The Price on Your Head

One of the things that I’m learning from my CCG, is that away from the sharp end of patient care, where if you’re lucky enough to have an excellent GP like me, you are valued because you are a human being and a patient, to anyone further up the chain you are just a commodity.

Considering our CCG repeatedly tell us that they have no money, they have no control over how money is distributed to GPs etc, they are very, very keen to tell us how much we are all worth.

In fact, they know how much each and every one of us 2,418 patients are worth down to the last penny.

It is no lie to say that NHS funding is a minefield. When the CCG repeatedly told us when we met with them, that we didn’t understand, they were not wrong. The fact that they did spectacularly well at doing very little to help us understand did not make it easier, so please accept my apologies for any inaccuracies in this post.

What was clear is that there used to be two tiers of funding for GPs. One was called PMS (unfortunate acronym). The other is called GMS.  Apparently PMS was a much more complex way of working out what doctor gets what money for what patient. GMS, as I understand it, and do correct me if I am wrong, is a more level playing field.

As such,  it was decided that PMS should be phased out. GPs who were being paid on the PMS scale were given various options by which they could level their money to GMS standards. This is supposed to represent fairness and equality across the board for everyone.

I will not get into the figures that talk about how much more expensive it is to manage the health of a pensioner, or someone with a long term, chronic condition, than it is to look after your average hale and hearty person. That’s an argument for another time. This levelling is just the way it is.

One of the things the CCG do say they do, is try to make everything level for us. There was a lot of talk about fairness.

My doctor, they are keen to tell everyone from the milkman to the prime minister, is not being fair, because when PMS was a thing, he had it, and he had more money than other doctors in the city. He is, in fact, the third highest paid doctor in the city, per patient. He still has PMS funding, because he has chosen to lose his extra money in incremental chunks, year on year. This was an option that was offered by the NHS funding body, and he took it. It was perfectly acceptable for him to do this. Although you might be excused for thinking that it was akin to eating babies if you talk to those people who think it’s unfair of him.

There are other doctors in the city with PMS funding. We did not go into the fairness or unfairness of their salaries, specifically not the two people above him, or anyone else below him but still above what is now considered to be fair.

What is considered fair in the current market is about £70 per head.

That’s what all of us are supposed to be worth to the NHS funding bodies. I hope you’re feeling a warm glow about it. How special we all are.

I’m more special than you. This is what’s unfair. Currently I’m worth about £97, as are my 2,417 special friends.

I do feel blessed.

We are a valuable commodity to those people who see us as units to be moved around and cost savings that can be made.

Funding, you see, travels with patients.

To my current GP, I am worth £97. When he closes his surgery and I register with another GP, I will be worth about £70, because ‘fairness’, and all that.

What of the other £27 I hear you ask?

Good question.

The CCG do not set GP funding rates. The money travels from NHS England, through them, to the GPs. I am not sure why this is, if as the CCG say, they don’t have any control over what happens to that money. If this is so, why don’t NHS England cut out the middle man and pay GPs directly?

I can’t possibly be expected to know. I’m just a valuable commodity, not a clever one.

The fact is, that they don’t. So, when there is an extra £27 per person kicking around that has already been allocated to me and my friends, but will not go to my new GP, who gets that extra money?

I’ll let you guess.

I’m sure it will be used fairly.




12 responses to “The Price on Your Head

  1. At a recent CCG Board meeting Professor Farooqi said GP funding has been cut by 30% when compared to NHS spending as a whole. I read somewhere else that GP funding has been cut by £987million in real terms since 2010.
    I tried to work out what we would be worth to our GP if the level of primary care funding had been maintained without any reduction. I didn’t have enough fingers and toes to do the numbers, but I think we would be worth a lot more than £70 each and more than £97 too.

  2. I’ll try to shed some light for you tomorrow.

  3. This all makes my head spin…there are so many parts of this that I don’t understand. What I do know is that I thank sweet baby cheesus for my local GP who is wonderful and I also know that my mothers GP 30 miles away is a saint who has to deal with my aged mother morning noon and night via visits, calls, letters etc., and still gives her excellent care. What I also know is that over 30 years ago I worked in a large office alongside a busty blonde barbie lookalike girl that today we would call a gold digger….and she told me one day that she was leaving to go into the NHS….as she wasn’t medically qualified in any way I asked her what she was going to do…she replied ‘I’m going to get into admin and then management…that’s where the money is going to be in the future’…….I often wonder where she is now……………..

  4. So the thing that wasn’t supposed to be about money is in fact all about money. What a surprise.

  5. So the thing that was not supposed to be about money is in fact all about money. What a surprise.

  6. That is very factually inaccurate. Accidental or deliberate?l I don’t know. Surely if you are going to commentate on the NHS you should at least try to understand some of the basics right?

    FWIW, I am a doctor (not in Leicester) and it’s right that inequity between highly funded practices and those like mine are addressed.

    Two thoughts:
    a) if your GP is getting £97 per patient at the minute he’s lucky.
    b) if as you say he has 2,400 patients and is a sole practitioner I cannot understand how the practice is not viable.

    My practice in the north west of the country has just over 4000 patients and two GP partners with core funding of £80 per patient. More would be nice but we get by and make it work.

    By the way, the money the GP will be losing will be the increments ‘chunks’ he opted to lose when moving from the PMS contract to GMS. It won’t be on top of that. The other doctors you mention in your area on PMS contracts will also be losing chunks at the same time. He won’t be on his own.

    • Not really sure why you are so hostile. I clearly stated in my post that funding is complex. I clearly stated that this was as I understood it. I also clearly stated that we had met with our CCG to ask them to explain and they hadn’t. I also said I was happy to be corrected. So your comment about whether I am doing this deliberately smacks more of your own inability to read and understand what I’m saying and asking than my own. If I were doing it deliberately do you think I’d allow your comments out of moderation, which is entirely under my control? Have you read the rest of my blog posts about this situation? Because I’m fighting for front line GP primary care services like yours to stay open in communities. Ours is the third practice to close in two months. More are slated to follow. If I can help my GP, I can use what I learn to help others stay open by sharing that information. Maybe you don’t want that? I really can’t see why you wouldn’t want that.

      • Tarik I also suggest you check out our Facebook page Save Queen’s Road Medical Centre for the full story. I have no reason to criticise the funding policies of other CCGs, but perhaps if you saw the whole issue here you might be more understanding of my questions about ours. Unless of course you are actually in sympathy with them and they have asked you to engage with me to try and discredit our campaign. I would like to think better of them, and you of course 😀

    • And above all this Tariq chap doesn’t actually correct any of these alleged inaccuracies – just like the CCG he tells you you’re wrong, but doesn’t say what’s right. I look forward to his funding going down to £70 a patient. And you would have thought a doctor at least would have asked about the patient demographic at a surgery before commenting in this way.

    • If you had bothered to read a little bit more about why we are fighting, Tarik, if that is indeed your name, you would not gave jumped both feet first in this muck. There is a lot of research that has gone in, a lot of it is on our FB page. Our GP is losing a lot more than a few quid, he is losing the job he has held for 20 years. He is losing the practice that has been in his family for 3 generations. He is losing the his livelihood so he could support his family. I don’t care about PMS or GMS because as the end of the day, it is taxpayers money who are also losing their much respected GP. Given the money CCG seems to be brandishing is our taxes and therefore we are completely entitled to question them about how they are spending it. So asking us to shut up, is not going to work, neither is it fair. Btw, your post sounds very much like what CCG sends us, you sure you don’t work for them?

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