>I really wonder what all the fuss is about.


Eh? Not been reading GP-UK recently, not worried about GMS predation,
shotgun marriages etc?

>PCGs COULD offer the chance to makethe NHS work by removing the perverse
>incentives (its dammed hard to do the right thing) and reward people for
doint
>it right.

I'm all for rewarding incentive and getting it right. In its current guise
PCGs will cause warfare between GPs. HMG will love that.

The caveats are :
>1. We need to be clear at the outset that this is about improving patient
care
>and the incomes of those who deliver it.

So go and (re)negotiate with HMG. Incomes are not protected and as for
incentives ?where?

>2. While we may reasonably be expected to account for our use of resources
we
>must stick on the point that we will never be accountable for their
provision.
>This is a non-negotiable issue and if not agreed by DoH the whole scheme
will
>founder.

The Regs make it quite clear that PCG *does* have responsibility for budget
and Health Care provision it offers. Do you really think when sh*t hits fan
that politicos will say "It's our fault, we got it wrong?" No chance it will
be the GPs who will take the can.

Again happy for this bit to be (re)negotiated but don't hold your breath.

>3. The only source for 1 is the patient care budget.  "Pay & Rations" has
to
>be ring fenced and can only move upwards in real terms.  We should not be
>embarrassed by this and need to be quite clear that it is acceptable for
>patients to be denied treatment if the resources to provide it are not
>supplied by those (the governent) rsponsible for doing this.  There should
be
>no question that incomes wouild be sacrificed to provide patient care.

Yup!

>4. The circle can be squared by moving activity and resources from
secondary
>care to primary care and then working out how to deliver the appropriate
care
>at lower cost.  The difference finances the incentive structure which
rewards
>those who deliver the care and also provides for more patient care overall
>(and more incentives).  The "average" PCG (100,00 patient) should be able
to
>release about £1-3M in the first year by doing this.  There is always spare
in
>prescribing budgets and if the incentives to release this were realistic
>perhaps we would here rather less winging about "pressure to prescribe"
from
>patients.  It is the doctors job to diagnose and advise on treatment.  This
>responsibility cannot be abrogated by excuses that patents "demand"
treatment
>where it is inapropriate.

So when HA says to you don't make precipitate moves which may destabilise
hospital then what do you do (and they have with us and will with you). I
agree that flies in the face of what HMG in past has said but I assure you
our HA did clearly ask our Multifund not to do any changes that would cause
the Hosp to lose significant revenue. £1-3M is significant n'est-ce pas?

>5 We just need to try harder and if we are adequately rewarded and keep our
>eyes on the ball we could do it.

Try harder? Do I want to? Do I have the time? How much will you pay me or
more sinisterly how much will you not cut my rent/staff pay then?

>6. I would expect to be able to increase staff pay by 10%, improve patient
>care and increase doctors' incomes as well in the first year IF WE ARE
ALLOWED
>TO DO IT.

I am happy for you to do it but please lets get the GMS angle sorted and the
compulsion to join lifted!

>7. You may say this is naive but if we are not positive we will achieve
>nothing.

You say no more than the DFI is asking. Don't go off half cocked in your
eagerness tho' ;-))

>Cheer up (or what's a heaven for?)


Hopefully for dead PCGs methinks, or burnt out cast off GPs! Oh dear! :-(


Paul Attwood
GP Thanet




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