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Cost of NHS

Community Veteran
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Registered: 21-03-2011

Cost of NHS

Grrr, I've just heard that one of my local Primary Care Trusts is paying GPs £100/hour to provide out-of-hours cover. These same GPs already have their own GP Practice which is funded in the usual way, so this is additional funding. Those GPs are nothing special, not consultants, just run off the mill "it's justa virus take paracetemol" grade. One of those GPs paid off a £660K mortgage in four years.
At the start of this year we paid over £8,000 from retirement savings to ensure our daughter received prompt treatment for a life threatening condition. Her PCT had blocked funding three times. Something is seriously wrong in the NHS.
Strangely enough I don't blame the GPs. I blame the useless administrators (I will not grace them with the word Managers) who allowed this situation to develop. It is no wonder that hospitals are being closed and nurses laid off. However this situation will get worse when Andrew Lansley hands the purse strings to the GPs.

Edited to remove apostrophes from GP's Wink
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32 REPLIES
Community Veteran
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Registered: 02-08-2007

Re: Cost of NHS

As they say, "whoever has the money has the power"
I Suspect  when the transfer of funding goes to GPs we will get a mixed bag of tricks, some will handle it better than others so feedback from patients (sorry customers) will vary.
My concern is that not long after the funding is moved the government will start to compare what GPs in each area are spending and without taking into account the particular needs of patients in that area start to put pressure on GPs to reduce spending.
This is similar to the government closing all the old mental hospital and transferring the care to private firms. Over a period of time the government makes less money available to pay for that care and we end up in the situation where homes go bust and vulnerable people (mostly elderly) suffer the consequences.
Community Veteran
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Registered: 12-08-2007

Re: Cost of NHS

Your GP will not individually control his own budget in the new setup.  He will be part of a consortium that will hold the budget.  This consortium may have as many as 100 GPs in it.  The GPs will have more say in how the budget is spent whereas at the moment these decisions are with the PCT and GPs follow their directives.
Community Veteran
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Registered: 30-07-2007

Re: Cost of NHS

I remember reading that the average GP salary is over £150 000 a year.  This has obviously risen, while the requirement to do out of hours work was removed.  GPs now "volunteer" to work evenings and weekends, and get the sort of hourly rate you mention.  Most of them are happy with £150 000 for a 5 hour day, and so aren't interested in out of hours work.  That's why we have to import doctors from the rest of Europe to cover that work.  A while ago, the Germans were complaining that young doctors could get paid more for flying to the UK on a Friday, working the weekend, and then flying home on Monday every week, than they could earn at home doing the job, so that's what they were doing.  Consequently, there was a shortage of doctors in Germany!
At the same time, we've had patients given the wrong medication or doesage, because the doctors don't speak good enough English to make themselves understood.
Crazy
John
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Re: Cost of NHS

Quote from: artmo
Your GP will not individually control his own budget in the new setup....

I personally know the people involved in one of these "consortia".  The active control effectively falls within a small clique of GPs. Other GPs in the area are actually annoyed at their effective exclusion. Don't forget almost all GP practices are in fact independent businesses. They do not have NHS employee status but are free agents and can, by and large, do exactly what they chose to do with little external sanction.  Decisions by the GP consortia will affect the profit margin of the GP Practices in the area; i.e. Will they have a new Range Rover or will it be a secondhand Mondeo this year type of decisions.  If they choose to give a lower local priority to a long term medical condition the patients will have little effective recourse to alternative supply. If as a patient you upset the GPs receptionist too much and you will be struck off the GPs list.
The way the GPs dropped the out of hours coverage shows how little they really care about patients as a whole, for them it is very much profit first.
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Community Veteran
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Re: Cost of NHS

A very alarmist and inaccurate statement.
The GPs will have their funds monitored and audited by a panel which will include lay people. Their performance is monitored now and will continue to be so under the new arrangements.  Patients will have a clearly defined course to follow if they wish to complain.
GPs are paid by the NHS but remain independent contractors.  Items such as cars are met from their earnings and not from consortium monies. All GPs get a salary based on patient numbers and this is added to for performing certain defined procedures.
Community Veteran
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Re: Cost of NHS

I'm afraid it is neither alarmist nor inaccurate.and is based from facts on the ground. (Most) GPs are not employed by the NHS nor do they receive a salary from the NHS. The Practices receive fees from the local PCT plus additional range of fees for various services such a fiver for each flu jab and a weird administrative measure called QOF points (example: http://www.dhsspsni.gov.uk/qof_context ) The GPs working for a practice work as Partners who take a share of the profits/losses or as salaried GPs employed by the Practice. The Partners in effect own the Practice. There is nothing to stop GPs taking on either private patients or additional work medicals for insurance companies/corporates etc. 
Currently PCTs often directly fund additional staff within the GP Practice, such as Practice Managers, administrators and specialist nurses. When the PCT's are scrapped these type of people will no longer be funded.
It is all about profit. The GP led consortia will commission (buy) services from the GPs i.e. their own clique, amongst others such as hospital services and also private sector medical services. At present it is not clear what will happen if a Consortia exceeds its funding and overspends. It will be an interesting test to see who is held responsible for the loss.
The involvement of  "lay" people, hospital doctors and nurses was added as an after thought following public protest. There is no clear indication that these third parties will have any veto over the GP spending decisions or whether their role will be advisory.
I saw what happened when the Government had "Fund Holding GPs" . History is about to repeat itself.
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Community Veteran
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Registered: 12-08-2007

Re: Cost of NHS

You have really just repeated what I already said.  Yes it is the PCT that currently pays the GPs but the money comes from the Health Service budget. PCTs are part of the NHS.  As already said, under the new arrangements all spending will be monitored by various bodies to ensure compliance with HS guidelines.
A new body will assume overall control of health matters under the new arrangements.  In my part of the country this body will have a budget of around £350M per annum and employ upwards of 7000.  All health care services will be paid for out of this budget.  We have already started to put in place agreements with hospitals, public and private, as well as other organisations to look after our population.
It is a big change for the NHS but if managed properly will provide much better care. 
Community Veteran
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Registered: 30-07-2007

Re: Cost of NHS

Quote from: artmo
It is a big change for the NHS but if managed properly will provide much better care. 

That is yet to be seen, I'll be surprised if it's better.
Artmo, judging from what you say, you clearly have some connection with the service, and I'm sure you do a great job of which you are justly proud, but there's one thing I'm pretty sure of, and that's that GPs will get even higher wages for doing even less work. That's just how it is.  The idea is that local GPs know what their patients want (and more importantly, need), but we've all met the "leave it to the professionals brigade" both in the field of health and in education, and they get so carried away with their own status, that they completely lose touch with the people that they're supposed to serve.
To paraphrase - what's the difference between a doctor and God - God doesn't think He's a doctor.  Undecided
John
Community Veteran
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Re: Cost of NHS

Hulls, in an earlier post you mentioned doctors doing a 5 hour day.  Nothing could be further from the truth. It is true they no longer work the hours that once they did.  Surgeries should provide Saturday appointments or extended hours during the week. This is part of a national initiative to offer consultations outside of usual hours.  In my town our surgery opens some mornings at 7am and closes in the evenings at 8pm.  I can only speak for my area where GPs work long hours and after surgery they will then attend practice meetings.
I am optimistic about the changes but as you say, time will tell.
One major change that will take getting used to is moving care into the community.  Much more of the treatment carried out presently in hospitals will be carried out at a patients home or local surgery.  Secondary care (hospitals etc) will see their role dramatically changed.
Community Veteran
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Re: Cost of NHS

Quote from: AlaricAdair
One of those GPs paid off a £660K mortgage in four years.

Like many MPs eh?
Funny isn't it, those who have money detest the thought of debt and want it cleared as fast as possible yet they expect the rest of us to live in it for as long as they can keep us in it.
Sickening isn't it?
They'd rather try to get this country out of debt in 4 years (which we can't afford) than let us have the services we need and make sensible cuts to pay off the debt over a planned (eg say 25 years like a normal mortgage).
There really is something wrong with people up the top. Still, who am I to mumble.. apparently my logic is screwed according to HPsauce.
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nadger
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Re: Cost of NHS

It would be much easier for the government to carry on getting deeper into debt and be popular - thankfully, for future generations, they don't see it that way.
Most of us who are totally debt free have been there and done it, debt wise. We've coped with 15% mortgage interest and now we have savings are seeing stupid rates of return.
Community Veteran
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Re: Cost of NHS

I never said they should carry on getting into debt.
All I'm saying is they should make sensible cuts and LONG TERM plan to GRADUALLY pay it off. Axing everything left right and centre and demanding it be paid off within 4/5 years will do more damage than good.
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David_W
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Re: Cost of NHS

They have to pay off a very reasonable amount within 4 years so they can initiate tax cuts.  Labour went the route of spending money all over the place which put us into debt we cannot reasonably manage.  Can you imagine the interest we have to pay on our debts?  It's currently £43,000,000,000 a year or 3% of GDP, by cutting the debt away that naturally drops interest payments so the government has more money to spend on services and not on repayments of debt.  If however we were taking the long road to paying our debts off it would call into question our ability to repay our debts which would drop our credit rating from AAAA or whatever it is which would up the interest rates.
The sad part is, this government is going to clear up a lot of the debt we have through harsh measures, so harsh that next election Labour will be voted back into power and they will undo all the work this government is doing by splashing the cash on things we cannot afford so they can be seen as "popular".  Of course, they will try to pay for that with indirect taxation , they can't rip off the private pension funds again as Brown already did that.
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Re: Cost of NHS

Quote from: David
They have to pay off a very reasonable amount within 4 years so they can initiate tax cuts.

Tax cuts? - Seriously when has that ever happened?
I stand by my point, we're in a mess and by rushing to pay it off ASAP we're still not learning from our mistakes. It's a huge amount to repay and like all little people are forced to do with their mortgages (which are also ridiculously high) the government should be making a long term plan which is stable and more realistic. Only then will we be forced to acknowledge that money has to be handled carefully and learn from our previous mistakes.
Cutting everything to pay it off within 4 years is stupid. After 4 years will we get our Nimrods or Harriers back? - No. So whats the point? We might just as well make a long term plan to sensibly pay it off and keep as much stuff as we can because otherwise the next Labour government will just go on another spending spree trying to rebuild the country and digging us into a mess again.. where we'll be cutting even more of whats barely left.
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