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Support general practice if you want commissioning to succeed

As GPs prepare to take the NHS helm and steer efficiency changes, our GP blogger, Dr Clive Henderson points out they've got plenty of other pressures to deal with back at the practice right now.

At a time when general practice is supposed to be the leading the changes – for better quality at no extra cost of course – there are an awful lot of things putting us under pressure as we take the helm.

As a rough guide, general practice makes up about 10 % of PCT spend with 60 % going on secondary care and 10% on prescribing. So if general practice is to act as a provider and gateway to defend against 70% of overall costs, then it needs to be robust.

So what attrition is general practice facing?

First there's the increased cost and bureaucracy associated with CQC, although registration has been delayed by a year now to April 2013. Every individual in our whole practice has just spent hours completing an online indoctrination . A mere tip of the iceberg approaching and coinciding with revalidation being introduced at the end of 2012.

Then there's our pay. Staff have been award pay rises but in the absence of significant uplift to practices, GP partners are disproportionately hit as their income is dictated by what is left in pot.

PMS practices now face draconian cuts following the defeat in the recent court challenge.

Pensions contributions are going up.

Dispensing profits are down as prescribing has been taken to the bone and regulations for dispensing services heightened.

Tariffs for certain procedures have been cut such as LARC fitments. It seems a fixed tariff procedure and no competition on price does not apply in primary care.

The patient survey has, in its usual flawed way, managed to damage reputation and cut income. For instance , the ability to book two weeks in advance sampled 0.003% of our practice population and because 8 out of 28 had a misperception that they could not book in advance we have lost 20 QOF points and £2,500. Ironically this may be a self fulfilling misconception if further redundancies are to come. I can categorically prove appointments are available and what is being surveyed ( at wide confidence intervals due to poor sample size ) is perception not fact.

And finally , if practice boundaries are to be lost , what is to stop clients shopping around for med3s , referrals and expensive drugs. If these are not doled out , then patients will register elsewhere and stick derogatory feedback on NHS Choices.

The troops need some support if they are to fight a battle.