-----Original Message-----
From: Peter Fink <[log in to unmask]>
To: GP-UK <[log in to unmask]>
Date: 26 April 1998 21:54
Subject: PCGs and maverick General Practices

>How will PCGs manage those General Practices who will have nothing to do
with
>them?

<snip>

>Comments?

What if no General Practices will have anything to do with them?

What have we elucidated so far in the many media in which the PCG issue has
been discussed.

1. A very small minority has actually come out to publicly support the
movement. (How many ballots do we need to provoke an undeniably meaningful
one?)
2. A substantial majority would prefer to have "nothing to do with them"
3. The GMSC feels that a ballot of ALL GPs is needed "like a hole in the
head" or totally useless in view of the Government's vast majority.
4. Commissioning or Priority Setting equals Rationing - Open rather than
disguised.
5. HMG wishes the PCG (GP led) to be publicly accountable for RATIONING
6. HMG wishes GPs to undertake the extra work of participating in the PCG in
addition to all existing duties. (and more ...... clinical governance, HIPs,
etc.)
7. There is no firm proposal for any resources to fund the additional
burden.
8. The NHS is apparently short of about 1,000 GPs
9. If there are not enough GPs, such that even if the resources were
available, additional ones cannot be employed to do the work of those
administering the PCGs then the latter will just have to do more, no?
10. The proposed compulsion to join a PCG will force many GPs into effective
financial partnership with about fifty other GPs. It's hard enough to get a
handful of Doctors to agree on anything significant let alone fifty! Can you
not think of any of your neighbours whom you would rather not be in
partnership with? How about the odd prescription fraudster?
11. No reassurances have been given that some will not subsidise the
performance of less efficient others.
12. The use of GMS funds to subsidise overspends in Hospital or Prescribing
budgets is a very real threat to OUR personal income.


The list may be interested to hear of a recent GP Forum meeting held in
Thanet which one of my colleagues already briefly described. He mentioned
that it was decided to have a local vote to see how many of our "local
community" were in favour of being involved in the obvious "Thanet" PCG. He
also mentioned that our local LMC member would be taking a clear message to
the next meeting that we wished a national secret ballot of all GPs. The
single most important message which I came away with was not mentioned and I
think it worth emphasising here.

Some pro-PCG members of this list have taken my indictment of them as
non-representative of the average GP as a personal attack. This was never
intended as a criticism of these Doctors but merely a statement of fact -
they are clearly interested in committee work whilst the vast majority of us
are not. Many local committees are populated not by those who have been
elected but rather by those who have volunteered. This sets the scene for my
important message and that was that the leader of our GP Forum and active
member of the Local Commissioning Team, whom one would think an obvious
candidate for a PCGer, publicly stated that if our local ballot indicated
that a substantial majority of us voted against participation then he would
not feel able to represent us.............. Let that sink in awhile! What an
honourable chap. (No smiley)

I agree with Adrian Midgley (even though he keeps repeating himself!) that
the issue should not be fudged by citing the disagreement over telephone
advice to T/Rs. We have to beware the GMSC negotiating with HMG because I
can just envisage it coming out proclaiming success in turning around that
decision which we all know makes SFA (handy abbreviation that!) difference
to GP remuneration. I can also imagine that HMG are already willing to
concede on one or more aspects of their plans - perhaps even the most
contentious so that the negotiators can save face and tell us all how
successful they've been because their position wasn't weakened by taking
note of the views of the majority of GPs (by all available indicators to
date).

The key to breaking this thing is to vote locally against participation
within our "natural (!) communities". How can the outcome be any worse than
it is now. The NHS cannot continue much longer as a free for all (neglecting
taxation which doesn't always apply) organisation yet no Government,
whatever its colour, handedness or majority, will ever have the courage to
admit it. Our professional situation will become worse and worse and worse
as the demand goes up and up and up, the budgets get tighter and tighter and
the GPs get fewer and fewer. Lets call a halt while there are still some of
us left. Let's have a fee for services - either in cash or voucher system.
Something .......... Anything to put a brake on the demand and the trivia.
Someone mentioned the "cosmetic" surgery for minor varicose veins - my lot
would say "but they ache so much Doctor even with those support stockings
you recommended" Let HMG say "Your a liar - they can't possibly ache." or
perhaps a PCG could just create a ten year waiting list for VV surgery or
unsightly moles that "itch" or ....... etc.

This is NOT a politically motivated mailing - I voted for 'em as well but
NOT for all this PCG crap - rather just to get the other lot out! I wonder
how many others did the same :-o

Still here!

Dr Peter Wilson
GP, Broadstairs, Kent.
Medical Manager - EKDOC



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