Politics - nGMS worries

Date	Publication	Contract deficit
24/5/04	PULSE	Increased partnership disputes as partners squabble over profit shares of supposed under-performing colleagues. Need better agreements. Beware of expulsion clauses.
		Discontent over pay-rise as global sum and MPIG payments smaller than expected in Bucks, Berks, Devon , Glasgow & Lancashire
		Survey of 179 Devon practices: doubts on pay and enhanced services
		GPs providing unpaid enhanced services in Kent
20/5/04	DOCTOR	Prof Carr-Hill “never satisfied” with formula because data given by GP Research Database was wrong. Govt still not asking for new data
		GPC/Govt dispute over what is a closed list
		Private companies may bid for enhanced services
		Diseconomies of scale taken out but Carr-Hill put them in and wants them back.
		Out-of-hours (OOH) creating problems because shortage of doctors and cash.
24/5/04	GP	New GMS could be under-funded by £1Bilion for first 3 years due to high quality aspirations, OOH and enhanced services. Chris Town, NHS Fed, says average Q points around 850.
		Hospital workload increases as data-hungry nGMS leads to more tests
		Complexity of nGMS increases GP bureaucracy says Strachan, “guidelines to guidelines”. Neither high trust nor low bureaucracy.
		>1/3 GPs doing unpaid enhanced services
		Premises funding appears inadequate. Grant Kelly “gloomy”. Meldrum “plans to meet ministers.
		Quality framework under pressure as IoW gives high value points for prescribing less and not meeting quality targets.
31/5/04	PULSE	GPs bullied to do unpaid enhanced work by some PCOs. GMC referral.
		Animosity and tension possible during Q & O visits. Written evidence demanded 1/12 before visit. Random fraud checks.
		Allocations still increasing despite GPC earlier saying it was a contract breaker. 2 in 5 practices complaining.
		DoH continues to reject deal for community hospitals
		Fears over pensions calculations. Accountants warn that practices may have to top up employers contribution for their own pensions – as well as employee contribution.
3/6/04	DOCTOR	GP leaders urge practices to formally dispute global sum payments after PCOs had been told to deduct between £1-5,000 from each practice
31/5/04	GP	Carr-Hill “Too much cash tied to quality compared to global sum because quality cannot be reliably measured.
		PCOs colluding to keep OOH pay down, claim GPs
		Insufficient cash for enhanced services.
		Quality, enhanced services and OOH underfunding total £1billion over 3 years
		Enhanced services harder to offer in rural areas, so pay is less.
7/6/04	PULSE	Demand for European Court challenge on restriction of trade as GPs cannot charge their own patients for non-NHS work.
10/6/04	DOCTOR	LMC motions: nGMS fails to reduce work, fails to empower GPs to control work, fails over allocations, fails on recruitment and retention
		Increased work = more staff but where’s the money in the global sum?
		GPs cease unpaid enhanced services and A&E overworked.
		Superannuation dispute not settled.
		Premises funding not settled. GPC to discuss with DoH.
7/6/04	GP	GPC refuses to publish C-H formula
14/6/04	PULSE	London 294 GPs short of quota
		NI GPs cash for new staff pay cut off
17/6/04	DOCTOR	Beds & Herts LMC tell GPs to do unpaid enhanced services so as not to sour relations with PCO.
		PCTs to spend enhanced services cash in secondary care.
21/6/04	PULSE	Core services not limited; list demanded at LMC Conference
		Demands for: OOH action, allocations action and right to charge own patients
		Crisis of confidence over new premises cash
24/6/04	DOCTOR	GPs powerless to stand up to PCOs over core services
		Demand to uplift global sum funding at LMC Conference
28/6/04	PULSE	GPs tell MPS “Crisis in OOH” because PCO struggling to set up services and recruit staff
		GPC told to pursue diseconomies of scale by LMC Conference
1/7/04	GP	GPC told to renegotiate seniority pay – LMC Conference
28/6/04	DOCTOR	OOH crisis imminent – as above
		Contract failures on workload: increased monitoring of chronic diseases Pressure to continue unfounded enhanced services; no definition of core services (compulsory work); must do quality work to maintain income; more data and bureaucracy; forced allocations persist.
5/7/04	PULSE	June 30 deadline passed and PCOs not agreed enhanced services contracts yet
5/7/04	GP	PCTs fail to understand new pay system and underpay or overpay. Practices badly affected by underpayments.
		German GPs drafted in by 3 PCTs, to cover OOH.
		Nurses “told” GPs paid more so demand more pay - RCN
		Chris Town, NHS Fed, says give enhanced services to chemists, it’s cheaper.
		Day-time surgeries could face increased demand due OOH making patients wait.
8/7/04	DOCTOR	Chaos predicted over Q & O visits by PCOs. Referrals to Fraud Squad
		Failure to gain joint negotiating rights for GMS and PMS by GPC leads to PMS setting up their own organisation and a schism in representation of GPs.
12/7/04	PULSE	LMC agrees its GPs to do unpaid enhanced services if OOH starts half an hour earlier
		Staff to be made redundant as PCOs fail to provide cash
19/7/04	GP	Prevalence formula may decrease quality pay by millions because measure is by national practice average prevalence rather than national average prevalence of diseases. Av. practice loss £1000 this year, £1,500 next. Quality point value cut from £75 to ,£73. Loss to profession £18M over 2 years
		Harsh quality data collection timetable prior to PCO visits in October. Walshaw expects "witch-hunts" to find poorly performing doctors. GPs to bear own costs for the PCO visits.
		No benefit to retention because too much paperwork, administration, poor IT funding and training, reduced autonomy and increased government interference and targets
15/7/04	DOCTOR	Expected GP enhanced services money to go to pay pharmacists' new contract. GPC in denial of this.
		Pension rules still unclear
26/7/04	PULSE	Pensions: Practices will need to cover increased employers' contributions from own pockets because cash not included in global sums. Practices who "incentivise" staff by bonuses or pay increases will not be refunded pension contributions.
		Inter-practice divisions and resentments are fomented over points system as partners accuse each other of laziness. Partnership breakdowns expected as sanctions are built into new partnership contracts.
		PCTs cut funding for established clinics e.g,. thrombolysis in Cornwall.
		Ulster GPs sue PCOs for failure to continue to pay for staff hired since July 2003
2/8/04	PULSE	PCOs refuse to fund GP staff sick or maternity leave. All eventualities must come from global sum, say PCOs. GPs face large losses.
		GPC still refuses to define the "essential services" paid for by the global sum thus allowing PCOs to add to them at will.
		GPs fear quality visits will be witch-hunts
		Overall full-time GP numbers increased by only 8 since December 2003. Contract failure to attract.
7/8/04	GP	DoH "crackdown" on access target threatens GP pay by £3000 each. PCTs threaten to withhold funds. Some PCOs fiddle the figures to attain DoH targets
		Out of hours: insufficient funds from DoH and Health Select Committee complains PCTs are not involving GPs.
		Lack of GP consultation on IT
		Superannuation decision delayed as DoH fears GPs will fiddle the figures
		Further delays in Welsh community hospital pay talks. 95% GPs intend to quit.
	PULSE	Small practices at disadvantage over quality payments. GPC (Buckman) virtually said "Tough cheese" and abandoned them.
		"Contract threatens pastoral care " says Prof Roland who was GP adviser to the DoH over quality and outcomes!! Lack of time for everything.
		NHS Confederation to be replaced in negotiations by another DoH group. No disruption, they say. GPC fear they are wrong.
16/8/04	PULSE	Quality visits may breach confidentiality. PCOs have no guidance from ministers
		GPs invoke dispute procedures against PCOs who refuse to give ground on pensions, pay and staffing
13/8/04	DOCTOR	PMS GPs instructed by PCOs to sign new contract by 30 Sweptember or face cuts in pay.
		Pharmacists attempt to take enhanced services from GPs
31/8/04	GP	9/10 PCOs cannot fund out-of-hours when they must take over
6/9/04	PULSE	An increase in intra-partnership disputes over "not pulling your weight"
10/9/04	DOCTOR	Heavy-handed PCOs demand identifiable patient records to check quality claims. Confidentiality ignored
		Fife GPs to lose thousands by being forced to sign employment contracts by PCOs (without employment benefits) if they do shifts for OOH service. Therefore they are taxed at source, not as self-employed
13/9/04	GP	Patient consent needed for Q&O checks but GPs not to collect it, says MDU. PCTs say they have no resources to collect it.
		Lincolnshire PCT has no overnight GP cover.
		Appraisal may be linked to quality visits
13/9/04	PULSE	Experts say GPs lucky to get even 50% of hypertensives to hit target.
		PCTs offer "paltry rates" for OOH and GPs boycott them
		GPs still "in the dark" about Q&O visit advice
		Advice given to be tougher with partners over shirking. Splits develop.
20/9/04	GP	Health Secretary Reid guarantees Saturday morning surgeries
		Software faults will prevent GPs calculating pay until next year
		A & Es now busier due to new contract
24/9/04	DOCTOR	GPC/HMG pension agreement leaves GPs £1000 short. GPC happy. It'll be alright next time - says GPC.
		Global sum calculations chaotic. GPs either overpaid or underpaid
		26 "minor" changes made to Q&O framework just before visits start
20/9/04	PULSE	Some PCOs resort to threats and pleading to fill OOH shifts - Cornwall, Somerset
4/10/04	PULSE	OOH services face collapse in some parts of the country
		Quality reviews face chaos over access to records and confidentiality. Some GPs face two visits. GPCs tell GPs not to show personal details or break the law.
18/10/04	PULSE	GPs who are high referrers to achieve Q&O targets will have pay cuts
		GPs who are high prescribers to achieve Q&O targets to have prescribing freedom reduced. GPC allows "over-prescribers" to be docked Q&O points.
		OOH still in chaos in several parts of the country
		BP targets harming elderly patients by causing hypotensive crises
15/10/04	DOCTOR	A&E pressure increased by OOH implementation, claim
1/1//04	PULSE	Govt tells GPs to spend 40% of "quality pay" on their practices. GPC objects.
		Low "quality" scoring practices may be taken over by provate companies - says government.
		PCTs underfund enhanced services
		Pharmacies and others to take over GP enhanced services