He told Danny Alexander MP, Chief Secretary to the Treasury, the prospect of industrial action was something doctors did not take lightly but they were ‘too angry to allow the unfairness and scale of the changes to remain unacknowledged’.

Dr Meldrum said having been radically overhauled less than four years ago, the NHS pension scheme was in good financial health, and currently provided £2billion annually to the Treasury.

The cost-sharing agreement reached at the time ensured that any increase in contributions needed in the future would be met by employees not the taxpayer.

Argued Dr Meldrum: ‘Tiered contributions mean the lower paid are better protected, but these are not logical if we are to move to a CARE scheme for all employees. Furthermore, the employee contributions are far higher in the NHS scheme, with doctors being asked to pay twice as much for the same pension as their civil service equivalents’.

He said the Public Accounts Committee had only pointed out last year that the 2008 reforms to the scheme were bringing substantial savings to taxpayers, with relative costs set to continue to decrease well into the future.

‘The Committee also rightly warned that another sharp increase in contributions for NHS staff, or a significant increase in the retirement age, could destabilise the largest public sector pension scheme, increasing the burden on the state, and creating problems with retention of senior staff’.

16 FEBRUARY 2012

With news of the Health and Social Care Bill facing further challenge in  the House of Lords, Cambridgeshire GP Dr Peter Bailey called on Health Secretary Andrew Lansley to now scrap it.

The former LMC chair and former vice chair of the Local Commissioning Group in Cambridge claims GPs are being ‘set up’ as they are asked to take over jobs previously done at PCTs without sufficient skills or time to do so, whilst simultaneously trying to save £20bn.

Writing in bmj.com he tells of the work the group and Cambridgeshire PCT did as recognition grew that the NHS (‘of which I was so proud’), faced financial crisis in the coming years. Through collaborative work on pathways, PCT managers, GPs and hospital consultants showed how costs could be contained. 

They met with the Health Secretary to explain how local practices were working to improve efficiency and reduce spending in the NHS.

But when the Health and Social Care Bill finally arrived, says Dr Bailey, the proposal that PCTs should be abolished altogether came as a surprise, especially in the light of the successes that had been achieved within the existing structures. 

GPs were invited to become pathfinders while the Secretary of State’s role was to be reduced to becoming a ‘promoter of the provision of health services rather than responsible for them’.

He says ‘setting the NHS free was the slogan, but what it was really about was setting the politicians free’.

Dr Bailey writes: ‘By the time the professions really understood the Bill much of the damage was already done’ with PCT mangers looking for other jobs and those who remain hoping for continuing employment in advisory groups.

He and his colleagues now stand ‘baffled in the wreckage’.

15 FEBRUARY 2012

RCGP chair Dr Clare Gerada claimed on Twitter at the weekend that everyone was at risk of ‘getting lost in the mess of the debate – the rhetoric, spin and politics’ surrounding the Health and Social Care Bill.

With more and more column inches being devoted to the arguments, over 1,000 amendments to the Bill, and Health Secretary Andrew Lansley facing mounting criticism, it is a good time for any confused AISMA member to go back to basics. In plain English, just what are the opponents worried about?

Healthcare commentator Roy Lilley (roy.lilley@nhsmanagers.net) has today issued a list of seven reasons why he says the Bill should be opposed and which he is happy to be passed on.

He says:

The Bill replaces three levels of management (DH, SHA, PCT) with Seven; (DH, NCB, 4 Clustered SHA, 50 Commissioning Support groups, 300-ish CCGs, Clinical Senates and HealthWatch.)

1. GPs cannot ‘do commissioning’; it is too complex, they can’t fit it in part-time and look after patients. They can and should influence local commissioning decisions.
2. The complexity of buying healthcare is recognised by the DH who have invented Commissioning Support Organisations (not in the Bill), to help. They are intended to be private companies who will decide what healthcare we can have and pocket any savings.
3. The Coalition has not saved millions in bureaucracy; they have shifted costs by sacking really experienced people who are now being re-hired to commission care on behalf of GPs.
4. No one is really worried about the ‘private sector’ per-se. But, if you spend £100 on healthcare in the NHS you get one hundred quid’s worth of healthcare less about 5% management costs. In the private sector you’ll get a hundred quid’s worth less 3% management costs, 5% profit, 12% to pay bank loans and charges, plus a chunk for bonuses, dividends and return for investors. And, no provision for what happens if they go broke or get fed up.  
5. There is no increase in patient choice; we are all stuck with our local GP who is stuck with his local CCG who are stuffed into CSO’s who will decide what we can have and when we can have it. All the decisions about us are being made without us.
6.  The NHS will function perfectly well without the Bill; it is performing pretty well now and can coalesce around what it is doing. But, waiting times are on the way up and we are getting fatter and older. The Bill does nothing about any of that and the Service should be allowed to concentrate its efforts to meet those challenges

13 FEBRUARY 2012

They say they are exploring every possible avenue to reach an agreement and stave off the first ballot on industrial action by doctors since the 1970s.

BMA Council chairman Dr Hamish Meldrum has held a meeting with Health Secretary Andrew Lansley to try and persuade him to get back around the negotiating table with the health trade unions.

And the Association is planning an emergency debate next week on where to go next. If there is no further progress with the Government then a ballot is seen as the likely initial outcome.

Meanwhile an e-petition submitted to the Number 10 website is urging the Government to reopen pension talks to try and find an amicable settlement.

If the petition is accepted for the website, and enough BMA members sign it, then this could trigger a Commons debate.

Efforts to find a solution came as GPs were warned they were having to now pay more for their NHS pensions than originally intended when total responsibility and funding for GP pension employer and employee contributions switched to independent contractors.

BMA head of pensions Andy Blake told members at the weekend: ‘Because practices are liable for the employer contributions, additional funding to meet these increased costs has theoretically been made available. In GMS practices, this is through an increase to the global sum. In PMS/section 17c practices, this extra money comes through the baseline allocations.

‘However, this funding was not expanded as it should have been and as had been anticipated. It would therefore be fair to say that the employer element of GP pension contributions is now only part-funded at best’.

13 FEBRUARY 2012

The MDDUS warned the bid to increase patient choice raises serious concerns for doctors over accountability and continuity of patient care.

The UK-wide medical indemnity organisation believes patients with complex health problems could face difficulties under plans to allow people to choose a GP in a location remote from their home address.

The pilot scheme is being launched in England in April 2012 and will operate in parts of London, Manchester and Nottingham.

In theory, it may seem reasonable to give patients the choice to register with a GP near where they work or close to their children’s school instead of in the area where they live, agreed the MDDUS.

But its medical adviser, Dr Barry Parker, believes the initiative could impact on doctors and their ability to provide continuity of care.

He said: ‘The flexibility of the proposal would work well for patients who normally enjoy good health and those looking for short-term intervention for something straightforward, such as an ear infection.

‘However, patients with complex health problems undoubtedly benefit from having a single source of care provided by a dedicated practice team that knows them well.

‘Doctors are focused on the day-to-day practicalities of providing care. The government proposals raise concerns which could jeopardise the quality of that care given to patients. By relaxing practice boundaries, there are potential consequences for both doctor and patient.’

One possibility within the initiative would allow patients to remain registered at a practice near their home and have consultations as a ‘day’ patient at another practice. The other option available would be to register as ‘out-of-area’ patients, meaning they would have to rely on their local PCT cluster for care when at home or out of hours.

Both of these patient choices present a significant challenge to continuity, said the MDDUS.

Said Dr Parker: ‘One of the main advantages of receiving care from your local GP is that there is no doubt as to who is responsible for treatment and follow up care of patients.

‘A local GP is also more likely to be able to build up a relationship with their patient and understand the social context and environment of the patient and their family.’

He believes it is essential that where care is split between two sources, communication channels must be very efficient and comprehensive. ‘Actions such as prescription of drugs, treatment plans and referrals must always be co-ordinated to avoid confusion, or duplication. Otherwise patients could inadvertently be prescribed medicines that interact with each other, or receive excessive supplies. Referrals and investigations could be initiated in one practice but with no clear agreement on who is responsible for ensuring follow up.’

The latest guidance from the Department of Health on the GP practice boundary pilot states: ‘We anticipate that people who register further away from home under the pilot arrangements will typically be working-age adults without complex health problems, who are less likely to require home visits. The NHS nonetheless has a clear duty of care to people who fall ill at home and need urgent care. All PCT clusters will need to ensure they have arrangements in place to meet these needs.’

Dr Parker said most patients valued their relationship with their local GP and it may well be that they were unlikely to change if given the choice. If they did then GPs in participating practices should ‘remain alert’ to the various pitfall possibilities.

6 FEBRUARY 2012

It claimed the changes had not done enough to address the underlying problems of the Bill.

The Bill returns to the House of Lords on Wednesday 8 February and although the BMA acknowledges that the Government has made some effort to try to address some of its concerns it says in a briefing to Peers today that the Bill remains fundamentally flawed and should be withdrawn.  

Association Council chairman Dr Hamish Meldrum said the latest improvements did little to address issues of concern to doctors such as an over reliance on ‘market forces’, which remained at the core of the Bill.

There was excessive control over commissioning groups, plans for incentives for commissioning were ill-thought through, and proposals to give hospitals more scope to generate income from private patients posed serious risks.

He said: ‘The Government has had to make so many amendments to remedy the initial flaws in the legislation and has brought in so many checks and balances that the level of complexity and bureaucracy in the new NHS will be huge. It would be better to withdraw the Bill altogether and come up with a new plan – one that will actually improve care and make the NHS more efficient’.

6 FEBRUARY 2012

PulseToday reported accountants were warning GPs had been hit hard by the introduction of the 50% tax rate for earners over £150,000 and the loss of the personal allowance for those earning more than £100,000.

AISMA chairman Bob Senior said the personal allowance change meant that GPs operating in the £100,000 to £112,000 tax bracket were effectively now paying 60% in tax.

He said: ‘If you look at that band there are a lot of GPs caught by that. That is a really big tax rate.’

A survey by some accountants found many GPs were boosting their outside income. Over half saw their total income rise by an average of 21% in 2010-11, the website said.

It added: ‘But those GPs saw tax increases far outstrip the rise in earnings, with an average rise of 41%, while a secondary category of GPs making up a quarter of the sample experienced an average 7.14% fall in earnings but a 5.94% increase in tax owed.’

GPs had to submit tax returns for 2010/11 by 31 January this year, GPs are taxed on their overall earnings, including practice profit shares, extra work such as locum or out-of-hours shifts and non-NHS income. Rosemary Smith, director at RS Medical Accountancy, said many GPs had taken on extra work or boosted their income from other sources to plug falling practice income.

3 FEBRUARY 2012

The study will be run by The Forum of Private Business which has teamed up with its member Frank Taylor and Associates, an agency for dental professionals.

They have joined forces to find out dentists’ investment prospects and the issues they face, including their views on industry red tape, spiraling costs, employment plans, skills and training and communications.

The research is being carried out as part of the Forum’s Get Britain Trading campaign, which aims to raise awareness of the huge importance of small firms and address the barriers preventing them from growing.

Dentists are being asked how they plan to develop their practices over the coming year – including whether they anticipate being forced to cut costs, hiring more staff, improving patient service or introducing new products and services – and also what factors they believe will help their businesses to grow.

Earlier Forum research into the ‘cost of compliance’ with red tape showed that complying with regulations now costs smaller firms a total of £16.8 billion per year – with tax compliance top of the list at £5.1 billion per year and external legal consultants pocketing £5.8 billion annually – so dentists are also being surveyed on their industry’s regulatory requirements and to discover how much they pay consultants.

They are also being asked to detail the main cost burdens that are preventing their businesses from growing – a further survey on costs carried out by the Forum recently revealed widespread high energy, transport and raw materials costs over the past year have impacted negatively on small businesses.

Further, dental practices are being surveyed about skills gaps within their profession and their training and investment plans for 2012 as well as preferred methods of contacting customers and communications issues they come up against.

Forum chief executive Phil Orford said: ‘Perhaps dental practices are not as readily associated with commercial activities as other businesses but they are an established profession and play an important part in the UK’s economy. It is essential to understand their plans and what drives dentists to grow and innovate – as well as what holds them back.’

3 FEBRUARY 2012

The College announced its decision in the wake of the amendments to the Bill laid down in the House of Lords on 1 February.

Despite the number and extent of the amendments, the College remains concerned that the Bill will cause irreparable damage to patient care and jeopardise the NHS.

Three quarters of respondents to a poll carried out by the RCGP said they thought it appropriate to seek the withdrawal of the Health and Social Care Bill. The last of three surveys commissioned by RCGP Chair Dr Clare Gerada, the poll found that GPs are increasingly concerned about the Bill and the effect it poses to patient care.

But the College held off from calling for wholesale withdrawal, instead writing to Health Secretary Andrew Lansley using the survey results to reiterate its concerns and provide another opportunity for changes to be made.

The subsequent responses from Earl Howe and the Health Secretary, and the amendments presented to the House of Lords, have prompted today’s decision.

RCGP Chair Dr Clare Gerada said: ‘This decision was not taken lightly, but it is clear that the College has been left with no alternative.  We have taken every opportunity to negotiate changes for the good of our patients and for the continued stability of the NHS, yet while the Government has claimed that it has made widespread concessions, our view is that the amendments have created greater confusion. We remain unconvinced that the Bill will improve the care and services we provide to our patients.

‘Our position has not changed, and the concerns we expressed when this Bill was at the White Paper stage 18 months ago have still not been satisfactorily addressed. Competition, and the opening up our of health service to any qualified providers will lead not only to fragmentation of care, but also potentially to a ‘two tier’ system with access to care defined by a patient’s ability to pay. 

‘We support a greater role for GPs in the planning, design and delivery of services within their local communities, but as the organisation representing the views of over 44,000 GPs, we cannot support a Bill that will damage the care and services that GPs deliver to patients and ultimately bring about the demise of a unified, national health service. 
‘Our view is that what is required now is to rapidly consolidate the current organisational structure, such that PCT clusters remain, with GPs placed as the majority of the Board so that we may address the serious issues facing our NHS. There should be a debate as a matter of urgency to determine what the NHS can provide, how it should be funded, and how we deal with the major health and social care problems facing our population.

‘We cannot sit back. Instead, we must once again raise our concerns in the hope that the Prime Minister will halt this damaging, unnecessary and expensive reorganisation which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt.

‘We will continue to do everything we can, both as a College and in partnership with our colleagues in the Academy of Royal Colleges, our nursing colleagues and across the wider health and social care sectors, to bring about change for the good of our patients and preserve the principles of the NHS that has served millions of patients so well for over 60 years – a universal healthcare service, free at the point of need.”

BMA REACTION

The BMA welcomed the RCGP’s call for withdrawal of the Health and Social Care Bill.

Chairman of BMA Council Dr Hamish Meldrum said the College’s statement ‘surely scotches, once and for all, the Government’s claims that there is professional support for this deeply flawed, damaging and unnecessary legislation’.

He said although GPs and other clinicians supported the concept of clinically-led commissioning, they did not believe this expensive upheaval of the health service was needed to achieve that.

‘If the Prime Minister really wants to put clinicians in control he should listen to what they are saying – louder and louder each day – and put this increasingly confused legislation out of its misery.’

3 FEBRUARY 2012

‘No win no fee’ companies are said to be behind the rise – but now doctors face an increase in interest from insurers’ own lawyers.

Defence bodies have warned them to expect more inquiries about their reports from the insurance industry as it tries to clamp down on rocketing claims.

Last week, LIVE magazine told how claim firms were making a fortune from bogus claims, which are resulting in huge rises in everyone’s car insurance.

One anonymous GP told The Mail on Sunday he found lawyers were increasingly interfering with doctors in order to change their medical assessments of a patient.

He said: ‘If a doctor sends a report saying that the patient’s injuries will recover in two weeks, then the lawyer writes back saying the patient will need longer, say six weeks. This is because they can make bigger personal injury claims.

‘I was recently approached by a medical agency that acts on behalf of lawyers who handle accident victims. The agency told me they would like me to give a prognosis saying a patient will take a year to recover from whiplash. I declined.’

The Mail on Sunday is continuing its investigation and has appealed for anyone facing an outrageous claim following a minor road accident to get in touch.

30 JANUARY 2012