Wednesday, April 15, 2009

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.

Tuesday, April 14, 2009

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.

Wednesday, April 08, 2009

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...

Thursday, March 19, 2009

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.

Thursday, January 22, 2009

Scarey stuff

Pandemic flu planning.

I'm in charge for my practice. I was quite relaxed until I started reading the official planning docs. Don't mean to worry you but thought you might be interested in some official figures. These are being used as a basis for planning and for once planning is on the basis of a worst-case scenario. But that shouldn't reassure you. That ranges are actually not that broad.

When it comes (as it inevitably will, we just don't know when) 50% of population is likely to get it (either in one or more than one waves, each wave lasting 8-15 weeks, with first wave peaking 50 days after the virus arrives in the UK, which in turn will be about 4 weeks after it erupts wherever). That's 30 million people.

25% will get complications. 7.5 million people.

4-5% will need hospitalising. 1.2 million people if its 4%. The UK has about 390 beds per 100k population, so about 234k beds.

1-1.5% will need intensive care. 300k. There are only 3500 ITU or high dependency beds in the UK including the specialist beds in cardiothoracic centres, trauma beds and the like. There a re a small number of paediatric ITU beds in addition to that.

2.5% potential mortality. That is three quarters of a million people.

Staff absence at any time (including health workers) expected to run at 25% (closer to 35% for smaller businesses) so fewer nurses/medics, tanker drivers, electricity engineers etc. Schools will be closed reducing the number of people able to work further. Of course, some people will not go to work to try and avoid exposing their families, which will make matters even worse.

Lets hope it doesn't come till the next century.

On a happier note, Panama by Van Halen is currently playing on Planet Rock...

Tuesday, January 06, 2009

National guidance and evidence base

I've been reading this:

Just out of interest really, as there seems to be a belief amongst certain noctors in secondary-care-land that GPs are filthy creatures who are responsible for a fair few MRSA infections.

Two main thoughts came to mind on reading the document.

Firstly, that most community acquired MRSA seems to be in people who've had recent contact with secondary care in some manner. Which is odd, as we seem to have a pelthora of posters up at the moment advising us to wash our hands at every available oppotunity so we don't kill people. I'm not aware of any evidence to suggest that GP surgeries are foci of infection, which this guidance would seem to support.

Secondly that the evidence base for this guidance is so poor. The vast majority of the recommendations throughout the document are graded as D (in other words, they are based on the opinions of the great and good rather than sound scientific data).

I can't help wondering whether HMG should be spending money on acquisition of reliable evidence for things like this rather than wasting it on white elephants (by which I mean NHS Direct, rating GPs on NHS Choices, Darzi centres and the like).