Wednesday, March 14, 2007

Number crunching

The Today programme are at it again. Or rather the Audit Commission as reported by the Today programme I suppose. Now it's the changes in Out of Hours arrangements that "have benefited no-one except the doctors".

Well, in purely financial terms this might well be so. You see, up until 2004 GP out of Hours care was provided to the NHS for free.

No really, it was.

Under the terms of the old GP contract individual docs had responsibility for their patients needs 24/7. To be sure right from the '60s the actual work was done by either co-ops of GPs working together or by commercial deputising services, but the responsibility for these arrangements was left with the patient's own doc, and it was that doc who paid for whatever out of hours arrangement he or she chose to use.

By the end of the 90's out of hours services had reached overstretch and were increasingly looked on not as an exceptional service there for genuine urgent need, but as an extension of normal services for anyone who chose not to make use of their own GP service in hours. Demand was steadily, even exponentially, rising, individual GPs morale was at rock bottom and there were even mumblings of mass resignations or industrial action if the spiralling demand was not better managed. In brief, the demands of the public at large, fuelled by the wholly unrealistic expectations of our political paymasters, had torpedoed and sunk the goodwill that had kept out of hours services going for four decades.

In the new GP contract responsibility for providing out of hours services was passed to the NHS management in the form of the Primary Care Trusts. GPs could still offer to be a part of the service provision, or could take a 6% pay CUT to no longer offer out of hours services. At the same time some of the process requirements made by the NHS for out of hours services (mainly to do with how fast the phones were answered) made it impossible for all but the largest GP run Co-ops to comply. In short we were shouldered out of being allowed to provide the service in a way we would wish, and obliged to pay for the privilege.

Granted, under the terms of the new GP contract our pay increased in a number of other areas, notably in the arena of performance related payments, but it remains the case that we continue to pay for the out of hours opt out to this day. And it should tell you something that the vast majority of us are happy to continue to do so.

For the following other lesser known facts of GP service provision in the UK I am indebted to the Avon LMC. Everything that follows hereafter is their work and was intended for wider dissemination, so do please tell all your friends.

There are approximately 36,000 GPs in the UK

It takes 6 years to train as a doctor and then a further 3 years to train to become a GP.

Each patient on average sees their GP 4 times per year – this means, there are over 250,000,000 GP/patient consultations per year; 15% of the entire population see a GP in a two week period.

The average practice in the UK has about 6,000 registered patients and 3 - 4 GPs. The average full time GP looks after 1,700 – 1,800 patients.

The average face to face contact with a GP costs £20, compared to £24 in a Walk in Centre, £27 for a telephone contact with NHS Direct, £75 for an attendance at A&E and between £100 – 300 for each attendance at a hospital Out Patient Department.

GPs are paid LESS than 20 pence per patient per day to provide all the day to day care that is required. This is less than the cost of a daily newspaper.

Surgeries are open from 8 am to 6.30 pm Monday to Friday.

Some GPs additionally provide care outside these times, via locally based out of hours services.

GPs refer about 10% of patients seen to hospital specialities, which means that nearly 90% of all health needs of the British population are managed entirely in general practice.

In a recent Government survey it was found that patients were more satisfied with their GPs than they were with the hospital service. General Practice in the NHS was the most popular of all public services.

In a recent Government White Paper, they stated that “by international standards general practice in England is efficient and of high quality. Indeed many countries view with envy our system of list based general practice”.

GPs are now paid differently in that nearly 50% of their income is via quality performance-related pay.

The performance-related pay is based on achievements made in the Quality and Outcome Framework (QOF). This consists of over 100 targets of which 76 cover 10 important disease areas, measuring performance against proven standards. This has contributed to the largest and most admired clinical database in the world.

The Government has transferred all its responsibility for funding part of GPs’ pensions to the GPs and then claimed this was a part of a pay rise.


Chairwoman of the bored said...

While you were on your way to the surgery listening to the Today programme, I was 'enjoying' watching Ms Hewitt being interviewed on BBC Breakfast.

I listened to her condescendingly lie about how the public feel about the NHS generally and out of hours performance in particular.

I have no problem with the out of hours service as I have known my GP a long time, we are near neighbours, and he takes a particular interest in my case, but I would hate to be in most peoples shoes.

I am usually very careful about ill-wishing someone, as I have seen Karma at work in everybody's life, but she is a special case.

To hell with her, and don't spare the horses.

Doctor Jest said...

Madam Chair-- it depresses me that these "Mouths of Sauron" are even allowed on the media to peddle their arrant falsehoods often apparently unchallenged. I'd also like to know why the editorial team at Radio 4 are so apparently anti GP at the moment. What really saddens me is that they'll miss us when we're gone, and that might not be as long away as they think.

There is an overt push from the DOH to let US style HMOs buy us all out, and from this side of the desk there are times when that option begins to look increasingly attractive.

For the time being I just go and have a bit of a lie down till the feeling passes, but the youngsters we are training nowadays see nothing wrong with it.

Anonymous said...

pity that no newspaper has ever seen fit to print the fact that the dept of health made it very dificult for GP's or coops to do OOH becauswe of their stupid rules about keeping records of phone answering times and auditing everything that was irrelevant. but no government spin has ever mentioned this in the handouts that the papers print in the guise of investigative reporting.

Doctor Jest said...

hughev-- 6.14am. Would you be writing after a shift in a co-op perchance. You're quite right. I think most of us share your frustration at the wholly uncritical way the broadcast and print media accept their spponfed rations from HMG with scarce a critical glance. I

t appears the views of those actually providing any service in the NHS at present is immediately discounted by both Gov and Media as "special pleading".

Plainly they all know what is best fpor us and we should stop worrying our pretty little heads over it.

Dave Dreghorn said...

I think comments about access to practices at weekends, evenings and bank hols are valid, but I think a lot of people miss the point that GPs/nurses within practices can only work a max amount of safe hours and a lot of the reason they are shut is because money is being spent elsewhere, for example walk in centres.
A good example is the proposed supermarket practices. The cost of this? £225 million over 5 years!

To put that in context the 30 deprived areas between them could have 1000 part time GPs working 6.30-9.30 (could start/finish latter) or weekends and bank holidays (thats 500 GPs in the night and 500 working weekends/bank holidays). They could have about 800 part time nurses at the same time. That is 33 GPs and 26 nurse’s PER AREA (that is 4 practices with 4 GPs and 3 nurses working at any one time). What are the chances of getting those numbers in Tesco's?

To that add the £13 billion spent on the spine and the amount saved by people not having to go to walk in centres.

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