In the Exeter PCG 21 individual independent small businesses with a 
total complement of about 60 GPs are to work together in a 
cooperative way for the benefit of the pateints, at commissioning 
and at distributing resources according to patient need.

Now at the same time the income of each of those 60 is to be 
determined largely by the profits of the particular one of the 21 
that he finds himsefl in and that is to continue to depend upon 
competing for business (makes some difference) and upon the 
differential funding of the practices.  

I do not see this as an effective or perhaps even a workable state, 
but it might be that we could all just roll up a trouser leg in the 
great british tradition and say that it is all working fine...

Or we could do better.

The Board of the PCG is composed of GPs from some of the various 
practices, and other stakeholders.  Pardon me for restricting my 
considerations to the shareholders, but the stakeholders' problems 
are less acute.
Already the board of the steering group has made decisions which have 
affected resources and have affected to be upset and surprised by 
the criticisms that have returned to them that they have acted in 
favour of their own practices and their own income.  At a board 
meeting when this was discussed I presented them with my view that 
their safety lies in the Firm, and it caused the second longest 
silent pause for thought I have yet achieved.

The existing systems of remuneration and of professional alliance 
have failed the State and failed GPs.  Replace them with a slide 
into a more logical arrangement.

Consider your own problems or concerns at present.
How many of them revolve around trying to get a working system built 
from 21 irregular bits of jigsaw?
How much money and time would be made available if you did not have 
to do that?

What the Firm does not mean is that different doctors would treat 
different patients differently in different buildings, although one 
might think some rationalisation might appeal to the partners as 
things settle down.




--- OffRoad 1.9r registered to Adrian Midgley


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