Monthly Archives: February 2016

Another brick in the wall

 

Another practice goes up in smoke and the politicians and their paymasters rub their hands with glee , for the patient continuity of care will become a thing of the past.

PFanotherbrickinthewall

FROM PULSE MAGAZINE

A successful ‘vanguard’ practice is in talks about becoming a salaried service under the local trust’s control because its workload has left partners on the brink of ‘physical and emotional collapse’.

The Brune Medical Centre in Gosport, Hampshire has approached Southern Health NHS Foundation Trust about a potential takeover.

The 9,000 patient practice has three whole time equivalent GPs, and has been unable to recruit partners or salaried doctors for three years and have increasingly used nurse practitioners to cover gaps…………..

 

GP leaders have warned that the new models of care could lead to practices being ‘devoured’ by hospitals.

The majority of practices in the MCP vanguard remain independent contractors, though they are developing a new framework which would allow merged practices to be contracted as a provider arm of the trust…………

Brune Medical Centre’s senior partner Dr Stuart Morgan told Pulse that being part of the vanguard has helped the practice, but they could not ‘hold on’ until pressures abated.

Dr Morgan told Pulse: ‘We’re a popular and highly regarded practice locally, and yet we have succumbed. It just shows how vulnerable practices are, even medium-sized practices such as ourselves are vulnerable. It only needs one resignation or one retirement for the whole house of cards to come tumbling down.’

’While one would like to hold on and hope things would change through vanguard, and I’m sure they will, it’s too late for us.

Dr Morgan told Pulse they had turned to Southern Health because they ‘don’t want to hand back our contract and open up a tendering process, potentially including private sector providers.’

He added: ’It’s more than burnout; it’s reaching the point of physical and emotional collapse due to the sheer overwhelming pressure of workload.’

Dr Nigel Watson, chief executive of Wessex LMCs, told Pulse: ‘Part of the solution for [Brune Medical Centre] and others is, we’re looking at developing an employed model.

‘So the partnership model can survive, but those who would like to move to a model where the risk of property ownership and managing staff goes, where they’re paid a salary and work with other organisations, is possible.’

Cancer fund changes confirmed

Cancer fund changes confirmed 026/02/2016

from DOCTORSNET

The Cancer Drugs Fund is to be reformed to tackle its spiralling costs, it was announced today.

 

……………………“Importantly, we believe the proposals will bring more certainty to patients and doctors about the drugs that can be prescribed, and swifter access to promising drugs.”

But Andrew Wilson, chief executive of the Rarer Cancers Foundation, said: “The Government needs to come clean about the impact that these reforms will have. There is a danger that these half-baked proposals could turn back the clock on cancer treatment, returning the NHS to the bad old days where the majority of new treatments are denied to the people who need them the most.”

NHS England medical director Sir Bruce Keogh said: “It will provide faster access for patients, I think that’s really important, and I think it will bring clarity to which drugs are the most effective sooner than we know at the moment.

A Recent article in the Guardian once again highlights the extent of under-investment in the NHS

A Recent article in the Guardian once again reveals the extent of under-investment in the NHS 

Many NHS scanners and machines ‘out of date’

63% of 111 English hospital trusts have at least one scanner that is at least a decade old, with oldest MRI scanner aged 23, figures reveal……..

Across 111 of England’s hospital trusts, 63% have at least one scanner or treatment machine that is at least a decade old, according to figures obtained following freedom of information requests by Sky News. The statistics show that 21% of Linac radiotherapy machines at the trusts questioned are at least 10 years old.

Meanwhile, 11% of CT scanners are a decade old and 24% of MRI machines are at least 10 years old, with the oldest MRI scanner being 23 years old.

Commenting on the figures, Dr Giles Maskell, president of the Royal College of Radiologists, told Sky News: “It’s scandalous, frankly. It’s a major problem. Patients who are being treated on older linear accelerators are not getting the precision of treatment that they would otherwise, so the effect is there is more radiation to normal tissue around the tumour and not precisely to the tumour itself. It becomes critical if the tumour is near vital organs.”………

chronic under-funding and under-investment in general practice

The Independent newspaper highlights the hidden problem of gross underfunding down to 6.5% of GDP for the NHS according to the King’s Fund.

 

Deloitte’s 2014 report for the Royal College of General Practitioners highlighted chronic under-funding and under-investment in general practice. The proportion of money going into general practice, as a percentage of the NHS budget, has been shrinking. At the same time, demand is rising – and ever more services are carried out by GPs. Surgeries have extended opening hours and there has been a shift of hospital care into communities. For example, type 2 diabetes care used to be provided mainly by hospitals but now generally takes place in the community.

As a result, GP workloads are stretched to breaking point. Patients are frustrated as they are unable to book appointments. When I applied to general practice training in 2008-9, it was seen as an attractive career prospect. Fast forward to the present and junior doctors are put off by the prospect of burn-out. Many older GPs are retiring early due to stress. There is a serious recruitment and retention crisis. Unsurprisingly, there is a reliance on locum doctors. Instead of training sufficient numbers, the Government’s strategy will be to recruit more doctors from abroad and introduce physician associates.

To add insult to injury, GP funding to deprived areas is in danger because of government plans to phase out the Minimum Practice Income Guarantee. Furthermore, the new GP contract is in the pipeline. Based on the junior doctor contract, it seems probable that this contract will not deliver what is needed. This would force smaller practices to close their doors. GPs are now threatening mass resignation as the only way of getting the government to listen.

GP workloads are stretched to breaking point.

 

Don’t worry about your local hospital – it’s your GP surgery that will shut first

Cost-cutting and privatisation are shattering the service

Hospitals up and down the country face closures of some kind. But another crisis has gone under the radar. Since 2010, 656 GP surgeries have closed, merged or been taken over.

We know why: Deloitte’s 2014 report for the Royal College of General Practitioners highlighted chronic under-funding and under-investment in general practice. The proportion of money going into general practice, as a percentage of the NHS budget, has been shrinking. At the same time, demand is rising – and ever more services are carried out by GPs. Surgeries have extended opening hours and there has been a shift of hospital care into communities. For example, type 2 diabetes care used to be provided mainly by hospitals but now generally takes place in the community.

As a result, GP workloads are stretched to breaking point. Patients are frustrated as they are unable to book appointments. When I applied to general practice training in 2008-9, it was seen as an attractive career prospect. Fast forward to the present and junior doctors are put off by the prospect of burn-out. Many older GPs are retiring early due to stress. There is a serious recruitment and retention crisis. Unsurprisingly, there is a reliance on locum doctors. Instead of training sufficient numbers, the Government’s strategy will be to recruit more doctors from abroad and introduce physician associates.

To add insult to injury, GP funding to deprived areas is in danger because of government plans to phase out the Minimum Practice Income Guarantee. Furthermore, the new GP contract is in the pipeline. Based on the junior doctor contract, it seems probable that this contract will not deliver what is needed. This would force smaller practices to close their doors. GPs are now threatening mass resignation as the only way of getting the government to listen.

Linked to cuts, we are seeing the privatisation of general practice as part of the wider privatisation of the NHS. Private companies now run GP surgeries, whole swathes of Out of Hours Care have also been outsourced and a quarter of walk-in centres have closed since 2010. Alternative Provider Medical Services (APMS) contracts are likely to be extended, which could mean no limit to privatisation.

Urgent steps need to be taken, including emergency funding, so that we can recruit GPs, increase appointments and improve service provision. Not only are GPs usually the first point of patient contact but the majority of patient care takes place in primary care, which facilitates early diagnosis, screening, management of long term conditions and preventative medicine. In other words, this is a sensible investment and ends up saving the NHS money in the long run and providing better patient care.

The combined agenda of cuts and privatisation only leads downwards. Smaller practices will not survive. The concept of the family doctor will be a relic of the past. There will be mergers and the development of federated GP organisations, which are likely to prove more enticing to buy-outs from private investors.

New GP deal for England.

……….worth an extra £220 million for practices, according to the BMA.

It will see an immediate end to the dementia enhanced funding scheme and there is a joint commitment between the BMA and employers to “explore” the end of the Quality Outcomes Framework and the Avoiding Unplanned Admissions scheme.

There will also be a commitment to a national strateg to cut red tape and to “manage demand” for GP services, the BMA said.

The BMA said the deal was a “step forward” but did not amount to a “clear rescue package” for GP services.

BMA GP committee chair Dr Chaand Nagpaul said: “The BMA’s GP committee was clear from the outset that these annual variations to the contract could not resuscitate general practice from the brink of collapse following years of underfunding, rising patient demand, staff shortages and unresourced work being moved from hospitals into the community.

“These limited changes provide some immediate financial support which, for the first time in years recognises the expenses being incurred by practices and resources needed to deliver a pay uplift rather than a pay cut. There is no new clinical workload requirement or any change to QOF, and the deeply unpopular and imposed dementia DES will be removed with resources moving into core funding.”

GP contract negotiations

Summary of the 2016/17 negotiations on the GP contract from Pulse magazine

What the 2016/17 contract deal includes

  • Increased investment of £220m (a 3.2% funding uplift) into the GP contract to deliver a 1% pay uplift and reimbursement to meet rising expenses facing practices, including higher CQC fees (£15m), practice upkeep and staffing costs.
  • An end to the dementia enhanced service with a transfer of resources to core funding.
  • No disruption for practices from annual contract changes, with no new clinical workload schemes or changes to the Quality and Outcomes Framework (QOF)
  • Joint commitment to explore the end of the QOF and “Avoiding Unplanned Admissions” enhanced service.
  • A commitment to a national strategy to reduce bureaucracy and manage demand on GP services.
  • A 28% increase to the vaccination and immunisation item of service fees from £7.64 to £9.80.
  • GP practices will be required to record data on the availability of evening and weekend opening for routine appointments, which is to be collected until 2020/21.
  • GP practices will record annually the number of instances where a practice pays a locum doctor more than an indicative maximum rate, as set out by NHS England.
  • The MenACWY 18 years will be extended to allow for the opportunistic vaccination of 19-25 year old non-freshers who self-present for vaccination.
  • NHS Employers and GPC will work with NHS England and the Department of Health to ensure that appropriate and meaningful data relating to patients’ named accountable GP is made available at practice level. This data will be shared internally within practices and used to improve services for patients.

Source: BMA and Department of Health