The major revolution in health care organisation in England has significant consequences for GP income, and none of them to the better.
The latest blows to practice finances are the immaturity of the local area teams of NHS England and the costs of regulation by the CQC. Practices across the country are being hit with deferred payments for their LES work – now in many places, including Swindon and Wiltshire where I work, being paid quarterly in arrears instead of monthly. This will impose a significant cashflow penalty on practices whose nurses and staff have the inconvenient expectation of a monthly pay packet.
Practices are increasingly being looked at more carefully by their bankers for viability when they ask to increase their overdraft facility to cater for this cashflow deficit.
Additional pressure was put on practice finance with the announcement of the cost of being regulated by the CQC. I have not met a single GP who thinks that this regulation regime in general practice will save a single life. GPs alone, out of all the profession who work in the NHS, are having to bear this cost from their own pockets. Our consultant colleagues do not have to pay a single penny from their pay packets.
The scale of fees is grossly discriminatory against singlehanded practices, with the first band for payment covering up to 5,000 patients at £550. Worse still if, like many rural practices, they run two sites in which case they will be stung for £1,200. To what benefit, one wonders.
The next challenge is the removal of organisational points from the QOF for 2013/14 and their reinvestment in various DES’s of varying do-ability and usefulness. All of them will require more work, more input from the partners in the practice and more stress on an already overloaded part of the profession. Along with rising thresholds, some to the point of unachievability, the loss of morale in the profession comes as no surprise.
The final straw for many is the levy of 14% of locum costs to be paid to locums for their employers’ pension contribution. The amount reimbursed from the pot into global sum equivalent will go nowhere near covering the costs of practices which are constrained by lack of partners or indeed partners away running CCGs. Some larger practices which manage to cross-cover for holidays and study leave will have a windfall. Younger locums in the NHS Pension scheme will lose out as practices seek to employ agencies or older locums to avoid the 14% levy.
The partnership recruitment crisis is already with us. The government wishes us to run the health service. It would be really nice if they recognised our value to patients and the health community.
Dr Peter Swinyard is chairman of the Family Doctor Association and a GP in Swindon.