Don't worry Ruth. It will only be a temporary two tier system, we'll all be
in the same boat soon enough.
Oxfordshire HA would like to get GPFH onto a capitation based budget next
year, and will be looking to us to manage budgets on a year by year basis.
This would be fine but for the 3% reduction in the FH pool last year (to
pay for the continued overspends in 2' care) and no prizes for guessing if
the pool we be uplifted in line with health care inflation this year (never
mind to account for the demographic shift). Of course the fund budgets will
have all elements above the top line, i.e. if you overspend in hospital
services but save on drugs they will cancel out. Oh, and of course the
national (?) commitment for the HA to fund overspends goes out the window
of course, they will simply roll over the overspend into the next year so
you're down before you start.
So inadequate 1' care funding, continuing overspends in the 2' care sector,
who gets the blame when you wait 12 months for your op...? It is up to
your local FH GP to prioritise care and manage the fund appropriately. So
if there's a problem, it's not "see your MP" it's "speak to your GP, we
gave him a budget of 2 million this year !"
It doesn't matter how you slice it, there's not enough cash in the pot, but
the politicians are going to love the next few years whilst we scrap
amongst ourselves for the pennies.
Any ideas for the next brainwave on how to slice the salami ? My hunch is
smaller salami, more attractive lettuce to garnish !
PS and Kenneth says Merry Xmas :-)
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From: Ruth Livingstone <[log in to unmask]>
To: 'GP-UK' <[log in to unmask]>
Subject: Two tier system
Date: Tuesday 8 October 1996 11:00
Contrary to assurances given at the beginning of fund holding, some years
ago, a two tier system is very much alive and kicking.
Non fundholders have often suspected that a two tier system is in
operation, but have been unable to prove it.
Unfortunately, we have just had confirmation from both our Health Authority
(Lincolnshire Health) and from one of our local hospital trusts
(Peterborough Hospitals NHS Trust), that for routine operations, our
patients will have their operations suspended until after 31st March 1997.
This is due to "over performance" on the part of Peterborough Hospitals NHS
Trust, or "underfunding" by Lincolnshire Health, depending on how you look
at it. There has been an unexpected rise in the amount of emergency and
urgent work done by the Trust.
Unfortunately, although the rise in emergency and urgent work (presumably)
arises from both fund and non-fundholder patients, the measures to reduce
expenditure will only affect the patients of non-fundholders.
We are the only non-fundholding practice in our town (actually, we are
community fund holders, but we don't fund in-patient proceedures).
We feel very angry about this, but powerless to do anything.
Ruth Livingstone
--http://www.Stamford.co.uk/littlesurgery
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