GP’s getting all hot and bothered

It seems that GP’s are stirring up a bit of trouble for Gordo. I received the following email yesterday and have decided to post it pretty much “as is”. The only thing I have removed is the name of the author who is a GP and on the GPC. The contents pretty much speak for themselves:

Dear All,

We currently appear to be being steered towards accepting imposition A simply on the grounds that in the short term we will take less of a financial hit. I think this is probably dangerous and that we will regret it next year if we do not stand our ground now. It will be your decision. There has been criticism that the GPC is not prepared to give a steer. They are in a difficult position and are still trying to formulate questions that will make it clear that if you accept imposition A then it is only under protest as being the least unpalatable of two unacceptable options. We are not negotiating with honourable people. I certainly hope myself that if you go for option A when you are asked to vote then no one at all in Gloucestershire or Avon will then do any extended hours surgeries whatsoever; regardless of how much you might be bribed to do so.

For what its worth my personal view on the way forward is : -

• Reject both A & B. Stay cool and then point out that the stand-off between us is another “faut pas” by Gordon Brown in person, caused by his insistence on the over-riding of his own negotiators. He is getting a reputation in the media for someone who cannot delgate any power. I think he is vulnerable and will not want an epitaph as being the man who destroyed the NHS. Unless we reject both A&B we are not in a state of “dispute” and cannot legally hold a ballot on any form of industrial action.
• Publicise widely that the Government has lied, interfered with the pension settlement, and has betrayed doctors who signed up in good faith to what they believed to be legally binding contracts, and that the NHS can no longer therefore trust Gordon Brown. Seek a General Election if feasible by whatever means available to us legally. Posters seeking that might help. Gordon Brown has no personal mandate as Prime Minister from the general population.
• Stress publicly the underlying privatisation agenda, with loss of the traditional family doctor as being our major concern.Stress Government intention to use nurses, pharmacists, emergency care practitioners, and overseas doctors from Eastern Europe as cheap GPs.
• Take every possible opportunity to educate patients in our daily dealings with them. It is very easy to drop in a relevant critical comment or two about the Government in general conversation. It is after all only informing them of the truth. If we all do this then hopefully opinion polls will rapidly show an impact based upon our disillusionment with the Labour Party. Our strength lies not necessarily in our patients’ support, but in our ability to influence them on matters political, such as the threat to the continuation of the NHS, via our frequent one to one contacts.
• Continue to publicise the enormous achievments and benefits of the new GMS/PMS contracts to patients, but don’t expect too much from patients as the media campaign against us has been too effective. They do indeed view us as fat cats now.
• Illustrate to patients that already practices are planning staffing cuts that will make it more difficult for them to access an already understaffed and underfunded primary care service, including access to both doctors and also to practice nurses. ( Don’t forget our nurses now often have as big a following as do the GPs – they spend longer with each patient and that can be interpreted as being a more personal service by the patient. Patients don’t understand the delegated responsibility)
• End practice based phlebotomy and anticoagulant control. It might cause patient protest, but we can simply point out the scale of cuts and that we can no longer afford it. That should soon cause a public outcry.
• Expose the cuts to practice-based primary care teams, with the associated widespread downgrading of senior clinical nurses and cuts to health visiting and midwifery, leaving but a few only as managers for groups of practices, simply to save money. Point out how this undermines team spirit, and has resulted in delegation of important clinical work to very much more junior nurses who often do not have the necessary skills etc.
• Expose the gross inadequacies of the emergency OOH services compared to those that GPs ran before PCTs took over. Also expose cuts to the ambulance services.
• Insist that the employers element of superannuation is handed back to PCTs immediately and is not in future recorded as part of our income whether intentionally or otherwise.
• Try very hard to use BMA lawyers to establish that the contract cannot be broken unilaterally as there is no “natonal emergency”. If necessary insist on a judicial review as delaying tactic if nothing else, regardless of what the BMA lawyers think about likely outcome, or whether the BMA quibbles about paying for one. ( I have serious doubts about the BMA’s willingness to support our campaign financially. It has spent too much on gutting BMA House!)
• Insist on the declared support of the wider BMA, which I don’t feel we have at present. If not forthcoming consider establishing a break-away organisation outside of the BMA, which I will personally be prepared to become involved with , I daresay along with others on the GPC.
• Seek a European judgement based on the current “Working Time Directive” etc. Lobby Euro MPs. If necessary get BMA lawyers to seek changes to European law along the lines of maximum time that pilots/lorry drivers are allowed to work without a minimum break.
• Seek support of Medical Defence Organisations to resist the enforcement, by financial threat or otherwise, of doctors having to work alone doing booked surgeries with just a prescription pad at antisocial hours, when they will obviously be at risk.
• Ballot on industrial action to comply with Trade Union law, and don’t leave this too late.
• Insist as far as possible that all GPs act in unison throughout the UK. Peer pressure will be vital for success. Get LMCs to prebook a series of large-scale meetings now.
• Make it clear to Government that refusal to negotiate fairly will mean an immediate embargo on all further IT developments including National Spine, electronic prescribing, GP to GP etc
• No statistical or survey information of any kind to be fed to PCOs in future.
• Withdrawal from all PBC and C&B developments by ALL GPs, with refusal to engage in commissioning of any sort until satisfactory resolution.
• Refusal to develop QUOF in any way.
• Refusal to engage further with “Access”.
• Doctors currently doing any extended hours will be asked to stop doing them for the time being as part of the national campaign of unity.
• There will be an end to any attempts to reduce referrals to secondary care which most of us have cooperated with to date. Any referrals sent back to practices by the inevitable referral management centres that will result, will be returned with a note to the PCT asking them to confrm acceptance of legal liability, and those patients affected will be given a letter to take to their MP.
• An end to any further generic prescribing.
• An end to 28 day prescribing, and a return to presciption for quantities of drugs dictated by clinical considerations only.
• Refusal to agree to any “drug switch” campaigns, whatever short-term savings there may be for PCTs.
• Seek to establish our right to treat any patient privately outside contracted hours, as per consultants. If rejected insist that consultants should have that right to practice private medicine withdrawn if they hold an NHS post.
• Refusal to train new GPs until satisfactory contractual negotiations are re-established.
• Encourage GPs to withdraw from OOH arrangements until satisfactory in hours contractual arrangements are restored.
• Insist that attached staff being accommodated in GP owned or leased surgeries are rehoused.
• Collect undated resignations.
• Point out to all managers just how vulnerable their jobs will be if we all resign.
• Ask for a detailed public analysis of the value of SHAs by the National Audit Office, with the intention that they are scrapped.
• Set up immediately a subcommittee that will assist the process of resignation if we are forced to go that far, will negotiate for a “Mediplan” type insurance etc., and will produce detailed guidance notes for GPs.
• Publicise that it is Gordon Brown personally who is responsible for threatening the NHS by starting yet another unnecessary war.
• Publicise that we have always been prepared to negotiate on detail of contractual arrangements and on improving patient care in line with updated evidece bases, given the necessary resources and professional respect, but that the outline of the 2003 contract is written in stone, and that general practice cannot continue without inflationary uplifts plus significant extra funding in addition in order to cope with the ageing population, developments in medical science, and new treatments.
• Publish comparative cost tables for drug costs, primary care costs, and overall health costs for all European countries.
• Insist that comparability is restored as a factor that must be taken into account by the DDRB in assessing GP pay.
• Call a Special Conference of LMCs, or convert the Annual Conference into a Special Conference solely for decision on the agreed way forward.
• Consider as an option seeking mass PCTMS salaried contracts as “consultants in primary care”. I was at a dinner yesterday with a PCTMS GP . He is a senior doctor, but he is paid £90,000 all found. ( The contract includes Crown indemnity, maternity and paternity leave, sick leave, NHS pension, all staff and premises provided etc). He is taxed by PAYE so does not have the disadvantage of payment of Schedule 4 tax in advance. I think many could find the advantages of such salaried contracts backed up by PROPER GPC negotiation ( instead of the half hearted support so far given)attractive compared with what we now face as supposedly “independent” contractors.
• Resign en-masse from GMS/PMS contracts as last resort on a pre-determined date following the Special Conference.

It was all a waste of money

Via Tim we get the winner of “Bleedin’ obvious statement of the Year” courtesy of Patricia Hewitt:

Patricia Hewitt, the Health Secretary, admitted yesterday that the extra billions of pounds invested in the NHS have failed to make much difference to patients.

Honesty must be so liberating for a New Labour politician because by this time she was on a roll:

“We asked the public to pay higher contributions to fund record investment in the NHS and we have to convince them that those resources are being used in the most effective way possible.”

Well, you are not doing a very good job so far love.

She was getting giddy by this point:

“For all the extra money, all the extra staff and extra patients treated, NHS productivity has remained almost unmoved.

“Statisticians argue about how best to measure it. If you just count the number of patients treated, you conclude the service has become a bit less efficient.

“If you take account of better quality care and the additional lives saved, which is what really matters, then the NHS has become a bit more efficient.

There you have it. It matters not how many people are treated, but how well those who get to the front of the waiting list are treated. Words from her own mouth.

So for an extra £48 billion pounds a year coming from our pockets, the NHS is either a bit less or a bit more efficient… depending on your point of view.

Spending on health services in England has risen from £33 billion in 1996-97 when Labour came to power to £81 billion this financial year. However with an overall budget deficit of £500 million, many local primary care trusts are trying to balance their books by cutting jobs, restricting services and closing wards.

Whilst Patty’s honesty is no doubt refreshing, it comes about 9 years too late. The money has gone.

Miss Hewitt said there were four key elements to the Government’s reform programme: more choice and a stronger voice for patients; a range and choice of health care providers; money following the patient; and a regulatory system to guarantee standards.

None of which even attempts to answer the £41 billion question: “Where the fuck did all that money go?”

Let’s look at her four key elements:

1. More choice and a stronger voice for patients

I just want treated. Efficiently and if possible, locally. Choice is a red herring designed to give the voter the illusion that they have some kind of say in the running of the NHS.

2. A range and choice of health care providers>

How is this different from point 1?

3. Money following the patient

Creating an infinite mountain of very costly bureaucracy. Why should the patient even give a shit about this? We just want treated!

4. A regulatory system to guarantee standards

Oh goody, even more bureaucracy. Wonderful.

Alex Nunns, of Keep Our NHS Public said: “If people have to travel twice as far to go to an A&E or to have a baby, most of them will conclude that the health service has got worse.”

Quite.

Politically motivated NHS cutbacks?

Right on top of my last post comes this story:

Labour may be trying to target hospital cutbacks in areas where rival parties have seats, the Conservatives claim.

The Tories say they have leaked emails detailing meetings between ministers and Labour party officials.

Shadow health secretary Andrew Lansley said there also seemed to be a deliberate attempt to cut fewer services in Labour constituencies.

Downing Street denied changes were politically motivated, insisting they were what was best for local people.

Tony Blair’s official spokesman said: “The restructuring is based on an analysis of what services are needed at a local level.”

The claims follow news an Accident and Emergency unit in a key marginal constituency is to be axed in favour of an “urgent care centre” dealing with less serious casualties.

The provisional decision to scrap Rochdale Infirmary’s A&E unit was taken by a joint committee of Primary Care Trusts in the area.

Rochdale Labour Party has been hoping to oust Liberal Democrat MP Paul Rowen at the next election. He snatched the seat from Labour in 2005 with a majority of only 442 votes.

Well well well. Playing political games with healthcare is about as low as you can get. I would love to see these leaked emails.

Can I also point out that only New Labour could spin NHS cuts to be “what was best for the local people”

Unbelievable.

Best Year Ever!

Some good friends of mine have just had to take their young son into hospital. He was running a very high fever and started convulsing.

They took him to the local A&E department which is about half a mile from their front door. A&E decided he needed to be transferred to the paediatrics ward. The nearest paediatrics ward is over 14 miles away.

The same hospital has also closed its cardiac unit. If you find yourself having a heart attack in my home town you had better be prepared for a long ambulance ride. The nearest cardiac unit is about 30 to 40 minutes away.

Yet according to New Labour we have never had it so good.

Best year ever my arse!

There is no excuse

To quote Ellen Ripley, “Did IQs just drop sharply while I was away?”

I will never understand parents who refuse to vaccinate their children. It borders on neglect.

There were 449 confirmed cases of measles in England and Wales in the first five months of this year, the biggest outbreak since the triple MMR injection was introduced in 1988. Opposition MPs blamed the rise on ministers’ refusal to consider single vaccinations and Tony Blair’s reluctance to reveal whether or not his son Leo had been vaccinated.

So what is New Labour doing to control this outbreak and make sure that vaccination rates rise?:

Fears of a major epidemic were expressed last night as it emerged that tens of thousands of children are missing out on vaccinations as a result of a postcode lottery created by Labour policies.

New figures have revealed that 60 times more family doctors in the poorest parts of the country have stopped offering vaccinations than those in the leafy suburbs.

The huge difference has been created by new rules introduced by ministers two years ago which allowed GP practices to opt out of providing childhood immunisation services.

Could this administration be any more negligent if it tried? Vaccination is the most effective method we have of eradicating some of the nastiest diseases we know about. It is also the most cost effective.

“We’re on an express elevator to hell – going down!”

Staking reputations

Is this man crazy?:

Health Minister Lord Warner said: “The project has made significant progress, but there are some areas where we could make further progress.

“In hindsight, there was more we could have done in consultation [with clinicians].

“But I would stake my reputation that in the long term, this project will pay for itself.”

Remember he said it, although he will probably be long dead before this particular white elephant is ever completed.

Sort out your debts

Are your finances a mess?

Is debt getting you down?

Would you like to consolitate all of your existing debt into a single loan with easy to manage repayments?

Then give the NHS Bank a call.

Our highly skilled, professional advisors are waiting to take your call and a decision can usually be given within minutes.

Our rates are variable depending on circumstances and typical rate is only 10% (20% if you are a Trust)

Our financial plans will give you the freedom to pretend that your accounts are hunky dory, keep Patricia Hewitt off your back and fool the public into thinking that you don’t have a funding problem.

Call us today. What have you got to lose?

NHS organisations are to be charged interest on money they borrow when they run up deficits as part of an overhaul of finances, the BBC has learned.

The NHS Bank, run in conjunction with the Department of Health, has traditionally lent money at no charge.

But, from April, health bodies will be charged up to 10% for borrowing money, while trusts which invest their surpluses could received 20% interest.

NHS trusts said the plan would penalise the groups least able to pay.

One in four trusts failed to balance their books last year, leaving the NHS in over £200m of deficit.

Down the drain

Don’t worry, it’s not as if $3.5 billion is a lot of money:

Management consulting group Accenture has reported a 67% profits drop after accounting for expected losses from building a new NHS computer system.

Second-quarter net income fell to $69.7m (£40.1m) from $209.8m a year earlier, the US company said.

It partly blamed delays by its UK partner in the NHS project, iSoft, in delivering vital computer programmes.

Accenture now fears that the system will not be used by the NHS as widely as had previously been forecast.

The $3.5bn contract with the NHS was for Accenture to help design, build and manage information systems to support patient care through electronic medical records, appointment booking and prescription systems.

‘Unacceptable’

In the light of the delays, the UK government has now decided to let doctors and local healthcare providers use alternative computer systems.

We simply cannot allow this to go on. Whether it is Accenture or EDS, Government IT projects always descend into unmitigated disaster, costing the tax payer obscene amounts of money.

I wonder if Dr. Crippen can fill us in on what iSoft is, why it is so bad and what are these “alternative computer systems”? I would really love to know where our $3.5 billion has gone.

The Teeth Of The British

British Teeth. Notorious for their lack of cosmetic appeal. From the end of March 2006 there will not be a single dentist in Milton Keynes that will treat children free on the NHS.

I had a checkup last Saturday. 50 seconds in the chair. £25. £1 every 2 seconds. Ch-ching.

Britain’s fastest growing town is about to spawn a generation of kids who could eat an apple through a tennis racquet.

Filed under: Politics, New Labour Spin