the question , are GP commissioners ‘average’.

To work for less than your practice’s usual pay rate is abusive to your partners. Furthermore, the idea of producing locum receipts is not only pedantic and bureaucratic but prejudices against sessional GPs and those working in their days off.

Are GP commissioners worth it? Well yes, if they can devise better care, closer to home, within budget. But how can we extract the money to pay ourselves? I would be happy to be a saprophyte on the body of moribund PCT staff costs if I could see that PCT carried dead wood. Trouble is, the more I work with PCT staff the more I appreciate them and respect their worth.

How can we have a bunch of highly paid (by comparison with PCT staff ) GPs sitting on boards yet reduce overall management costs ? Especially if the average consortium is half the size of current PCTs and choice and competition is all very well but it increases the number of contracts and providers that need overseeing.

I can’t see that the NHS is currently a self serving inefficient bloated bureaucracy when the King’s Fund states overall management and admin costs run at 13 % versus a UK wide average of 16 % for all businesses, yet alone the 20% plus in the US.

The Government has made a lot about avoiding top-down targets, yet I suspect we will be heavily audited on running costs and not given the autonomy over total budget. Surely it should be up to consortia to decide the makeup of its spend as long as the outcomes for patients and taxpayers is good.

Can we afford to pay GP commissioners their worth? Can we afford not to ?

Dr Clive Henderson