OK, first, the HIP is a health improvement plant, not a contracts document,
so it will not specify which hospital you have to refer to. If you stay
outside a PCG, the HA will set the contracts, and *then* they may start
specifying where you can refer.
Boards will have at most seven GPs on them. It is unlikely that a board will
meet more than ten times a year, and they should be remunerated fairly well,
if HAs are anything to go by.
Shadow PCG money needs a bunk up, but our groups negotiated double that from
the HA.
The HA wasn't meant to be cut by early May, but I would agree that it seems
unlikely that the guidance will appear on time. However, you never know,
there is still time for a miracle...
Believe it or not, GP incentives can still be paid out on an overspent
budget (even if it is overspent overall.) This is the only reason the
non-fundholding prescribing incentive scheme has worked at all.
GMS may be transferred to other budgets, but it is highly unlikely that a
PCG board as constituted per the Milburn letter would agree to it.
OOH would be much more easily axed under the HA than under a PCG. Why should
the HA care as much about it - there is only one GP on most HA boards?
It may surprise people, but I am pretty neutral on the subject of PCGs.
Personally, I am sure that the *next* reorganisation is the one to worry
about. The NHS gets reorganised every seven years on average, and PCGs don't
represent enough of a change to get me worked up. They do represent an
opportunity for GPs to find out how NHS finance works though. From my
reading of some of the comments and interpretations on this list, I think
people will need to do that before we are subject to a really threatening
reorganisation.
A
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of
> [log in to unmask]
> Sent: 22 June 1998 23:44
> To: [log in to unmask]
> Subject: Re: Millburns Letter Summary
>
>
> I can't believe some of the 'positive' views on Milburns' letter!
> Surely *ALL* seven points had to be met?
> 1. Independant contractor status - ok?
> 2.Clinical freedom - how can we have clinical to refer when the HIP,
> largely set by the HAs, will determine which hospitals we can refer
> to, and only those?
> 2. Overspends - will be met as HAs handle them now i.e. budgets will
> have to be top-sliced to meet the debts.
> 3. GP led boards - fine, except where are we going to find time to do
> it?
> 4.Financial support - the initial £22M is less than 40p per patient,
> so in our area for a poupaltaion of 250K we get 100K, for three PCGs
> 33K. How can a 'shadow' PCG run for 6 months on 33K?
> 5.Ccontinuing resources - 'every PCG will know by autumn, the
> resources available' - HA, like the HCG on HIPs was meant to be out
> in early May, no sight of it yet. Define 'autumn' please!
> 6. GP incentives - not much room for primary care development with
> top-sliced budgets. See above.
> 7.Legal liabilities - ok
> 8. GMS - this still *ISN'T* ringfenced. Indeed, he has said explicity
> that GMS can be transfered to other budgets.
> 9. OOH's - fine, until it is reviewed and then axed?
>
> I move that the letter is rejected.
>
> Dr David J Plews
> ------------------------
>
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