Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

John Glasspool in the British Journal of General Practice writes as one of many who have taken early retirement. His final paragraph reads: “Many GPs are using their own strategy now to keep their sanity. “RLE”: Retire, Locum, Emigrate. A senior colleague recently said to me that the government has taken general practice back to the 1960s. What is proposed is too little, too late, but may possibly make the public think something is being done until the election in May”.

Just cry after reading the correspondence below, (Rationing by ineptitude.) at the bribery and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

Neil Roberts in GPonline 1st October: Conservatives pledge 5,000-GP workforce boost

Sofia Lind in Pulse 23rd September 2014: Miliband announces plans for 8,000 new GPs

and patients always go for the “free prescriptions (Itv News 18th November 2014): 5,000 more English patients signed up with Welsh GPs than vice versa says NHS chief

Christine Kenny in Pulse 26th Feb 2015 describes the latest panic bribe: GPs offered £25 per patient they register after practice closure leaves thousands without a GP

And the perverse recruitment of an excess of female doctors (due to undergraduate entry favouring women) is reported in The Mail 26th Feb 2014: Soaring number of part-time women doctors fuelling a crisis in GP recruitment, government warned

Exclusive GPs are being offered a £25 ‘administrative payment’ for every patient they agree to take on from the list of a closing neighbouring practice, after 3,000 patients face being left without a practice when it closes in two days’ time.

NHS England’s Surrey and Sussex local area team said that the ‘short term, one-off support’ was being made available to practices in light of the Eaton Place Surgery – which has a patient list of 6,000 – closing at the end of the week with the retirement of both its GP partners.

The closure of the practice has been mired in confusion after Simon Kirby, MP for Brighton Kemptown and Peacehaven, told local residents that the surgery was to remain open.

The practice manager told Pulse she was ‘disgusted’ by the actions of the MP, and warned there were 3,000 patients who had not registered elsewhere.

This is the first known offer of additional financial support to practices to take on patients from neighbouring practices.

Pulse has been campaiging for NHS England to pledge support to practices under threat of closure as part of its Stop Practice Closures campaign, after finding scores of practices on the brink of shutting, and has previously reported that one in five GP practices had struggled to cope with the influx of patients from closed neighbouring practices.

NHS England told Pulse that it was offering the support as an ‘administrative payment’ because of the short time frame in which practices will have to take on these patients.

A spokesperson said: ‘NHS England is providing short term, one-off support to reimburse practices in registering new patients. This reflects the imminent closure of Eaton Place and the number of patients other practices need to support to re-register safely within a short time frame.

‘Providing practices with a one-off administrative payment recognises the additional staff and resources they may need to make available to do this and will ensure they can maintain services at the same level for their existing patients while they are undertaking this work.’

The practice had contacted patients last week to confirm that it would close on 28 February after a neighbouring practice’s plans to install a branch surgery in the premises fell through.

Both the practice and the local area team had been advising patients to re-register with other providers since it was first earmarked for closure in November 2014.

However, Mr Kirby wrote to constituents in the practice’s immediate vicinity in January to tell them that the Eaton Place Surgery had been saved from closure following campaigning and lobbying on his part.

Practice manager Jeanette Corps told Pulse that more than 3,000 patients had yet to re-register elsewhere.

She said: ‘I’m pretty disgusted, to be honest. I don’t know exactly what the letter said, other than that the practice would definitely remain open.

‘We wrote to all the patients last week to tell them the surgery was closing. Some patients are very understanding, but others are obviously very upset. As much as I can understand that, it doesn’t help that I have at least four members of practice staff who still don’t have other employment to go to. It’s a difficult situation all round: there are no winners.’

In a statement sent to Pulse, Mr Kirby said that he was ‘frustrated and disappointed’ that the practice closure was to go ahead.

He said: ‘Having worked so hard to put all the interested parties together to enable the approval and ratification by NHS England of the branch application, I was very optimistic that local people would continue to enjoy a GP surgery at Eaton Place. […] I did indeed write to share the latest information at the time with local residents in the area surrounding Eaton Place.’

The MP offered to hold a roundtable with the current GPs, local GPs and NHS England to ‘try and find a way forward for patients, even at this late stage’.

NHS England told Pulse that there were 13 other GP practices within a two-mile radius of Eaton Place with the collective capacity to register all affected patients. All will be offered a £25 administration fee for each new patient they accept from Eaton Place.

A spokesperson said: ‘NHS England was clear in its communications to patients and local stakeholders that we could not guarantee that a new branch surgery would open at Eaton Place, or by what date. We therefore recommended to patients that they should continue to re-register with other local GP practices while these negotiations were ongoing. Unfortunately the practice that wanted to set up the surgery is no longer in a position to go ahead with its plans.

‘NHS England’s ongoing priority is to make sure all affected patients are able to choose alternative arrangements for their care and to guarantee that they will all have ongoing access to GP services once the current surgery closes.’

This comes after Pulse blogger Dr Hadrian Moss was threatened with a breach of contract notice after he informally closed his practice list.

Comments from readers:

One off support and then NHSE wishes it’s hands off and leaves you to perish- that’s what this sounds like. I think one has to be cautious of ‘offers’ not only from supermarkets.

6000 patients registering at 13 local practices so >460 per practice on average. This is a huge number to incorporate, assess, summarise notes and achieve working familiarity with their history in one fell swoop. What exactly is the £25 per head supposed to cover? Apart from the above, it seems likely that additional doctors will have to be recruited to provide continuing care if the surviving practices are not to be destabilised; that, too, takes time.

if you have mass registration it is not about incentives it is having the frontline staff in place to deal with it, extra clinicians to cope with the increased demand on appointments, extra admin support to get records tagged and summarised. The closing practice would have given 3 months notice of its intention to close so that is the time that NHS England should have come up with a support package and let neighbouring practices know as they are the ones that are affected by the fallout and I bet those practices probably did not get to know until the patients had been written to, this happened in Liverpool so in effect they only got 3 weeks to plan for the stampede to register.

PPPPPP as the management gurus would say
(poor prior planning produces piss-poor performance)

So NHSE are, in effect,, selectively paying practices to take on extra patients – while at the same time threatening a different doctor with breach of contract notice if he doesn’t take patients on when he can’t get the staff.
So what about all the other practices up and down the land who don’;t really want to take on extra patients as neighbouring practices close – or don’t they count?
It seems to me that this is short-term, discriminatory thinking of the worst possible variety.

Unfortunately, you are dealing with a QUANGO that has gone out of government hands and even the PM has no influence on those controlling funds in NHSE. As for NHS Fraud, they are probably preoccupied with small fry where there is no opposition.

I posted this last year as This is about my practice . We have 2 day left working as GP’s here and the outpouring of emotion from patients has had me in tears nearly all morning .I like to think I’m a pretty resilient chap , ridden Motorcycles all over the world , Kept pretty fit , but nothing could have prepared me for the bereavement that we are going through with our patients . I had really hoped it would continue as a practice but it was not to be . We have to sell the practice as we have a huge Mortgage a redemption Fee for early repayment of that Mortgage , and the redundancy package for staff , not to mention the other accountancy costs etc to wind down a business .When you consider £500 Million is being spent on our local Hospital you’d have thought the NHS buying our Practice would have been a better use of money than spending £100000 on “incentives” .How will the other local practices cope ? QOF ? Having the manpower to help our patients .I have been in this practice for 26 years .I thought I’d stay until 65 .i would not survive . I feel for my lovely patients .
Here is my Quote from Last Year

Our patients got the letter that we are closing today .A sad day , the practice has been there for nigh on 100 years .A mixture of increasing workload and dropping income meant there was no way we could safely carry on .The two of us are spent.The added stress of now managing the staff redundancies has me at the very brink of a silent MI .No one except the patients really seem to care that our old fashioned cradle to grave partnership is done.No new Doctors showed a realistic interest in taking up the challenge .It has been heart warming today to hear my patients come in , some in tears ( me too when they leave the room) to tell me I am like their family , what am I going to do without you ? I thought I had a job for life .How wrong I was .Twenty sis years in the same Practice and I feel like a Rat leaving a sinking ship .However if we do not shut the practice down we will not make old bones . I fear for the rest of you .I am lucky and can go as I am 55 soon .A new chapter will open to me .RIP the NHS family Doctor

dead goose

This entry was posted in A Personal View, General Practitioners, Patient representatives, Perverse Incentives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

1 thought on “Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

  1. Pingback: Is the Adam Smith Institute correct? Does the BMA really want fewer doctors to boost pay? | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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