Blog post by Dr Email Shehadeh
OH DEAR, Oh dear. According to the Mirror, The NHS is being robbed by GP’s who are collecting money for unregistered patients! This was mentioned in a comment on my last blog. To be more precise, four GPs have been charged for cheating. And the remaining 33,000 GP’s? Let’s see!
There is no equivalence between waste and abuse of appointments by the public on the one hand (the topic of my last blog) and a handful of cheating GP’s on the other. There are corrupt people in every walk of life.
The waste of appointments has gone on for many years and no politician has had the moral mettle to confront the public. By contrast cheats are a tiny minority, who usually and fortunately are brought to justice.
There is a distinction to be made between cheats registering patients who do not even exist, and GPs who have people on their list who hardly ever use the surgery, or who, for whatever reason have moved on or died and have not been removed from the GP list.
Recently our local health authority carried out a sweep of patients registered with GP’s. They wrote to those who have made no contact with their GP in three years. If such patients failed to respond, they were automatically removed from their GP lists. Was that fair?
The per capita fee of £66.00 per year is based on the assumption that the average patient consults their GP 3.4 times/year. This is an average, which covers those who consult their GP 30 times/year as well as those who may consult their GP once in 10 years. So it could be argued that the sweep is sheer robbery and is in breach of the agreement on registration. If the NHS were not cheating GPs, they would pay additional fees for frequent consulters, and no lack of such patients. £66.00 means that the average consultation costs the NHS about£17.00. If one takes into account nursing appointments, and time spent processing letters, prescriptions and results and the running of a practice, each appointment is paid at £8.00. This is cheap labour. Who is cheating whom?!
As for patients moving to another area, if the practice is not informed, the practice would not know. Usually, when patients register with another GP, their new GP will trigger a mechanism, which will result in their records being moved to the new GP, and their deduction from the old GP list. There is a whole load of bureaucracy between the old and the new GP’s. Anything can go wrong in the process, including unfair deduction of active pateints. Why blame the old GP for something not under their control?!
We actively pursue anyone who does not respond to invitations for regular checks, as they actually lose us money by preventing GP’s from reaching targets set by the NHS. If such patients fail to respond, we remove them on the basis of breakdown in communication. So it is not in the interest of GP’s to keep unresponsive patients on their list.
The registration of overseas patients is a mess. As of April 2013 we were instructed to register anyone who asks to be registered without checking their eligibility. However, a hospital could refuse to treat overseas patients who are not entitled to treatment. So GP’s hands are tied; they have to register overseas patients without demanding evidence of entitlement. Are we surprised that there are more registered patients than live in the UK. Blame out spineless stance on immigration!
As usual there is another side to this story. The NHS robs GP’s of money on a daily basis. The NHS has invented this new creature called the “weighted-list”. In other words if you have a 1000 patients on your list and this includes a higher number of elderly patients than average, you may be paid for 1100 patients. Conversely if your list includes a lower than average number of elderly, you will be paid for 900 or even 800 patients, even though you are looking after 1000 patients.
It is known that deprivation creates more work for GP’s. Deprivation has several determinants other than age. Yet the NHS in Essex chooses age rather than deprivation as a determinant of workload, because they wish to pay GP’s less. Every year my practice is denied payments for about 150 patients we actually look after, because although we are in the 2% most deprived parts of England, we have fewer than average elderly patients. This costs the practice £10,000.00/year. What a fine way to reward hard work. What an example to industry; If you want to reward your workforce, rob them of their hard earned cash!
If the NHS were to base the weighted list on deprivation, we would be paid a lot more than average. Although deprivation is a fairer way of measuring work load, the NHS in Essex chooses to ignore it, because they want to pay GP’s less. Then they brag about making savings. In reality they have robbed GP’s of money they have earned fairly. Nationwide, the NHS has recently announced that deprivation will not be used to calculate the weighted list till 2015. In the interval, my practice will have been well robbed by the NHS.
Let’s look at extended hours. Mr Brown, very much in the news for underhanded tactics, forced GP’s to do extended hours, that is evening clinics, by taking away some £7,500.00 from the average practice unless GP’s offered ½ hour, during out of hours, of consultations per week for every 1000 on their list. This is forced labour. But he got away with his underhanded tactics. I have recently calculated that by working from 06:30 pm till 8:00 pm, I am making about £30.00/hour. Get a plumber to work for that rate after hours!
Talk about cheap labour! Look at phlebotomy (taking blood samples for laboratory tests), a service we have offered in general practice for almost 2-3 years now. The NHS pays my practice £ 1.60 /blood samples taken and spun. A nursing hour costs the practice about £22.00. In one hour, a nurse can take 8 samples of blood. Assuming all patients attend their appointments, this equates to £2.75 per sample taken. Assuming half the patients do not turn up, this amounts to a cost to the practice of £5.5/patient, which adds up to an average of £4.12. In other words, the NHS pays my practice less than % 40.00 of the actual nursing costs incurred, let alone handling/processing costs. Is it my mission in life as a GP to fund the NHS?!
Besides, GP’s have only just had the first uplift to their contract value in eight years. For all these years we have had to increase our staff pay, take on their superannuation, absorb the increase in NI employer’s contributions and the additional telephone and energy bills, without any increase in practice income. As the BMA has recently reminded the government, investment in General practice has declined by £400M over the last few years. All the while the NHS has got more and more and more out of GP’s. We are not far from the snapping point, which will be the topic of my next blog.
The NHS is not the victim, but the offender. It is not the robbed, it is the robber. There are cheats in every profession, including General Practice. However, on balance it is the NHS who cheats GP’s, not the other way round, not by a long shot. Worse still, whilst a handful of GP’s cheat secretly, the NHS cheats GP’s openly and brazenly by unfair exploitative policies only fit for the age of slavery.