To: <[log in to unmask]>
From: "PETER FELLOWS" <[log in to unmask]>
Date: Fri, 3 Apr 1998 22:03:25 +0100

"The SW Regional Association of LMCs met yesterday in Exeter. Cornwall
in
particular has a problem coping with the influx of TRs in summer. We
are all
very angry at the snub to GMSC with Alan Milburn refusing to allow TR
payment
for telephone advice. "

  The manner in which it was done was indeed rather abrupt.

"This not only flies in the face of common sense, and the 
changing style of out of hours care in particular,but it will pose
numerous
problems for both patients and doctors, "

  If Gov is serious about it, and they appear to be, then a 
  simultaneous move to get pateints in Devon on holiday ring their own 
  GP/out of hours service in Birmingham instead of the local GP should 
  occur.

  There are regional implications in this of course, and it would be 
  a pity for us to seem too unwelcoming to tourists...  Make sure 
  the right goat is scaped

"and is a direct challenge to our negotiating strength. 
It is an insult to the profession."

  Indeed.  Never reinforce defeat, counterattack on a flank, surely 
  the Gov has many things we should be expecting the DoH to have 
  sorted out several years ago to concentrate on.
  Indeed, surely the specific (un-named so far, can I have him for 
  my list please)  civil servant who advised Mr Milburn that it was 
  an urgent problem that could easily be sorted could have been 
  expected to have organised the provision of cut sheet FP10s and 
  the revision of the SFA to include paperless practice...

  As to the insult, it is time the 
  profession moved into real-time on planning.  With a Gov that 
  appears to be keen to change the things that should be changed -
  of which we all have lists - it would be a pity to bog down on 
  this.  If we can get up to speed then we might even be able to 
  demonstrate against the abysmal slowness of thought of many HAs
  
"As the money is part of the pool, payment is merely a
redistribution exercise anyway."

  So the evidence to the Review Body, naming being in an area of 
  outstanding natural beauty etc where tourists flock goes in as one 
  of the job weight factors (£60 000 000 available, no)  along with 
  other forms of deprivation and need.

"The gauntlet has been thrown down, and the outcome will have much 
more significance for the future of GMSC as an effective negotiating
body, 
than the issue itself may warrant. "

  Less significance than some.

"The interesting thing was that when this idea was proposed there
seemed to be  
excitement that we might have come up with a realistic way of
empowering the
profession to put the brakes on PCGs, regardless of the outcome over 
telephone advice! "

I do so like honesty and clarity of purpose.  If, and I stress if, 
we want to put the brakes on PCGs, then let us have a motion to put 
the brakes on PCGs.  I think steering is more useful in avoiding 
accidents than brakes, but obviously some form of control is highly 
desirable.
On the other hand if our main contractor has decided not to purchase 
a particular service, let us accept that, and draw the obvious 
conclusions, that along with a national advice line service, 
patients wherever they go remain on our lists and can ring us.  The 
out of hours arrangements make it simpler to remind patients that 
they must _first_ ring their own GP, wherever he is and they are, 
since the Health Minister has decided that that is the way to run 
the NHS.  If we decide that one of our patients needs to see a 
doctor, then let us pass them on to the local controller, to have 
their attendance arranged at the local OoH centre - for which a fee 
remains payable.  Personally I think Mr Milburn decided to buy the 
woring service, and to reduce convenience to pateints, but then if 
the patients become convinced of this, they will tell him.

"Perhaps it is indeed time for a  national ballot on the whole idea of
cooperating with the White Paper, until such time as proper funding and
security for GP income is gauranteed."

I am in favour of motherhood, applepie, and proper funding of GPs.
At a stroke of course one could reduce the iniquities and paperwork 
by setting a base income for GPs amounting to say 2/3 of the current 
net intended amount, and just paying it for being in practice...


--- OffRoad 1.9r registered to Adrian Midgley


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