Mike Wells was puzzled about NHS spend and GP income.

The structure of pay and allowances for GPs is ridiculously complex,
and far overdue for the application of some common sense to -
immunisation fees and contraceptive service claim intervals are two
areas which it should be possible to sort out in about half an hour
with a pencil and eraser and two people who actually wanted to make
progress.

However, notwithstanding the various allowances I get, including a
grand per month for having a building in the right place, "cost rent"
and the reimbursement of apprximately 70% of my staff costs - the
lowest amount per patient of any practice in the whole of N&E Devon HA,
BTW, 

if I take on another patient then regardless of their class or mine I
get a capitation fee per year for them which is about £16 as quoted.
In fact in my opinion too high a proportion of GP funding is delivered
via the capitation fee, and this is another factor making the mental
convulsions necessary for PCGs to work properly more difficult than
need be.

That is all I get extra for that patient - lets call it on-pay unless
someone has a proper accounting term, marginal income perhaps?

However, I will take their measurements and talk to them, and that nets
another £7.50 or so as a registration fee.

If they are kind enough to be female and sexually active or interested
but not intending immediate pregnancy then advice and services relating
to that net another £13-80 ish.

and so on...

Now my colleagues and the department of health have agreed for some
years that if it was not for all these smidgeons of income, which soak
up amounts of that 70% reimbursed staff time comparable to the
percentage profit most orgs make on small sales in claiming, then I
would just sit back and not work hard.

Of course, they don't actually believe that, or there would not be a
staturoy requirement that I do the new patient check as well as the
offer of the princely ("put no faith in the gratitude of princes"
Machiavelli, N) sum offered for being successful at it.  Would there?

Mind you, they might be right, if I didn't have to chase up this crap I
would probably only need to work half as hard to do as much good and
since I am a model Y worker rather than a model X worker it is likely
that I would in fact work as hard and do more good.  Perhaps there is
an Illichist in the adminsitration achieving his dire aims in such a
fashion, but I think there is a simpler answer.

Of course, given the administrative top hamper which would be liberated
to swing wildly in the gale of progress if we abandoned the nit-picking
minutiae of IoS it is highly probable that some pillock would
institiute a system of requiring us all to record, in longhand, details
of all the formerly paid items in order to fulfill out terms of
service, and this is th esuspicion which probably prevents the
liberation of the massive wasted brain activity of GPs and the
provision of a wide range of highly trained, motivated and experienced
adminsitrators and managers from the NHS to boost wide sections of the
economy elsewhere.

Harrumph.




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