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Is it down to GPs to deal with PCT debt?

Last week my practice had its second visit from the Yorkshire Cancer Network to support us in the early diagnosis of cancer – a worthy way to direct our efforts, no doubt.

We learned that one of the reasons the UK performs poorly compared to some of our European colleagues is the failure of GPs to refer or investigate sufficiently early. Hence later diagnosis and poorer prognosis. Hands up: it’s a fair cop, must try harder. The methods are clear: refer more, spend more money on investigations. Simple. 

However, in the same week, we are informed that yet again our PCT is in dire financial straits. Forgive us for not being too surprised. That makes at least 10 years running where we’ve collectively overspent by tens of millions. This year we have quotes ranging from £20 million to £60 million pounds.¹

The consequent action, we are told, is going to be drastic. Whereas in previous years the PCT has been bailed out and figures fudged to achieve a declaration of financial balance, this year is different. Our new paymasters won’t be bailing us out and the handover to the CCG needs to be as close to parity as possible. 

And so numerous drastic cuts are threatened across a range of services and the consequence will be the clawback of at least £10,000 in income per GP.

Frantic negotiations ensue until the Department of Health-appointed bully boy in charge of our regional cluster is persuaded that kicking those charged with actually wrestling the appalling situation around over the next few years is probably not a great idea. The measures are watered down.

So here we are again, back in harness after our lovely summer breaks during which we blithely buried our baking heads in the blissful sands of far flung beaches. Yet again we are being told about a whole new (but distressingly familiar looking) raft of money-saving activities to engage in this autumn and winter in another hopelessly short-term attempt to make the books look better than they otherwise might. 

This is just how we roll in North Yorkshire, where funding is low and dominant hospital trusts have held successive PCT regimes to ransom and run rings around seemingly helpless managers for years.

The pressure on referral numbers and investigations means that improving our statistics for early diagnosis of cancer seems a forlorn hope. How will it be next year when we have very tight personal practice budgets to focus our minds? Scary times indeed with no promise of any uplift in funding whatsoever.

We’re now being asked to sign up to the constitution of a commissioning group with no real answers regarding what is going to happen to the historic debt. Furthermore the commissioning group itself assesses its chance of achieving financial balance in the first few years of its existence as zero, although there is plenty of enthusiasm and optimism regarding a longer-term approach and an all-new clinician-led backbone to deal with overtrading foundation trusts. We shall see.

Or shall we? Is this not the time to register collectively our disapproval of being asked to take responsibility for the underfunding of the NHS in our area? Won’t it be too late once we’ve signed up and failed to balance the books? What will the consequences be of this seemingly inevitable failure and the consequent media war that must ensue? This seems like a critical moment to register disapproval and send a message to the new minister of health, surely not ravenous for a fight after his drubbing over the News of the World scandal.

But I fear there is not the collective courage or will to take such a radical stance. It wouldn’t be seemly for such a benign and conservative group of professionals who are, on the whole, committed healers and peacemakers, not fighters. And so this scenario will play out, for better or for worse, for richer or poorer, in sickness and in health… You know the rest. 

Dr Andy Field is a GP in York and a member of North Yorkshire LMC


1 NHS North Yorkshire and York Cluster. Cluster Board Meeting: Chair’s Monthly Report for October 2012.