It's less than six months since the squeeze on NHS finances began in earnest in April, and yet already PCT managers are panicking.
They are adding valuable services for patients to their apparently arbitrary lists of ‘low clinical priority' procedures, and entering into unprecedented levels of legal activity against PMS practices. Now, and most outrageously of all, we learn that trusts are clawing back sums as high as £40,000 in accumulated overpayments from practices, and barefacedly breaking agreements that would have allowed GPs to keep commissioning savings.
Accountants and LMCs warn that PCTs have begun recouping overpayments dating back as far as the start of the new contract, in April 2004. Often the glowing red notices land on the doorsteps of a different set of partners from the ones who received these overpayments, or find their way to GPs who have long since retired.
It instinctively feels wrong to demand, without any warning, five-figure sums from practices that are already under huge financial pressures. But more than that, it is out of kilter with good practice across other industries. Energy suppliers, hardly known as paragons of virtue, have a code of practice that prevents them from claiming payments dating back more than a year from when a bill is issued. Yet some NHS managers are chasing up overpayments made over a period of seven years, punishing practices for the PCT's own accumulated incompetence.
Equally disturbingly, one PCT – NHS Bury – has refused to pay 10 practices an agreed £100,000 each to reinvest in patient care, after they delivered a combined £3.5m in savings back in 2009/10 as part of a PCT cost-cutting drive. Such an explicit breakdown in trust between a PCT and practices could hardly come at a worse time, as we enter a delicate handover period to clinical commissioning groups.
PCTs should not be viewing GP practices as a quick-fix source of cash, but as valued partners in navigating the rough waters ahead. Trusts have entered a period of unprecedented financial pressure, just as GP practices did several years ago. Together, PCTs and GP commissioners will be required to make some enormously difficult decisions in the coming years, and it will demand boldness, imagination and collaboration to minimise the impact on front-line services.
And managers and doctors together have an argument they need to win, too. The Government continues to insist that the NHS is receiving a real-terms increase in funding, a claim that is true only in the most technical sense. As long as the public believes that the health service is getting all the money it needs, GPs and managers will jointly be held responsible for every inevitable cut to a front-line service.
It is time the BMA and the NHS Confederation set out the financial pressures faced by the NHS, and prepared the public for what is about to happen.
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