GPs Pose £2bn Threat To Commissioning Budget

Letter to HSJ

Dear Editor

In many ways, I am comforted. I know exactly where GPs stand in relation to the rest of the NHS and the journals supporting it. There is no longer any pretence, no longer subterfuge; it has all now become transparent and explicit. GPs with budgets and brains attract loathing from the NHS' remaining constituent parts. And so it was the case with GP Fundholders and those dear to them.

The above article in today's edition of the HSJ is another piece of scaremongery and seeks to mislead all who read it, as many have already commented electronically. The pitfall is to believe the figures reflect the performance of practices and PBC groups. The analysis is fatally flawed. The sample was of 2000 practices, when there are around 8,300 practices in England; it only looks at 25% of the PCT budget and fails to take into account the whole budget. Most PCT acute budget deficits are offset by the remaining 50% of PCT revenue budgets. Any residual financially failing PCTs' budgets are offset by other PCTs' budgets, top-sliced by Strategic Health Authorities, resulting in net savings nationally (for 200/910).

Many PBC groups were forced to take on their PCTs' overspends when they were allocated budgets at the same levels as the previous financial year, with an uplift for PbR. The reasons for overspends can be multifactorial:
• Provider over-performance against contract;
• Poor PCT contract management of acute activity and poor performance management of PBC groups;
• Excess of patients presenting at A&E rather than utilising OOH provision and other services;
• Toolkit ineffective in establishing correct budgets - huge variations in PBC budgets for practices with same populations of similar size and same providers;
• PbR ties activity into set costs;
• Data is mainly 3 months old;
• Huge swings in elective activity at practice level, which even out over a three year period

To manage activity and to manage budgets require timely, accurate data and MONTHLY budget statements - without this data how can the NHS seek to improve the services it commissions, manage activity, improve variation and stay within budget. At least GP Commissioners will insist upon the information when the responsibility is theirs. There yet remains hope for the NHS and its patients - GPs will rescue them from some of the worst excesses of mediocrity and apathy.

Yours sincerely

Maggie Marum
Independent Consultant