February 14, 2013 • 12:08 pm

For some time now, at the entrance to one Surrey GP, patients have been confronted with the following notice:

“Why is it getting harder to get appointments?

Due to a massive increase in workload caused by the changes within the NHS we are struggling to cope with demand. This is compounded by a huge cut in funding and the fact that we are required to keep our list open. We are also facing a massive influx of patients from neighbouring practices, whom we are again required to accept on our list.

We are now at a point where demand outstrips any ability to cope with workload.”

The pressure at this practice is attributed variously to “changes within the NHS”, “a cut in funding” and “a massive influx of patients from neighbouring practices”, and it’s implied that patients are noticing an impact on their service. 
 
Interestingly, the GP practice claims that it is “required” to keep its list open – in other words, to accept new patients who wish to register – even if this is to the detriment of its existing patients.
 
According to the NHS Choices website, a GP surgery is within its rights to refuse new patients if its list is already full. We contacted the Department of Health to ask whether this guidance had changed. A spokesperson issued the following statement: 
“All GP practices are expected to make sure they protect the needs of their patients and plan their patient numbers according to capacity. GPs are paid for the amount (sic) of patients they register; they should make the judgement when their lists are full. No practice is expected to keep lists open beyond its capacity.” [emphasis added]
On its website the Surrey practice explains that it faces a shortage of available doctors at the same time as it must cope with an increase in its workload. It’s possible that even when it’s already over-subscribed a GP surgery ends up accepting new patients onto its list in order to balance its books. We don’t know if that’s the case here. But what this example does show is that the Government is in the process of overhauling general practice, and this in turn is likely to impact upon how family doctors treat their patients. 
 
What’s been proposed?
 
At the beginning of the year the Department of Health outlined the changes it would be consulting on. These included:
 
- “equitable capitation funding for practices” or, in plain English, GPs receiving a standard sum of money for each patient in their care;
- a range of “new and improved indicators” for the Quality Outcomes Framework (QOF) – a system whereby GPs receive financial rewards for meeting certain targets;
- less money for administering the Quality and Outcomes Framework, with these funds diverted into improving the assessment of people with dementia, managing unplanned hospital admissions and using technology to monitor the health of people with chronic illness.
 
Is the plan “bad for doctors, bad for patients and bad for general practice”?
 
That’s the verdict of the General Practice Committee of the British Medical Association (BMA), the trade body that represents the interests of doctors. It argues that while the planned changes to the GP contract have been designed to achieve efficiency savings (of some 4%), the Government has failed to consider the fact that many GP practices are already feeling the strain. For GPs up and down the country the result will be “significant increases in their workload”. 
 
Today’s Daily Telegraph explained how the medical profession has criticised the proposals.
 
The Family Doctor Association is adamant that the changes will involve a “serious loss of resources”. Meanwhile, as part of its response to the Department of Health’s consultation, the BMA sent out more than 25,000 survey requests to GPs in England.
 
Of the 8,000+ GPs who responded to the survey, two thirds admitted that they would need to change the way that they manage patient services. While they said that their most likely course of action would be to reduce the cost of employing administrative or clinical staff, more more than half of those planning changes (a third of all those surveyed) said they would reduce access to patients. It’s also possible that under the reforms GPs will see a reduction in their take-home pay.
 
The Government appears to be determined to see through the reforms. If the new GP contract is introduced, it will coincide with GPs being handed control of a greater percentage of the NHS budget. From April, all 152 of England’s Primary Care Trusts (PCTs) will have been replaced by 211 new Clinical Commissioning Groups (CCGs). These CCGs will be led by GP practices and GPs themselves will be in charge of purchasing care for their patients (“commissioning services”). This means that GPs will be in control of a much larger portion of the NHS budget.
 
Many GP practices are already run like small businesses, with GPs being paid according to the services they provide. And GPs are certainly not the first group of employees to complain about being over-worked and under-paid. But in the NHS the stakes are certainly higher, and in the coming months there will be close scrutiny of the reforms to general practice. The Government will be hoping that the Clinical Commissioning Groups, the beating heart of its Health and Social Care Act, prove to be a success. How GPs rise to this challenge might yet determine how the general election in 2015 is decided.
 
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