Government panic shows lack of understanding of General Practice. “Penalties for seeing too few patients” and Locum subsidies will have perverse outcomes which have not been thought through.

Remember the GP rescue plan from 2016? The Times Chris Smyth headines with “Doctors face penalties for seeing too few patients – \javid plans to tackle underperformance of GPs. Nick Triggle in the BBC News reports the governement line “GP rescue plan to boost face-to-face consultations” but NHSreality and Huw Pym know this is a superficial and banal plan, which will lead to perverse outcomes. GP practices often have Locum Insurance, but if there are no Locums this money seems poorly spent.
The Sajid Javed subsidy will have several perverse outcomes as locum GP pay rises and the practices add on to government money . Now some are getting £1500 per day, but it could rise to double this if government pays half, and even more if practices choose to add in some Locum Insurance!  The medical interviewers and reporters need to focus on the reasons and drivers for this long term undercapacity. The initiative is too little, too late, and the performance penalties for “professionals” are insulting.
If a GP partner can earn much more as a locum, and escape penalties, we could see many of them leaving their partnerships, partnerships imploding, and buildings being taken over by either big business (where authorities guarantee to fund locums) or closing where they dont!. Then again, should the subsidies be assigned progressively to the poorer and deprived areas of the country, where it is harder to find locums?
Private practice could then start to thrive in the areas where funding is lighter or non existant. This could mean a complete re-thinking of the 4 UK health services, all in different directions! There are opportunities to use retired GPs, and reverse the rationing of places in Med School. The immediate import of doctors from 3rd world countries is happenning right now… The litigation risk is increasing . The management of doctors by “performance related pay” with “league tables” is a very short term prospect, with long term implications for burnout and disillusion. Unfortunately its too late. No amount of cash can clone diagnosticians immediately...
As Dr Rant comments (Facebook):

Dear Savage Javid. I see that you are all over the news this morning, promising £250 Million for GP services this winter, albeit with a massive bundle of strings attached.This represents 0.19% of the NHS budget, or 100 dodgy PPE contracts, which your chum Matt Wanksock ejaculated all over his chums last year. Or around £3.70 per patient, i.e, an extra minute of GP time per person in the UK.You are not just flogging a dead horse. NHS primary care is a zombie horse who has been flogged to death repeatedly, and is now being asked to run the Grand National using only one leg.Kindly engage with the BMA and figure out how to fix the problems with primary care, rather than offer GPs peanuts in return for demands.

Dennis Campbell in the Guardian: England’s GPs to get £250m boost if they see more patients face-to-face – Practices to receive share of ‘winter access fund’ if they increase in-person appointments

GPs to be “named and shamed” in the telegrap

Ross Lydall in Sky News: League tables are all about helping GPs, claims Sajid Javid and Naming and shaming GPs gives power back to the patient, says Sajid Javid

BBC Breakfast: The new plan for GPs

Saffron Otter for The Manchester Evening News and MSN network: GP ‘rescue plan’ rolled out amid face-to-face appointment criticism – but doctors deride ‘insulting’ initiative

In July College sounds SOS for general practice – and calls for rescue plan …

GP rescue plan to spice up face-to-face consultations

Performance related pay is risky, and has been rightly reversed for GPs and Primary Care. Will it work for Trusts and Hospitals?

Its almost certainly too late to act. The workforce crisis is upon us…

The gambler Boris, is putting it all on “Health”, but he’s out of aces, as there are too few staff. He is right about it going to get worse though…..

There are just not enough geese to lay enough golden eggs. The cupboard is bare. We cannot be cloned.

update 15th letters in the Times:

PENALTIES FOR SEEING TOO FEW PATIENTS
Sir, Sajid Javid’s plan to measure GP practices’ number of appointments is a case of “never mind the quality, feel the quantity” (“Doctors face penalties for seeing too few patients”, News, Oct 14). There is a conflict between the volume of appointments offered and quality of consultations delivered. Practices that offer longer GP appointments, and appointments with specialist mental health practitioners and women’s health practitioners for example, may offer a lower total number of appointments per week but more total consultation time for patients.

This simplistic drive to promote the volume of appointments risks penalising the quality of care.
Dr Martin Breach
Chairman, Mid Mersey Local Medical Committee; Clinical director, Newton and Haydock Primary Care Network

Sir, Remote consultations were imposed on GPs and hospital consultants alike by the triad of Chris Whitty, Matt Hancock and Boris Johnson, to avoid super-spreading among potentially ill patients in doctors waiting rooms. It wasn’t, and isn’t, satisfactory for doctors or patients but GPs did not choose to “hide” (letter, Oct 14). Our workload in fact doubled because of the need to consult by phone or online and subsequently face to face; this took longer. The pandemic was grossly mismanaged from the start by delaying the lockdown; the consequences of this are clear.

Supermarkets have space for social distancing. In my surgery there is only space for four people to sit down in the waiting room and there is no parking. Magic wand, please.
Dr Jane Bowskill
Binstead, Isle of Wight

Sir, Sajid Javid thinks patients should be able to “see their GP in the way they want”. Although face-to-face appointments must be offered, many consultations can be dealt with very effectively over the telephone or a video call. I suggest that patients should be able to see their GP in the way they need.
Dr Annie Middleton, GP
Tunbridge Wells, Kent

A predictable Update as there are no Locums and Locum Insurance is useless.. 22nd October 2021 Kat Lay reports in the Times: GPs threaten to strike over face-to-face appointments

GPs are to vote on industrial action after formally rejecting a government support package set out last week.

The general practitioners committee of the British Medical Association voted yesterday to reject the measures, which health bosses said had been designed to “improve access for NHS patients and support GPs”.

The plans offered extra funding to hire staff and locums and improve telephone systems but warned that practices would be excluded from a £250 million fund if they failed to see enough patients face to face.

Update 30th October 2021: Kate Gibbons: BMA claims victory as monthly GP league tables plan ‘scrapped’ and Caitlin Tilley in Pulse 29th October: Worst-performing GP practices will get no winter funding, NHS England advice confirms
England’s GPs to get £250m boost if they see more patients …Guardian and Constanza Pierce in Pulse: the hoops GPs will have to jump through for winter funding