FPM's secret diarist and practice manager updates us on the new government's views on the partnership model, plus funding, wastage and a glut of doctors.

Lord Darzi

September started with a report from Lord Darzi into the current state of the NHS.

The findings were no surprise, any of us could have written such a report. I am not certain of the benefits, nor exactly how much it cost to produce but I wonder if the money could have been better spent better.

Lord Darzi did a similar report before the Conservatives came to power in 2010 so not much new here.

Labour pains

The new government is continuing to make pledges about the NHS moving forward.

Although they said no new money, I am not sure how changes can be made in primary care without new money. We all have stories on the wastage we see, especially in secondary care, and so without addressing this as one of the issues it is hard to see how we can move forward.

Wes Streeting is not sure about the partnership model, going forward, in general practice…

Well, I am!!  When you look at Primary Care against Secondary care, it is so much more efficient, and absorbs the majority of the work for a fraction of the NHS budget.

Just suppose the partnership model is scrapped, and partners become salaried - the quality of service will go down, as there will be no incentives to work the extra hours, or go the extra mile, that partners do today.

There would be no penalties for not achieving QOF, or concentrating on disease registers.

The partnership model works by paying by results, unlike secondary care, where the service is expensive to deliver, and where there are few incentives for the staff to work harder.

If the government cannot see the benefits of the partnership model, then we have no hope in getting on top of the NHS crisis that is getting worse. 

Have they thought about how Practice Managers, other clinical and Reception staff etc would get paid and who would be responsible for employing them? I bet they haven’t!!

Scrapping the partnership model would see many partners retiring and seeking work outside the NHS.

Taking this a further step forward, would current partnerships be bought out by the NHS?

Would premises be purchased from those partnerships that have invested in their infrastructure?

Where is that money going to come from?

Getting rid of the partnership model will be the death of the NHS in the way we know it now.

Secondary care is poorly managed, and money can be seen to be wasted; for example, I recently had an ECG at the surgery where I work, and my own GP asked for a copy and referred me to the rapid access pain clinic. 

The hospital would not accept the ECG and I had to go to my own doctor to get it redone, a waste of time and money, and that’s just one example.

If secondary care was controlled better, then some of this wastage could be avoided.

We need to get away from thinking that the NHS is free at the point of entry. It is not, we pay for it, when we shop, eat out, when we fill up our cars. We are Taxed! Taxed! Taxed!

We need to get all these messages out there as most patients trust us.

Recruitment

It seems ironic that, with everything mentioned above, there now seems to be a glut of doctors. 

We recently had a vacancy for a salaried GP.  We advertised it and within about 2 weeks we had over 60 replies… in the past getting 3 or 4 was doing well.

We closed the application process and interviewed close to 20 applicants.  

What a waste of resources that so many doctors cannot get a job.

The cut in finance means surgeries have to watch costs.

So as the honeymoon period of a new government comes to an end, the hopes of positive action diminish.