PCT Funding of Leatside

Devon Primary Care Trust (PCT) has recently sent us some information about the amount they pay to GP Practices for ‘core’ services.

We receive from Devon PCT £62.90 per patient for your health care.

The National average is £59.41 apparently, so you might think we're not doing too badly.

But.. Devon PCT offers a wide range of funding per patient to different Practices. The very lowest is a Practice in North Devon with £60.01 per patient and the highest funded is in Exeter with £112.83 per patient. Yes!... twice as much as we get for your care.

We were wondering as a practice how this has come about.

Most of the higher-earning practices in Devon currently(but not all) negotiated a few years ago to take up a new contract to provide health services to the PCT.
In Totnes we were, and have always tended to be, a little bit cautious so stayed on the old contract known as GMS (General Medical Services).

The idea was that the newer contract would have allowed the PCT to stray from national rules on funding and agree local arrangements.

The purpose of this was said to be to allow local flexibility- allowing practices to get funding for local problems or needs. PCTs were happy with this as they assumed that this would translate into better care for the patients and presumably fewer hospital appointments; as local needs were being met locally.Clearly the amount paid to practices did then begin to vary as can be seen in the disparity of funding mentioned above.

Oddly this doesn’t necessarily seem to be the case now with many Practices that currently receive a higher level of funding still making greater than average use of hospital services and Practices such as ours with lower funding sending people to hospital less often.

What seeing these sorts of figures has done of course is to make us look a bit at what extra services we do provide our community for the relatively meagre funding (for Devon).

Firstly there are a range of services we provide on the NHS for which we receive no funding at all. This includes things like initiating insulin prescribing for newly diagnosed diabetics; dermatoscopy of worrying skin lesions; treating minor injuries; allergy scratch testing; some acupuncture; Doppler studies and compression bandaging; removing blood for therapeutic reasons; intravenous infusion of drugs; and insertion of Mirena coils for mennorhagia. This list is not exhaustive and if we didn't provide these services our patients would have to travel to hospitals such as Torbay to get this care.

Secondly there are a range of services we provide for which we do receive some NHS funding but where we offer a higher level of service than the funding provides for. This includes things like the range and quantity of diagnostic tests we offer including ECGs, 24hr blood pressure monitoring, cardiac event monitoring and arrhythmia analysis; our long opening times, direct access to doctors on their personal telephone numbers and ‘check in’ screens at reception for your convenience; enhanced and personal care of people with chronic lung disease to improve the quality of their life and prevent hospital admissions; and health screening of young children. Again this list is far from exhaustive and the consequence of us not doing these things often would be people travelling to hospitals such as Torbay for their care at far greater cost to the NHS.

Having basked a bit in the warm glow from the good stuff, I do wince a bit still about our telephone system which could probably be better. When we have the spare £7-8,000 for a new better one we'll consider it. It is a key interface between you and us and should be better. We'll be looking for now at how to improve the system we have for now.

So where is this going?

Well, at the end of the day this funding issue is important because it affects our ability to invest in new equipment to improve the service we offer; as well as determining the number of doctors and nurses we can employ which in turn affects things like the availability of appointments.

For this reason we would like to get additional funding for our Practice to at least the level of the average Practice in Devon. Unfortunately the PCT is in a financially poor situation at the moment and doesn’t appear able to agree to do this directly. They might be able to provide additional funding however if we are able to help them make savings in other areas of their budget for example the cost of the drugs we prescribe or the cost of hospital care when we have referred you to a specialist.

There is nothing new in GPs having to think about whether a prescription or referral is necessary and cost has always come into that, but more on a global, “saving the NHS funds” basis - never so directly linked to funding of services in our Practice.

Which leaves us on the horns of a dilemma..

.. on the one hand we know that it might be possible to make the savings the PCT wishes by changing the way we work but on the other hand we feel anxious that if the patients were aware of this they would be concerned they were receiving sub standard care because of our efforts to save NHS money.

It is absolutely clear from the PCT however that if we do save them money by referring less that this will not and can not translate into additional personal income for the partners in the surgery.

Before starting to discuss these points with the PCT we would really like to hear what you think.. are we right to try and get more funding?.. would we be right to reach an agreement with the PCT for additional investment in the Practice in return for savings elsewhere?.. and how would you like to see us improve: more appointments, a better phone system, a treatment or service we don’t currently provide, or…?

Let us know by commenting on the blog...

Transplants

There has apparently been stuff in the press about getting GP practices to more actively campaign to get patients enrolling in the national organ donor scheme, so I thought I'd make a few jottings on transplants.
27% of the population, or 16million people are currently enrolled to donate organs in the event of their death (including myself).
There are currently 380 patients on the waiting list for a transplanted liver- 38 of them under 25.
I personally was delighted last month when the department of health banned private transplants as i feel confidence in the system to work fairly was undermined constantly with the knowledge that some rich foreigner, paying for it, might take your relatives kidneys.

I think, and it is my experience, that when people agree to donate the organs of a dead loved one they have an idea that they will be doing someone some good.

It is the one good thing people can take away from what is almost always a terribly traumatic time.
There is a sort of expectation as well that the person receiving the organs will appreciate them and try and "do well" as a result.

It doesn't always turn out quite like that. I'm sure George Best meant to do well with his new liver, but just didn't really manage to.
Liver transplant units do have a proportion of patients who have damaged livers through drink or overdose. I remember my first day as a Medical SHO in Leicester General Hospital (August 1993), the Nurse explaining to me urgently that a young lady in one of the bays had had a marked deterioration in her liver over the weekend due to a paracetamol overdose and that she might bleed to death if not treated urgently. After discussing this with the patient she really did seem concerned now to try and live, so my first duties in this job were to arrange her urgent transfer to Birmingham liver unit under Prof Neuberger. Their doctors were and are very used to making sensible, if difficult, decisions on who is likely to make the best fist of it if a new liver comes up.

One in three of all kidney transplants now are from living donors- eg parents to children.
You may know already that our nurse Ali Cull donated a kidney some years ago to her son Pip who was on dialysis.

In a study looking at the reasons why people aren’t signed up to the NHS Organ Donor Register, the over 55s were twice as likely as the rest of the population to say they didn’t think they would qualify as suitable donors. Professor Neuberger, now Associate Medical Director at NHS Blood and Transplant, said: “The belief that there is some sort of age limit on becoming an organ donor is a complete myth. Organs are successfully transplanted from people in their 70s and 80s and the oldest cornea donor recorded was 104 years old. There are also very few illnesses that prevent someone from donating their organs after death – that’s why we would encourage anyone who wants to sign up to the NHS Organ Donor Register to do so and ensure those close to them are aware of their wishes.

So I guess the message is- get youself on the organ donor register. Do it online now. A link to their website here. Or call, local rate, on 0300 123 23 23