Suffolk: How the GP funding review is set to affect your healthcare
11:13 13 August 2014
With a funding review for general practice currently being undertaken by NHS England, one GP has raised concerns that many surgeries in Suffolk could become financially unviable, make a significant number of staff redundant, close or see patients wait even longer for an appointment. Here Saxmundham GP Dr John Havard shares his views about the funding review and what it could mean for the county
NHS England response:
A spokesman for NHS England in East Anglia said: “NHS England is committed to supporting innovation and quality improvement in
primary care and reducing health inequalities.
“We need to ensure that there is an equitable approach to funding.
“Where GP practices are receiving extra funding per patient, this has to be fairly and transparently linked to the quality of care they provide for patients or the particular needs of the local population that they serve.
“The purpose of this review has been to put in place a much clearer framework that will enable our area teams to ensure that extra investment in Personal Medical Services meets these criteria.
“The review concluded that there was a need to move to a position where each GP surgery receives equitable funding regardless of which contract they have.
“It also concluded that where GP practices are receiving extra funding per patient, this should be fairly and transparently linked to the quality of care they provide for patients or the particular needs of the local population that they serve.
“Our role is to ensure that funding is allocated in the fairest way.
“Over the next two years our area teams will work closely with local communities to ensure that these resources are used
in the best possible way to provide more joined-up services for patients.”
What is going on?
NHS England is reviewing general practice funding across the land to try and make it cheaper to run. In this era of austerity it may sound perfectly fair and reasonable to reassess the budget for primary care. However a one-size-fits-all reassessment makes no sense when you realise that general practice funding has evolved over the last 66 years with no two practices being alike.
Each part of the country has historically been funded at different levels and within each region different proportions have been spent on GP, community and hospital-based services.
Many practices nationally provide care under a contract called General Medical Services (GMS).
Suffolk only receives 90% of the health budget that it should on a population basis, but there has been higher than average investment in general practice services than in many other parts of England through an enhanced contract called Personal Medical Services (PMS).
This has supported GP to aid recruitment and retention of healthcare workers to provide good quality care.
That extra funding allowed the employment of extra healthcare workers such as GP’s, practice nurses and phlebotomists. Removing this funding now will take the wheels off the wagon and jobs off the pay-roll with worse service for you.
Can this extra practice funding be justified?
Good general practice involves better continuity of care which leads to lower A&E attendances and admissions.
Suffolk enjoys higher than average patient satisfaction rates, better patient access and lower use of hospital services than in the rest of England.
Suffolk has one of the lowest in-hours admission rates in the country and much of this local NHS efficiency is because of the extra investment through PMS in Suffolk over the last decade.
How could these cuts affect Suffolk GP practices?
The current review will affect the PMS practices covering 75% of Suffolk’s population and remove up to 20% of the current funding to these practices.
There is a very real risk that many practices will either become financially unviable risking closure or will have to make a significant number of staff redundant in order to survive.
As a minimum strategy to remain viable practices may have to let go one or two GP’s or an even greater number of nurses.
This will have a profound effect on the high quality general practice that Suffolk has been proven to deliver and actually make the total NHS cost more expensive as we approach the national average.
This NHS England Review will therefore undermine the many decades of work that practices have put in to provide good care for their patients.
Most worryingly there is a risk of a domino effect as practices collapse and patients are unable to sign on at other practices due to lack of capacity.
Is Suffolk really that different from other parts of England?
Actually yes. In 2006, the Department of Health noticed that Suffolk had the most PMS practices in England and wanted to know if patients really were getting better (and more importantly ‘better value’) services.
They found that the NHS costs in Suffolk were less than average, and outcomes better, so left well alone.
The latest NHS patient survey information shows Suffolk practices come almost always in the top 20% in the whole country across a large range of measures.
What is happening nationally?
Successive governments have steadily removed funding from general practice reducing the share of the NHS pie from 11% to 8% while GP consultations have increased by 40%.
General practice accounts for 90% of patient contacts with the NHS so it should be better funded not worse.
Why interfere now?
Why indeed? Ostensibly it is to save money but increased pressure on a reduced number of GPs has the potential to impact on A&E attendance, referrals and prescribing costs. The provision of blood tests, leg ulcer care and minor injury services at your surgery may all be transferred to the hospital after these proposed cuts.
That would be a huge step in the wrong direction and very inconvenient for you as patients.
This is why any savings from the 20% budget cut to practices could be easily wiped out due to all these increased costs elsewhere.
How can you help?
Your Clinical Commissioning Group and the Local Medical Committee representing your doctors are trying to demonstrate to NHS England that we provide both better care and better value than the national picture – but your opinion and support is vital.
The proposed changes have the potential for implications for your healthcare.
If you feel strongly you can raise your concerns about the risk of 20% cuts with your MP and you could consider supporting the campaigns to improve General Practice funding nationally being run by the Royal College of General Practitioners (www.rcgp.org.uk/campaign-home.aspx) and the British Medical Association (http://bma.org.uk/working-for-change/your-gp-cares)
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