As we all know, the NHS is facing a tough financial future as it is hit not just by Government demands for £20bn in effiency savings, but also the costs of yet another pointless reorganisation. We are living in arguably the most difficult economic climate in generations and everyone accepts that with much reduced resources we need to find ways of making the health service more efficient, without hitting patient care. Unfortunately, as austerity bites, we are seeing evidence on the ground that this vital goal is simply not being met.
In primary care, practice expenses are rising steadily, yet income in the form of global sum, LESs and in many cases QOF is falling or at best not keeping up with expenses. After many years of dealing with these circumstances and an ever-increasing workload, practices are facing up to some tough choices over their staff’s working hours and the size of their workforce. Budgets are still being set for the years to come, and it is difficult to get a clear picture of what is happening across the country, but there is a real fear of redundancy and cuts to contracted hours among the GP workforce. Unsurprisingly the BMA is receiving increased inquiries about redundancy.
As employees in practices, many salaried and locum GPs feel this concern particularly keenly. Already in my area of Devon, we have seen this emerge as a practical reality with some salaried GPs being laid off and decreasing number of sessions being tabled in many pracitices.
It is this last element that could turn out to be the most damaging and hidden factor, as reducing contracted hours hits not just the earnings of salaried and locum GPs, but the number of hours of patient care avaliable to the local population. Again, this is only an emerging picture, but one that is nevertheless deeply worrying for healthcare providers in Devon.
It is local NHS and practice managers who ultimately have the responsibilty to ensure that any changes to funding must not impact on patient care and by extension the size and capability of the GP workforce to deliver that care. Managers need to work with the BMA, practices and the workforce to ensure that these vital services are protected.
Where decisions do have to be made at practice level, salaried GPs also need to be consulted and involved in the process of deciding what measures should be taken to make savings. As the workers on the coal face of general practice, they are the ones with the experience to see what can be done and how.
If sessional GPs are not involved in these discussions they should not be afraid to challenge what is put before them and how the process if being conducted. This is about their livelihoods and their ability to support their families; they are not just numbers to be shifted around on a spreadsheet. They should be vocal in getting heard in any discussions about staffing hours or redundancies, as well as ready to put forward alternatives on how best to make savings. If sessional GPs feel shut out of the decision-making process they should get in touch with the BMA.
Needless to say, this is a minefield in terms of employment law so practices and salaried GPs alike need to be clear about what their rights are. If you are a salaried GP and not a member of the BMA, now is a good time to consider joining, if only for the benefits of employment advice and contract-checking. In the event of redundancy and changes to hours or pay, all BMA members need to be confident that they will be represented and advised independently and without prejudice.
Dr Mark Selmanis a salaried GP in Devon, deputy chair of the GPCsessional GPs subcommittee and a member of Devon LMC