Practice Boundaries: a proposal

Text of a press release follows:

BMA sets out its proposal for how to reform general practice boundaries


The BMA today (Tuesday 26 January 2010) sets out its solution for how to reform GP practice boundaries* and make it easier for patients to see a GP in a place and at a time that is more convenient.

The government wants to abolish practice boundaries by October 2010 and the Conservatives have said they want patients to be able to register with the practice that best suits them (near their home or work). A government consultation on practice boundaries is to start shortly.

The BMA paper, Reforming General Practice Boundaries, explores the possible consequences of completely abolishing practice boundaries and suggests a solution which, while not a total abolition, would significantly improve choice and access for patients without the huge cost, upheaval and unintended consequences that completely free registration would cause.

Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, said:

“Complete free choice of registration is a good idea in principle and we want patients to be able to choose the GP surgery that is right for them. However, we don’t want it to come at the expense of continuity of care or for it to lead to increased risks for vulnerable patients and a widening of health inequalities.”

The BMA believes that total abolition of practice boundaries could have a number of unintended consequences. Examples of issues that would need to be addressed in advance of completely free registration include:

* How to reform the home visiting system so continuity of care for patients, who are registered with practices far from their home, isn’t affected
* Current IT projects, such as the electronic patient record transfer project, would need to be accelerated so GPs could have access to full patient records in order to make safe clinical decisions
* How to avoid widening health inequalities – this could happen if frail people or those without access to private or affordable public transport are not able to access practices further from their home, while others can
* Systems would need to be put in place to protect and track ‘at risk’ patients who could be vulnerable if they are regularly re-registered at practices not within their social services boundary
* Funding arrangements for GP practices would need to be reformed to ensure that, with increased movement and changing patient demographics, funding for all practices is fair and equitable
* Popular practices that had reached the limit of physical capacity would need to be helped to improve their premises in order to match patient demand
* Primary Care Trust (PCT) funding would need to be completely changed in a way that would take into account the impact on hospitals and social services. This would be extremely complex if the patient lived in one trust but registered in another.

The General Practitioners Committee’s solution is to combine a series of local improvements with a national change in the current “temporary resident” arrangements. Local solutions should include permitting the widening of the boundaries of all practices in an urban area so patients have greater choice, the introduction of videophone and webcam consultations, as well as formally allowing patients who move outside a practice boundary the option of staying with their GP. The change in the temporary resident arrangements would mean unregistered patients could be treated by a distant practice on an ‘ad hoc’ basis whenever necessary, while their normal GP practice would still oversee their care. It would have the added benefit of encouraging patients, who might otherwise inappropriately attend A&E, to go to the nearest GP surgery instead.

Dr Buckman added:

“Getting rid of practice boundaries altogether is fraught with difficulties. Having worked through various alternatives, we believe this solution is the best option for the health service at this point in time. Not only will it be the most cost effective solution, it will also serve patients far better. They will get more choice and are less likely to be adversely affected by the new set of problems that total abolition would create.”

An explanation

Hello, been a while.

Someone noted that I haven't blogged for a while. I thought I should explain.

I have been busy. I am now very much part of the establishment, being Chair of East Sussex Local Medical Committe. Additionally, in June of last year, I was elected to the General Practitioners Committee of the BMA for a year. I am not sure whether I will get re-elected this year, time will tell.

As a result, given I do not (and have never) blogged anonymously, I partly have no wish to cause our negotiators difficulty by commenting publically on matters political, but mostly I have less time to post and comment.

Consequently, my blog has fallen by the wayside almost entirely. I spend sufficient time discussing medico-politics during the day, one way or the other!

On which note, I'm hoping to start using my camera more as a means of relaxation, so you might get some photos on here, interspersed perhaps with the odd bit of politics.

(By the way JD, it was nice to be missed. Thank you. That also to the few dozen people (or at least aggregators) who have persisted in checking my blog every week.)

Flickr

This is a test post from , a fancy photo sharing thing.

Darkness at the Heart of the Labour Party

I don't normally re-blog what others have, but this one is illuminating.

A greek chap I read pointed me to the blog of Frank Field MP.

"Harold Wilson asserted that the Labour party was a moral crusade or it was nothing. The McBride affair has left Labour members looking at nothing. That is the reality check that McBride has wrought on the party.

The whole of the government's energy should be spent on governing now and building a programme from which, within and year, we will be seeking permission to rule for another five years.

Far from helping sketch out a new roadmap, the McBride activities shine a searchlight on the paucity of the government's programme."

Please, go and read the rest.

How to work out your increase in funding

This one is for GMS GP readers (and possibly practice managers, I've no idea if any of those read my blog).

What does the DDRB recommendation mean for your practice? I was rather confused initially, so after working it out (with some help including an illustration by Dr David Shaw on DNUK) I wrote a very short paper to share with others.

So here it is. A quick guide. Except that I wrote it in Word to start with and discovered that copying and pasting from Word into HTML is an interesting experience, one that I will try and avoid in future. Anyway, I retyped it here.

How to work out your GMS funding

There are 4 components to it:

1. Global Sum (GS) increases by 2.4%
   
2. Global Sum Equivalent (GSE) which equals the GS plus your correction factor (if you are an MPIG Practice). This increases by 0.7%
3. QOF points increase by 1.7%
4. Enhanced services (ES) funding increases by 1.7%

For non-MPIG practices, your GS goes up by 2.4%, QOF and ES go up by 1.7%. Simple.

For MPIG practices, it is slightly more complex. Obviously the QOF and ES bits are the same, increasing by 1.7%. But for the rest of it, keep reading:

• Calculate both your new GS and your new GSE.
• If the uplifted GS exceeds the uplifted GSE, you move off MPIG (congratulations).
• If not, the GS component of GSE is uplifted by 2.4% and the CF is likely to drop to give an overall increase in GSE of 0.7%.
  

What this actually means in practice is that your Practice Manager will be able to see if Primary Care Support Services are paying you what they should each month.

Obviously your QOF and Enhanced Services monies will vary from practice to practice, but you should (at least) be able to work out how much each QOF point is worth to you practice. Ask your LMC rep if your PCT is uplifting the Enhanced Services Floor by 1.7%. They should be.

A couple of worked examples to illustrate differing magnitudes of CF:

Practice 1

• GSE £101,000, made up of GS £100,000 and CF £1,000
• GSE increases by 0.7% to £101,707
• But GS uplift gives £102,400
• This is bigger the GSE, so you no longer have a CF and you move off MPIG.

Practice 2

• GSE £110,000, made up of GS £100,000 and CF of £10,000
• GSE increases by 0.7% to £110,770
• GS uplift is also £102,400
• CF=GSE-GS, so =£8370
• So the net effect is an increase of 0.7% with a decrease in reliance on MPIG with a reduced CF (goes down by £1630)

Addendum: the CF is recycled into the GS, so as more Practices move off MPIG, there is no loss of money from the overall pot.

A decade

I really haven't been very good at keeping up with this blogging lark.

Part of the problem is my decision at the outset NOT to be anonymous. Consequently, much of the material others publish is not possible here as I have no wish to identify anyone, even if inadvertently, that I have seen in surgery.

Nevertheless, this week marks my tenth year at Manor Park. I think that deserves a mention.

I initially wrote a long piece about my time at the practice so far but frankly it was boring. However, the fact is that it can be summarised quite briefly: The patients keep coming because they need us, we are seeing more and more people all the time, I am still enjoying the clinical side of things greatly. The admin side of things gets increasingly onerous as time goes by. The "light-touch, high-trust" contract which was brought in in 2004 has proven to be anything but, though we are much luckier in our relationships with our PCT than many.

I have seen many changes in the last 10 years, some of which have happened to me and some of which I have been instrumental in.

The gradual adoption of our computer system's facilities has been a very significant change, one which I initially led. We now have a website as well, where patients can pre-book appointments and request repeat prescritions.

The new contract in 2004 was an eye-opener. Initially I can confidently say it improved matters in Primary Care. However, as is the nature of these things, the consequences (intended or otherwise) are playing havoc with General Practice, not helped by a predatory and antagonistic Government who seem to feel the need to grind us into submission when all we want to do is do our job. This despite our patients constantly supporting us in whichever survey you care to mention.

I have also been an active member of the East Sussex Local Medical Committee since 2000. I suppose this makes me a politician. I try my best to contribute in a meaningful way, though it is for others to say if I am successful. Whether any of those others read this blog, though, I have no idea. I can't see the pointing in whinging about things if you're not prepared to do somethig about it. So I try to.

I've also changed in the last decade. My experience base has grown. My practice has, too. I've been divorced, remarried and made a father again. I swear (a bit) less, laugh as much as I ever did (quite a bit) and I think I am both more considered by more adamant in my viewpoint and espousals. I guess I've grown up some more.

Anyway, I'm starting to ramble.

I will try and post more frequently...

Self confidence

"I'm a Normandy veteran you know. Yeah, I won the war.

Well, me and another bloke, but he was rubbish."

I love these old veterans.

Darzi and coffee

Honestly, he really has no idea, does he.

(With thanks to Hairy Aerosol for the image)