NHS Reforms
This is what I sent in as a response to the proposals for health reform by the coalition government:
"I retired as a GP just over 5 years ago after working in Castleford, West Yorkshire, since 1978 and before that in Cheltenham. I was a trainer, course organizer, GP Tutor and latterly Associate Director of Postgraduate General Practice Education at the Yorkshire deanery until I left to take up my PCT post.
I was employed part time by the PCT, until my retirement at the end of May this year, as GP Adviser, Protected Learning and Appraisal Lead. I ran the education programme for 250 GPs and locums and supported and developed 17 local GP appraisers. I was an appraiser myself and also a Quality Outcome Framework Medical Assessor. I have mentored many GPs in trouble. No one has ever doubted me when I say that I have talked face to face and at length to more GPs than anyone else working in the Wakefield District.
When fundholding was introduced I joined a group called “The Five Towns Family Doctors Forum” (I have left out the apostrophes on purpose!!) This was a group that was vehemently anti fundholding on ethical grounds We were forced to become fundholders - and I really mean forced - by the threat and actual withdrawal of staff by the then Health Authority. From 1994 to 1998 I was a board member and vice chairman of the Wakefield Multifund. The multifund was essentially a fundholding consortium of the anti fundholders. We had our own manager who did all the work. I got on with teaching and clinical work and was not the slightest bit interested in our fundholding status. We forfeited big money with this approach.
Some of the fundholders in this area made a serious financial killing. Any fundholding monies put into buildings owned by GPs would be a future personal financial gain.
I undertook mobility and attendance allowance examinations during the time of fundholding. I came across several patients of fundholding practices that I felt should have been referred to a consultant but had not been. There were patients I saw who had not had investigations undertaken. When the 1997 election was approaching I asked the then chief executive of Wakefield Health Authority whether he had any plans for fundholding being abolished by an incoming Labour government. He replied that they could not do that as it was well “set in”. The abolishing of fundholding was announced soon after the 1997 election results were declared. I was really happy with that.
As I mentioned above, I worked for the PCT part time for 6 years. The people I worked with were truly concerned about improving patient care. I have read the manifestos of both the Conservative party and the Lib Dems as well as the coalition document. There is no mention of abolishing PCTs. Rather there is a load of platitudes. What is the point of these documents with regards to helping one decide for whom to vote? They are a farce.
Andrew Lansley keeps repeating that the GPs he talks to don’t like the behaviour of the PCTs telling them what to do etc. Of course they don’t. It is normal for GPs to bellyache about management. (I gave a farewell presentation to the people I worked with at the PCT called “working for the enemy”!!)
What do I know about the GPs working in the NHS Wakefield District area?
There are about 250 GPs (and this includes locums) working in the Wakefield area. I have read each of their personal development plans for the past 6 years. I have also undertaken appraisals of over 40 different GPs over these years. I can count on the fingers of both hands the number of GPs interested in “management”. The vast vast majority are only interested in clinical care and improving their clinical knowledge and skills. The less than 10 GPs interested in financial stuff are the “old fundholding gang”. The majority of GPs in our area did not want to engage with the PCT in planning services despite being offered money for this work. Pockets will be lined again. GP Commissioning Groups will be mandatory and I imaging GPs handing over the responsibility for commissioning etc. to private companies. It will take 10 years for this change to be functional and cost billions. Fundholding, total purchasing, PCTs, PCTs merging, strategic health authorities and now this. I am glad I am retired.
One group of GPs in one practice has set up a company and it has bought practices in Leeds, practices further afield and out of hours centres.
Another GP, with a huge annual income, is also purchasing practices out of the area. I must say that all these activities are legal and have been allowed by the Labour government and the PCT. I know that the business activities of some GPs take them out from clinical activities and put a strain on the remaining clinicians in those practices. This will happen with working in consortia.
There are some reports that say that the Local Medical Committees (LMC) are mostly in favour of these proposals. That may be so. Our Wakefield LMC (of which I was a member as a GP educator for many years) does not truly represent GP’s views, in my opinion. It does not seek views. However, it certainly helps GPs in trouble and answers GP’s questions. Not one of my partners ever mentioned the LMC or its newsletter. I am sure they are typical.
The Labour government introduced targets for improving health care in the form of the Quality Improvement Framework (QOF). I was a PCT medical assessor for the past 6 years. I must have assessed over 30 different practices over the years. My job was to check that they had achieved the clinical targets they claimed they had achieved. The GPs did not complain about having to achieve targets. The main complaint of GPs was that “ticking the boxes” intruded into the consultation. If a patient goes along to the GP with a depression problem and has not had their weight, blood pressure etc measured according to the warnings put up by the QOF software these measurements are doe as they are linked to GP’s income – and it is a seriously huge amount of income. (It is interesting to note that being involved with the QOF is voluntary). However, I never came across a single GP who thought these targets were a bad thing as they were evidence based and led to seriously better outcomes. I personally think that the QOF was one of the best things the labour government did for patients and that this boosted GP’s incomes considerably was worth every penny.
There are some fantastic people working for the PCT and they truly have only one motive and that is to improve patient care. When fundholding was abolished, I think I can count on the fingers of one hand the number of primary care managers that lost their jobs. These were in practices that had used fundholding savings to pay for salaries. The abolishing of Primary Care Trusts will demotivate those working there in the transition period and result in huge unemployment. I have already been asked to give a reference for one of my ex PCT colleagues. Most GPs are unaware of the role of PCTs in improving patient care. Most GPs, for example, are unaware that there are 4 or 5 expert people managing the quality of care of the 100 plus nursing and residential homes and this includes looking at costs. I worked in the same open plan office as these people and they work extremely hard.
The proposals in this white paper if enacted will destroy the NHS.
18 members of my family have worked in the NHS as doctors
I know my comments will make not jot of difference to anything.
Here are the first and last lines of Ben Okri’s poem “Dancing with Change” 2007
"Change is good, but no change
Is better............
No change is good, but dancing
Gracefully with change is better”
Richard E G Sloan MB, BS, BSc, PhD, FRCGP
RSloan7798@aol.com"
This is what I sent in as a response to the proposals for health reform by the coalition government:
"I retired as a GP just over 5 years ago after working in Castleford, West Yorkshire, since 1978 and before that in Cheltenham. I was a trainer, course organizer, GP Tutor and latterly Associate Director of Postgraduate General Practice Education at the Yorkshire deanery until I left to take up my PCT post.
I was employed part time by the PCT, until my retirement at the end of May this year, as GP Adviser, Protected Learning and Appraisal Lead. I ran the education programme for 250 GPs and locums and supported and developed 17 local GP appraisers. I was an appraiser myself and also a Quality Outcome Framework Medical Assessor. I have mentored many GPs in trouble. No one has ever doubted me when I say that I have talked face to face and at length to more GPs than anyone else working in the Wakefield District.
When fundholding was introduced I joined a group called “The Five Towns Family Doctors Forum” (I have left out the apostrophes on purpose!!) This was a group that was vehemently anti fundholding on ethical grounds We were forced to become fundholders - and I really mean forced - by the threat and actual withdrawal of staff by the then Health Authority. From 1994 to 1998 I was a board member and vice chairman of the Wakefield Multifund. The multifund was essentially a fundholding consortium of the anti fundholders. We had our own manager who did all the work. I got on with teaching and clinical work and was not the slightest bit interested in our fundholding status. We forfeited big money with this approach.
Some of the fundholders in this area made a serious financial killing. Any fundholding monies put into buildings owned by GPs would be a future personal financial gain.
I undertook mobility and attendance allowance examinations during the time of fundholding. I came across several patients of fundholding practices that I felt should have been referred to a consultant but had not been. There were patients I saw who had not had investigations undertaken. When the 1997 election was approaching I asked the then chief executive of Wakefield Health Authority whether he had any plans for fundholding being abolished by an incoming Labour government. He replied that they could not do that as it was well “set in”. The abolishing of fundholding was announced soon after the 1997 election results were declared. I was really happy with that.
As I mentioned above, I worked for the PCT part time for 6 years. The people I worked with were truly concerned about improving patient care. I have read the manifestos of both the Conservative party and the Lib Dems as well as the coalition document. There is no mention of abolishing PCTs. Rather there is a load of platitudes. What is the point of these documents with regards to helping one decide for whom to vote? They are a farce.
Andrew Lansley keeps repeating that the GPs he talks to don’t like the behaviour of the PCTs telling them what to do etc. Of course they don’t. It is normal for GPs to bellyache about management. (I gave a farewell presentation to the people I worked with at the PCT called “working for the enemy”!!)
What do I know about the GPs working in the NHS Wakefield District area?
There are about 250 GPs (and this includes locums) working in the Wakefield area. I have read each of their personal development plans for the past 6 years. I have also undertaken appraisals of over 40 different GPs over these years. I can count on the fingers of both hands the number of GPs interested in “management”. The vast vast majority are only interested in clinical care and improving their clinical knowledge and skills. The less than 10 GPs interested in financial stuff are the “old fundholding gang”. The majority of GPs in our area did not want to engage with the PCT in planning services despite being offered money for this work. Pockets will be lined again. GP Commissioning Groups will be mandatory and I imaging GPs handing over the responsibility for commissioning etc. to private companies. It will take 10 years for this change to be functional and cost billions. Fundholding, total purchasing, PCTs, PCTs merging, strategic health authorities and now this. I am glad I am retired.
One group of GPs in one practice has set up a company and it has bought practices in Leeds, practices further afield and out of hours centres.
Another GP, with a huge annual income, is also purchasing practices out of the area. I must say that all these activities are legal and have been allowed by the Labour government and the PCT. I know that the business activities of some GPs take them out from clinical activities and put a strain on the remaining clinicians in those practices. This will happen with working in consortia.
There are some reports that say that the Local Medical Committees (LMC) are mostly in favour of these proposals. That may be so. Our Wakefield LMC (of which I was a member as a GP educator for many years) does not truly represent GP’s views, in my opinion. It does not seek views. However, it certainly helps GPs in trouble and answers GP’s questions. Not one of my partners ever mentioned the LMC or its newsletter. I am sure they are typical.
The Labour government introduced targets for improving health care in the form of the Quality Improvement Framework (QOF). I was a PCT medical assessor for the past 6 years. I must have assessed over 30 different practices over the years. My job was to check that they had achieved the clinical targets they claimed they had achieved. The GPs did not complain about having to achieve targets. The main complaint of GPs was that “ticking the boxes” intruded into the consultation. If a patient goes along to the GP with a depression problem and has not had their weight, blood pressure etc measured according to the warnings put up by the QOF software these measurements are doe as they are linked to GP’s income – and it is a seriously huge amount of income. (It is interesting to note that being involved with the QOF is voluntary). However, I never came across a single GP who thought these targets were a bad thing as they were evidence based and led to seriously better outcomes. I personally think that the QOF was one of the best things the labour government did for patients and that this boosted GP’s incomes considerably was worth every penny.
There are some fantastic people working for the PCT and they truly have only one motive and that is to improve patient care. When fundholding was abolished, I think I can count on the fingers of one hand the number of primary care managers that lost their jobs. These were in practices that had used fundholding savings to pay for salaries. The abolishing of Primary Care Trusts will demotivate those working there in the transition period and result in huge unemployment. I have already been asked to give a reference for one of my ex PCT colleagues. Most GPs are unaware of the role of PCTs in improving patient care. Most GPs, for example, are unaware that there are 4 or 5 expert people managing the quality of care of the 100 plus nursing and residential homes and this includes looking at costs. I worked in the same open plan office as these people and they work extremely hard.
The proposals in this white paper if enacted will destroy the NHS.
18 members of my family have worked in the NHS as doctors
I know my comments will make not jot of difference to anything.
Here are the first and last lines of Ben Okri’s poem “Dancing with Change” 2007
"Change is good, but no change
Is better............
No change is good, but dancing
Gracefully with change is better”
Richard E G Sloan MB, BS, BSc, PhD, FRCGP
RSloan7798@aol.com"
posted by Ivan at 4:16 AM
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