Monday, February 04, 2008

GPs' Opening Hours

Labour have showered GPs with cash yet left them seething

Under Labour, the average pay of NHS GPs has more than doubled. You'd think they'd be tickled pink. In reality, relations between GPs and the government are even worse than under the evil skinflint Tories.

Following their mega pay deal and truncated opening hours, GPs are now under the cosh. And today Commissar Johnson has written directly to all GPs, circumventing their trade union altogether. He's told them the customers are v unhappy about non-opening hours, and they'd better follow his new instructions. No matter that the commissars' crackpot pay deal was directly responsible for the present mess, Johnson says:

"Significant numbers of patients consistently tell us that improving access to GP services should be a priority for the NHS."

Sheesh! Who'd have thought customers might want easy access to services?

That much maligned GPs' pay deal was of course a key part of the new Soviet system, the Quality and Outcomes Framework (QOF), designed to give the commissars greater control over what GPs actually do.

Quite simply, QOF means points, points mean prizes, and outstanding performers can even qualify for the Star of Lenin (second class). By awarding points for undertaking approved monitoring and treatment regimes, the commissars reckoned they could bolt those hopeless poorly informed GPs firmly into their grandiose National Health Plan.

The reality has turned out rather different. The GPs being just a tad smarter than the commissars, they took those QOF points, span them round, and suddenly- without sacrificing any income- they were able to dump their hated unsocial hours into the laps of the Primary Care Trusts, with the customers left wondering WTF had happened.


Now, soundly walloped by all and sundry, the bumbling commissars are crying foul. They might have been comprehensively outplayed, but they want a second shot.

Johnson is offering the average practice an additional £12 grand pa if they'll open an additional 3 hours per week. £12 grand? Talk sense, will ya? Today's plutocratic GP wouldn't wipe his bottom on £76.92 per hour (actually, although that's the commissariat spin, we should remember that money has to cover not just the GP's own pay, but the full cost of keeping the surgery open).

Al clearly understands £3 grand isn't enough so he's also planning to reallocate 58.5 QOF points away from "indicators that are no longer needed" to reward GPs specifically for improving the "quality of service".

Quite apart from the worrying loss of services that "are no longer needed" (by whom?), how on earth will Johnson judge quality of service? An excellent question. He'll do it however he damned well likes, although to preserve the usual niceties, all decisions will be validated by plebiscite (aka customer satisfaction surveys) that he will run. It is top-down bureaucracy masquerading as a customer driven market.

Finally, as the GPs have been pointing out, the commissars' evidence for customer dissatisfaction with current opening hours is very weak. They had MORI conduct a customer survey just last year, and despite the curtailment of opening hours they found 84% satisfaction (see here on the DoH website). As per, the commissars are spinning regardless of their own "evidence" (HTP Stephen D).

What a convoluted deadweight spaghetti coil mess. No wonder the GPs are fuming.

Now entertain conjecture of a time, when creeping murmur and the poring dark no longer fills the wide vessel of universal healthcare. The NHS does not exist. We don't need the commissars to tell GPs how their customers are feeling. The customers make their feelings known to GPs directly.

They look at opening hours, they look at quality of service, and they look at price. They switch their business if they think they can do better elsewhere. No fuss, no central direction, no planning bureaucracies and interminable negotiations, just the straightforward operation of the market.

For GPs it's brilliant: they are free from the commissars, and just need to keep their customers happy.

For us customers it means services that give us what they want, rather than what the commissars bungle us into.

And another NHS thing...

We've blogged the widespread NHS use of expensive agency nurses many times (eg here). It costs us well over £1bn pa, and reflects a wholesale inability of NHS managers both in staff planning, and retention.

Today we got an update on the extraordinary pay rates the NHS splashes around on temps:

"The highest figures included £121.10 an hour for a nurse at Chesterfield and Royal Hospital NHS Trust and £111.96 for a nurse at Salisbury NHS Foundation Trust. The highest hourly rate for a non-clinical worker was £119 for a turnaround director at Coventry Teaching Primary Care Trust, followed by £110 for financial staff at Heatherwood and Wexham Park Hospitals NHS Trust and £106.66 for a director of healthcare and procurement at Havering PCT."

Now imagine you're an ordinary NHS nurse on maybe £15 per hour. How do you feel about working next to an agency nurse on £120.

Hmm. Thought so.


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