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.