GPs may end in exile

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When did referral rates and prescribing costs become the measure of quality of general practice?

It would be much more meaningful if local figures (and national ones for that matter) bothered to provide 95% confidence limits for the rates for referral and prescribing expensive drugs. No NHS/PCT admindroid seems capable of using EXCEL spreadsheet statistical tools for this purpose in any data sent in all the years I have practiced. Would confidence intervals show that the 'outliers' were fewer than the politicians want to believe?

What a slippery slope we are stepping on if the Telegraph article here is wholly true. You can imagine that after the first cull of 5-10% poorly performing GPs, our Masters will announce a further round of culling of the poorly performing GPs in the remaining group and so on until we are left with no-one capable of prescribing anything other than things like aspirin or paracetamol which can be handled by Noctors and Phoctors. 

The Noctors and Phoctors will be cheaper for whatever guise primary care evolves into because they will do what they are told, have little if any imagination concerning differential diagnosis, and have so little training in pharmacology that prescribing costs will be well contained. However, the British public will no longer receive the high quality primary health care that we have been proud of for many decades.


So, after considering these matters, would anyone wish to follow our leaders to a new NHS?

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Foundation Trusts get green light to take over GP practices

18 Apr 11

The Co-operation and Competition Panel (CCP) has given the go-ahead for foundation trusts to take over general practices, provided they implement a number of measures to overcome potential conflicts of interests.

It follows a CCP review of a Transforming Community Services merger in Warwickshire which will see the George Elliot Hospital NHS Trust take over three local practices that were previously run by the PCT.

The case has obvious potential conflict of interests for the GPs involved as they will be both gatekeepers and employees of the main local provider of acute services.

The assurances, accepted by health secretary Andrew Lansley, include:

- A leaflet given to patients to read in the waiting areas of the GP practice explaining it is now owned by the foundation trust

- GP training on NHS Choices and Choose and Book

- Tracking of referral patterns from the practices

- The option of allowing the PCT to appoint a ‘choice adviser’ funded by the FT if the PCT feels this is necessary

The CCP has said the assurances are likely to be sufficient to address any potential adverse effects on patient choice and competition that might arise from other mergers taking place as part of the Transforming Community Services reforms.

Despite the assurances, in a statement the CCP said: ‘We continue to be concerned that there is the potential for a conflict of interest to arise in these circumstances and suggest that this is a potential issue for Monitor or the NHS Commissioning Board to consider in future, once they have been established.

NHS Alliance chair, Dr Mike Dixon, said the CCP's recommendations were something of a 'landmark'.

'It's very interesting the CCP have allowed this and it will make a lot of other foundation trusts think about whether to take over their front line outlets.

'It creates a very large monopoly that's secondary care centred. We're all for bringing primary and secondary care together but not in the context of foundation trusts. It's this secondary care pull that we're trying to get away from.'

The CCP currently has an advisory role to the DH, secretary of state and Monitor.

Once the new competition regime is implemented and Monitor becomes the economic regulator it will have powers to enforce compliance and prevent anti-competitive behaviour.

At least six similar cases involving major local providers looking to take over general practices have been referred to the CCP including:

- The transfer of PMS/APMS contracts by NHS Salford with Royal Salford NHS FT

- The transfer of PMS/APMS contracts by NHS South Tees to South Tees NHS FT

- The transfer of PMS/APMS contracts by NHS Sheffield to Sheffield Health and Social Care Trust

- The transfer of PMS/APMS contracts by NHS County Durham and Darlington to County Durham and Darlington Foundation Trust

- The transfer of PMS/APMS contracts by NHS South of Tyne and Wear to South Tyneside NHS Foundation Trust

- The transfer of PMS/APMS contracts by NHS Oxfordshire to Oxfordshire and Buckinghamshire Mental Health Foundation Trust.

The Warwickshire case’s recommendations will apply to these and the CCP will not investigate these individually.

In 2009 the CCP looked into the merger of a practice in Sunderland with City Hospitals Sunderland NHS Foundation Trust when it became one of the Government’s integrated care pilots.

At the time, the NHS Alliance said the scheme would create problems by enabling the foundation trust to refer to itself.

The CCP said it was confident appropriate measures were in place to ensure GPs at the practice referred appropriately and that there were enough alternative local practices patients could register with if they wished to attend a surgery not linked with the foundation trust.

Thanks to PULSE for this...http://www.pulsetoday.co.uk/story.asp?storycode=4129164

Proposed NHS reforms threaten English healthcare as we know it

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Be afraid, very afraid.

The proposed health reforms set out in the Health and Social Care Bill which is in Committee Stage now is NOT about giving control to GPs but more about breaking the Secretary of State for Health responsibility for the NHS.

This is the first step needed to move to a private healthcare system with several insurers and companies managing healthcare for the population of England.

This is not good for the vulnerable in our society.

The citizens of this country need to know this and fight back before all is lost.