Who thinks these terms up ??

[Darcydog]

Originally Posted by topman

As far as I understand it if someone from another country comes here and uses their EHIC, the NHS bill that particular country that we have an agreement with. The same works in reverse.

Have a read of this

http://www.dailymail.co.uk/news/arti...t-card-GP.html

As for what went on in Primary Care in the 1990's - Fundholding Practices were introduced but the GP contract remained the same as set out in the "Red Book".

What happened in 2004 was a fundamental change whereby GP's ceased to have individual contracts with the Area Health Authority and could chose to work in a Partnership or as a single handed GP practice. GP's received a per capita fee based upon number of patients.

nGMS required the new PCT's to have contracts with "Service Providers" who technically could be GP's but could also be any organisation that had GP's on its books such that it could meat the terms of the contract.

Thus for the first time in the history of the NHS, GP's who are Independent Contractors to the NHS GP's rather than employees of it - were not the only people able to be providers of Primary Care - or indeed Partners in the Practices that provide Primary Care.

Fundholding Practices in the 1990's were a bit like the words sound - the GP practice was able to control more of its spending - but the funding still came from the old AHA's - as such the GP contract with the AHA's remained unchanged.

In marked contrast - nGMS in 2004 was a route and branch change of how Primary Care was provided with totally new contracts being written for GP's.

[topman]

Its in the DM, enough said i think.
My point was more across the whole health section that a pct deals with rather than just GPs. But i suppose we'll have to wait and see how they get on.

[Darcydog]

Well it does seem all a bit of a mess - with GP's saying they are unhappy with workload etc.

But at least we have no more of the silliness of having to ring the surgery that day for an appt or else you cannot see a GP because they got paid more for seeing patients within 24 hours!

http://news.bbc.co.uk/1/hi/uk_politi...ge/4495865.stm

Hard to believe all that nonsense was only a decade ago and came as a direct result of the nGMS contract introduced in 2004. And here we are after yet another wholesale reorganisation with still a huge problem in Primary Care Provision.

[topman]

It wouldn't surprise me if it were or something similar still going on. I'm sure it goes on around here all sorts of funny stuff to make sure they meet the targets.

Correct and it'll get worse before it gets better. Being a GP simply isn't appealing to many new drs. We've got loads retiring soon and no one to replace them. Plus there's the ones leaving the country.

[Darcydog]

Originally Posted by topman

It wouldn't surprise me if it were or something similar still going on. I'm sure it goes on around here all sorts of funny stuff to make sure they meet the targets.

Correct and it'll get worse before it gets better. Being a GP simply isn't appealing to many new drs. We've got loads retiring soon and no one to replace them. Plus there's the ones leaving the country.

Agree - One odd spin-off of the nGMS contract was that those GP's already in place and who were Partners in the Practice now had a very real financial reason not to take on more Partners into "the business". There are various financial reasons for this the main ones being that prior to nGMS they had the Cost Rent and Notional Rent schemes that enabled them to claim money from the old AHA's to pay the interest on the business loans the Practice had to build/buy the surgery building.

In a stunning piece of generosity to those GP's - despite the Taxpayer paying the business mortgages for the GP practices, the building ended up being owned by the GP's themselves.

No other Profession were given this incredible financial help. But it meant that when that system changed, those who were already GP Partners who owned the Surgery Buildings - were distinctly disinclined to take on new Partners as they would have to share their "pot of gold".

Under the old system, if the took on a new GP the Practice income increased because of the per capita fees paid to that individual GP which went into the Practice "pot" of which they were a member.

Under nGMS - the "Service Provider" (GP Practice) got a "Global Sum" and this was not dependent on any individual GP.

This has led to "Employed" GP's who are employed by the practice. Some of these employed GP's are saying that their employment contract is for, say, 35 hours or so many "sessions" and once they have done that - they are off home!.

I have met Practice Managers who complained when these employed GP's went home after their "shift" - to which the answer is

"Why do you expect them to work unpaid overtime?"

And the answer was usually - "Because that is what the other GP's do"

But these other GP's were Partners with a vested interest in the good running of THEIR business.

A salaried GP has no vested interest in the Practice other than as their employer.

The result of this is that there are now some incredibly well of GP Partners who not only accrued a huge NHS Pension via the A9 Concession (despite being self employed - this concession allowed them to be in the NHS Pension Scheme) but had their business mortgage paid for by the Taxpayer such that they own a huge chunk of real-estate.

Thus these very well of GP's can retire pretty much when they like, leaving mainly salaried GP's behind who have got used to working their sessions then going home.

I admit the above is quite a simplification - and is not representative of all GP's - employed or Self Employed Partners - but I do believe it is an accurate assessment of why we "Service Users" do not get the Primary Care provision we used to.

OOH's service being the classic example.

Our local practice suddenly stopped taking blood samples - forcing all patients from children to the elderly to travel to our local Hospital to have blood taken. That meant a lot of inconvenience to the sick, the elderly and to parents of sick children.

The reason they gave was that there funding for this service had been withdrawn.

This despite the part time Phlebotamist earning less that £8 an hour.

How the nGMS contract worked is outlined here

http://www.nhshistory.net/gppay.pdf

[topman]

I imagine it is the cost of keeping them on. For all the generosity we've got a shortage and it's getting worse. We've not enough coming into general practice.
The question in the here and now for the CCG is how to solve that. But with GPs running them I'm sure they sort it and I'll bet the house that it doesn't involve cuts for gps.

[Darcydog]

Originally Posted by topman

I imagine it is the cost of keeping them on. For all the generosity we've got a shortage and it's getting worse. We've not enough coming into general practice.
The question in the here and now for the CCG is how to solve that. But with GPs running them I'm sure they sort it and I'll bet the house that it doesn't involve cuts for gps.

Oh I suspect that too!

But I have to say that i feel better that it the medics that make most of the decisions rather than administrators.

And the reason why we have too few Doctors choosing General Practice is that the contracts are with the existing Service Providers - and if the new GP's can only be employees of these Service Providers - and not become Partners themselves? - why is general practice possibly attractive?

This is basically what happened with Dentists - They were treated badly by the administrators and in the end most Dentists said enough is enough and they walked away from the NHS.

Very few of them regret going out on their own.

[topman]

Like i said earlier personally I'm not too bothered as to what their background is, more about competency. Can they do the job. Hearing some of the complaints it's a bit more than about just money. It's the workload as well. I imagine they 'locked' them into a service provider to keep them in as GPs perhaps there was a threatened shortage of GPs then. There was a pound of flesh for this big boost in money, i can't remember what the gp i was chatting to said
I suppose there was nothing stopping the gps with the pot of gold from sharing it for the good of primary health care. Let's hope none of them are running the new CCGs