Changes in NHS affecting GP Practices
NHS is the biggest employer in the UK and it is a pride of Britain when healthcare systems around the world are compared. The features and benefits it offers to all people in Britain and the visitors are immense and not provided in any country, particularly USA. Canada does have a very good system like UK in most areas.
The government, since 1993, has been doing a lot tinkering with the way the GP system in the main is operating and also the Hospitals. They had allowed administrative staff to multiply without reason in trying to check and control the care provided by the GPs and hospital doctors to the patients.
There were lot changes that were welcome like use of computers and moving away from paper records, which still a lot of surgeries use; in fact they operate a dual system. Treating patients as customers, the demands on the GPs were very severe and often unrealistic.
A patient can be seen anywhere in UK, which was happening before these changes; now it is expected that the new GP should have the records available via his computer. This has not yet happened due to the immensity of technical problems and there is also a major element of fraud in such transfer of data.
Patient confidentiality cannot be guaranteed but Ministers decree that safeguard should be built in. Even large banks face hacking problems and NHS with its limited funding would never be able to provide such safeguards.
The companies, which were to provide IT support, have failed immensely with large wastage of money. Still as new Minsters take up their jobs, the main task is to tinker with the NHS GP system. A lot of time King Canute philosophy is still applied with utmost vigour.
Not a day will pass by without some criticism of NHS neglecting patients but what the Ministers would not realise is that due to overspending in some areas, mostly on exorbitant salaries to top level administrative staff, they have decimated the jobs of lower grade crucial supporting staff to balance the books and in many cases closed several hospitals by opening new improved ones. Then the complaints come in the form of lack of beds, transporting patients to hospitals at a great distance from their area to find beds incurring heavy costs in the process.
There is no philosophy of how to improve the old hospital but to close it and make a new one with modern facilities, which only appeals to creature comforts but not in more beds, convenience of access, more clinical and support staff etc.
Despite all these tinkering, NHS is still the best healthcare available in the world.
Just like in the poem ‘Men may come and may go but I go on forever. A PMgr has to keep up with the new changes and developments in the NHS GP practices. PMgr is required constantly to reading publications like Pulse, GP Commissioning, Online, Diabetes UK, BMA, RCN and others to keep abreast of changes and be alert to know when these changes would come into practice and how it would affect the services the Practice has to provide.
GPs are usually briefed at their weekly meetings about impending changes; the above publications also highlight the good and bad of the changes; their interactions with other GPs in other practices; and contacts in PCTs and GP friends in other areas to mention a few. They will also have separate communications about these from PCT, MPS and MDU. Still they may not read in detail or remember in detail the various aspects except when it refers to their contract payments and terms.
PMgr has therefore should be alert to the impending changes and notify the GPs by raising these issues in the monthly meetings so that these are not forgotten and then one fine day they may find that they have to institute the changes immediately. If the surgery has a writing board, PMgr should leave points in bullet form for GPs to read during break hours for tea and lunch. This should be done continually about all impending changes.
NHS has always been in a constant state of flux. More so, when a new Minister takes over or the government changes. The changes are not just cosmetic but usually too fundamental; and involves a lot of consultative stages making the working life of the Doctors and staff very difficult.
Sometimes one wonders whether there is a fault finding secret agenda on NHS. Always one of the aspects of care or disease would be highlighted to show NHS is not functioning as well as intended; thereby justifying the principle of changes are needed continually.
Some of the changes that are imminent are given below:
- From April 2015, every patient would have a named GP, who would be responsible for his or her care. The change will definitely affect GPs, practices and patients.
- There is a move to have GP coverage 24/7; this change would involve substantial lay out of money for the practices and how effective this change would be on patient services has to be monitored.
- APMS (Alternative Provider Medical Services) contracts can play growing primary care role. Primary care commissioners to allow providers to run GP practices have increasingly used APMS contracts. This is partially due as a response to the recruitment problems the surgeries are faced with. APMS does not provide a universal solution, but it is an option and one that CCGs are likely to increasingly explore when they begin taking responsibility for primary care budgets. APMS contracts are time-limited and the contracts need to be of longer duration with less risk of a provider being ‘turfed out’ even if they are performing well. APMS practices, many in deprived areas of England, face funding cuts or closure as NHS officials complete a wave of contract reviews.
- Practices may consider boycotting a scheme that would pay them £55 per patient diagnosed with dementia.
- Primary care funding will rise sharply over the next five years as part of a ‘new deal for GPs’ that will merge primary and acute care in parts of the country but maintain valued existing practices.
- The number of QOF points for 2015/16 will remain at 559, with some changes to indicators, the GPC and NHS Employers have confirmed. Five indicators have been retired and others amended in what the GPC hailed as ‘important, clinically appropriate changes to QOF’. Changes have been applied to indicators for AF, CHD, dementia and CKD.
All patients in England will have a named GP who is responsible for coordinating their care from next April and practices will be forced to publish average GP earnings as part of changes to the GMS contract agreed for 2015/16.
Incorrect coding may mean the prevalence of particular diseases within your practice is not accurately represented – and this could have a significant impact on your QOF income.
Boost QOF income by improving data accuracy.
- GPs should consider working with other practices to ‘increase the scale of delivery of GP services’, the CQC has said in its annual review of health and care services in England.
- More of Co-commissioning to bring a holistic approach to commissioning services for a specific population; achieving greater integration of health and care services, in particular more cohesive systems of out-of-hospital care that bring together general practice, community health services, mental health services and social care to provide more joined-up services and improve outcomes.
- Military-style restrictions could be placed on medical training to tie newly qualified GPs to the NHS and stop them moving abroad, the government’s primary care minister has said. One solution to the ‘brain drain’ was to make training funding conditional on remaining in the country and serving the NHS for a set period.
- GPs should be able to form expanded group practices, which also directly employ hospital consultants.
- Labour proposals to remove GPs’ independent contractor status and take away their commissioning powers. Labour plans for GPs to become salaried employees of hospital-led integrated care organisations and to downgrade their CCG responsibilities.
- NHS pensions will change from 1 April 2015 and will impact the impact on members of the scheme.
- GPs will not control primary care commissioning when CCGs are handed expanded powers under new CCG reforms proposed.
- All GP practices in England have to carry out the Friends and Family test from 1 December 2014 as part of their contract.
The Friends and Family test is continuous rather than a one-off traditional survey. Patients must be able to give feedback after every interaction with the practice, and anyone on the practice list should be able to complete the test at any time. It is up to the practice how it promotes the test and how it collects responses.
- The key GMS contract changes from 2003 to 2015, starting with the first three-year GMS contract, which was introduced in 2003/04, are well covered in the web site
On 30 September 2014, NHS Employers and the General Practitioners Committee of the BMA announced changes to the GMS contract in England for 2015/16.
The focus of the changes is on providing a named, accountable GP for all patients, publication of GPs’ average net earnings and a further commitment to expand and improve patient online services.
GPC and NHS England would separately submit evidence to the Doctors’ and Dentists’ Review Body (DDRB) in relation to the 2015/16 uplift to the GMS Contract. The Government will consider the DDRB recommendations before making a final decision.