The reason why so much new money has done relatively little for the quality of the NHS is that so much has been wasted. This is part and parcel of how state monopoly services tend to operate.
One of the ways in which money has been wasted in the NHS appears to be in paying GPs more than is necessary to retain their services. Of course it is also true that the NHS has increased the amoung of money that is necessary to retain their services by making the job less satisfying and more bureaucratic. So there has been a double-whammy of extra cost.
This is from a good article in the Sunday Telegraph detailing quite a few examples of waste in the NHS:
There is no doubt that GPs have been the biggest winners of the boom in NHS spending, which has increased by £22 billion over the past four years. In 2003/04, the last year before GPs were put on to new performance-related contracts, they worked according to a contract that gave them an intended annual income of £61,000.This year, admits the BMA, GPs are taking home an average of £94,000 a year, making them the best-paid in the world outside the United States. Moreover, many have simultaneously managed to cut their workload dramatically. Until 2004, GPs were responsible for 24-hour care of their patients. They didn't have to be on call at night, but if they opted out they were obliged to provide cover out of their own pockets.
Under the new contracts, by contrast, GPs can opt out of being on call at weekends and during evenings by giving up just £6,000 a year of their pay. But they can quite easily more than make up for this in other ways. GPs are now paid on a points system called the Quality and Outcomes Framework. Points, each worth £125 a year, can be earned, for example, by monitoring diseases and providing advice.
For example, GPs can earn an annual bonus of £8,472 if they record whether patients with heart disease or asthma are smokers and offer them advice on giving up smoking. Compiling a register of diabetics, taking their blood pressure and treating their symptoms can earn a GP a further bonus of up to £11,587.
"The system was predicated on the basis that GPs would get 700 or 800 points," says Dr James Le Fanu, a GP for 20 years. "But it quickly became clear that it was not very difficult to start getting 1,000 points a year, which is where salaries of £125,000 a year come from. What's more, GPs are earning this extra money for doing things that they should have been, and most were, doing anyway. Paying GPs to meet targets is a very bureaucratic view of what the health service should be about. Being a GP is not just about measuring blood pressure. It is about sitting down with people and talking to them."
Posted by James Bartholomew • Indexed in NHS • Waste in public services
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James,
You should see Dr Crippen on this topic. He thinks it is nuts too.
PG
Posted by: The Pedant-General at April 24, 2006 08:50 PM
Yes, he does think it is mostly nuts.
I am in a well-organised, patient orientated, computerised practice. Earning QoF points for us was money for old rope. At least 75% of the information was there at the press of a button on the computer. Yes, we have done some chasing, and juggling, but mostly this was about data presentation, not healthcare.
It enabled us to achieve a 20-25% pay rise over two years.
Sadly, we are not earning £250,000 or anything like it...but nonetheless we have done well.
And, yes, certainly, the out of hours committment has gone. This is the government's fault for being so cynical and disbelieving about the amount of work we did. The OOH night committment was onerous beyond belief. The governemt thought that we were doing bugger all at night and that few doctors would "sacrifice" £6000 a year to get out of this minor committment. In fact, 98% of the profession walked.
Now the government is faced with paying a market professional rate to get doctors to work these nights. And they cannot afford it. They had it on the cheap for years, and now they have been caught out.
Hence NHS Redirect and nurse/emt run walk in centres. Cheapo cheapo productions.
I am happy to be well paid. Obviously. I am human. But this is nonesense. They could have paid us to do something related to healthcare - but that does not go with the Stalinist control freakery of the nationalised monolith of the NHS
John
Posted by: Dr John Crippen at April 24, 2006 11:03 PM
No co-incidence then that my 75 year old father has suddenly been diagnosed with diabetes - along with half of the rest of the over 60's at his local practice.
Posted by: Mark T at April 26, 2006 11:30 AM
Mark, what is your point?
Statistically, it is nonesense to suggest that 50% of the over 60 year olds are diabetic.
So, the GP practice should already have screened most of the elderly for diabetes; my practice had; but there is no doubt that we have unearthed one or two who we might not have found so soon were it not for the targets.
If we are discuss this rationally, it is only fair to say that some of the targets were sensible and have produced improvement in health care.
The stupidity was that many of the targets were not as sensible as the diabetes ones, and in any case, the governemnt was just paying us to present data that we already had.
The point is, the money could have been much better spent; and were the NHS run more on the lines of a private company, that might have happened.
John
Posted by: Dr John Crippen at April 26, 2006 01:31 PM
Because the Labour government of 1945 nationalised the infrastructure along with the health insurance aspect, we ended up with a monopoly in provision. This has now resulted in a 'reverse monopoly' where GPs know that the monopoly cannot work without them, and so they negotiate from a stong position. I do not blame the GPs (and have said so on Dr Crippen's Blog), but I solidly blame the monopoly that is NHS provision. Split the two up! Make the NHS trusts truly trusts and unhook them from government and allow the people to decide which scheme they use to run their health service and the Trusts compete for provision to the insurance providers.
Posted by: Tim at May 2, 2006 09:30 AM
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AS far as being careful with cash is concerned New Labour aren't new at all. I think the New bit must refer to its authoritarian policies which are reducing our fredom.
Posted by: simon at April 24, 2006 07:14 PM