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GPs, where were you when they stole your profession?


People are sending more and more parcels these days, if you’ve noticed the queues at your local post office.  This has got me thinking.  I’ve learnt from a focus group that people would love to be able to send parcels from home at a time convenient to them, evenings and weekends especially.

So I’ve invented a new service called Mailidioto where we collect from your own home at any time you choose for one simple fixed fee.  We take it towards the destination address and if you’re lucky, your fee will get it all the way.  Obviously, if the fee runs out before we get there we’ll have to chuck it in the hedge, but that’s business.

How do you rate my chances with Mailidioto?  Have I stumbled upon the difference between a contract for inputs and a contract for accountability?

There’s a wonderful thing in the NHS called the GMS/PMS contract for essential services, which balances unlimited accountability for managing the registered patient who is ill (in hours), with unlimited discretion on how to manage them (for the qualified professional performer).

So when we hear talk of salaried models, or “GP hubs”, WICs etc, these are all about inputs.  They undermine accountability for the registered list, losing continuity of care and increasing costs.  They are about hours worked, or appointments supplied (most APMS contracts) .  We know the tenuous connection between “inputs” and “outcomes” (hello USA), and yet we see NHS England promoting these input models.

“£6 per patient to extend GP access from 2019” runs the headline.  “Well actually…I’m just going to locum for as long as I can because I cannot see why anyone would want to commit to losing their (social) life” runs the comment from one anguished reader.  You all know how hard it is to recruit GP partners.  The more sessions are available for transactional GP, both in and out of practices, the harder it is to recruit for long term relational GP – they are the same people.

Extending hours makes no difference to capacity, and therefore has no impact on the three week waits to see a GP.  Worse, it cuts capacity as utilisation is lower out of hours.  Worse, it takes GP time away from high demand core hours.  Worse, the unscrupulous will simply work the same time but claim the extra pay.  The unscrupulous near to hubs are simply fending their patients off to them.  It’s happening now – bad money drives out good money.

It doesn’t have to be like this.  Scotland has abolished the abomination of QOF, and put the money into core funding.  Northern Ireland is helping its GMS practices cut the wait for patients to minutes, and cut GP workload at the same time for a tiny fraction of £6.

The BMA and RCGP need to be absolutely clear against this undermining of the GMS contract and GP professional accountability.  Put the £6 into core GP, making partnership more attractive.  Put it disproportionately into deprived areas, bringing equity in place of the inverse care law.

GPs, where were you when they stole your profession?

Are you going to stand up?

Before it’s too late?


Harry Longman


PS  We’ll be at the RCGP conference next Thursday/Friday, on stand 33.  See you in Harrogate!

PPS “Meet the digital GPs” in Pulse includes an interview with Dr Rupert Bankart about his practice and askmyGP.

4 responses to “GPs, where were you when they stole your profession?”

  1. Yes, what you say is so right. I have lost heart as this is not about doing what is ‘right’ for a better NHS service, it is a political choice to run the service down. I would like to help to stop it. I will join ‘defend the NHS’ for a start.

  2. Maggie says:

    So very well put. Why would anyone want to join the GP profession at the moment. It seems to be a loose loose situation. the shortfall in GP’s and the failure to recruit bears this out.
    The powers that be need to listen to their providers
    Talk, compare and grow.

  3. Nan. says:

    The most worrying aspect of all these changes is how little the general public, health professionals and politicians understand about them.
    Hence their proceeding unchallenged.

  4. Harry Longman says:

    Dr Tony Kelpie writes:
    Do keep banging away; you seem to have a lot of sound ideas which I hope some people in NHS management will think about, and act on.

    QOF isn’t all bad; the carefully negotiated package introduced in 2004 was welcome (effectively paying well organised practices for work they were already doing), and QOF is of course part of GMS income for partners- it isn’t difficult to tick the boxes with personal lists and an ongoing clinical relationship with patients, and there is some benefit in lowering a patient’s BP, HbA1c, or Cholesterol to target.

    Excessive ‘me-tooism’ and misguided tinkering has undermined QOF and made it yet another good idea spoiled by bad implementation.

    Effective telephone advice-with appropriate building of patient’s confidence and ability to look after themselves, coupled with streamlined access to the GP when indicated- has always been the way to do things. Personal lists enhance the effectiveness of this approach.

    Uncertainty regarding financial commitment to premises etc., will continue to deter doctors from partnership; unfortunately HMG seems too dim to understand the effect of their repeated undermining of GPs on this uncertainty.

    Best wishes

    Tony Kelpie

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