NHS Changes - consultants
Discussion
The whole NHS change thing is quite complex but I would like to focus on one aspect on this thread.
Andrew Lansley was just on Newsnight saying they definitley WILL save money as PCT wasted so much money, example being £150m on consultants when PCTs were meant to be so called experts.
As I understand it a lot of these PCT people will now move onto working with these GP consortia.
The other issue is that GPs will end up with lots of work they possibly don't want/understand. If that is the case surely they will just end up having to spend huge amounts of money not only on employing managers and possibly said PCT people but they will also probably end up employing consultants anyway.
Will they just end up with less money to spend on consultants and be forced to go without?
Andrew Lansley was just on Newsnight saying they definitley WILL save money as PCT wasted so much money, example being £150m on consultants when PCTs were meant to be so called experts.
As I understand it a lot of these PCT people will now move onto working with these GP consortia.
The other issue is that GPs will end up with lots of work they possibly don't want/understand. If that is the case surely they will just end up having to spend huge amounts of money not only on employing managers and possibly said PCT people but they will also probably end up employing consultants anyway.
Will they just end up with less money to spend on consultants and be forced to go without?
Edited by Mojooo on Monday 12th July 23:30
Mojooo said:
The whole NHS change thing is quite complex but I would like to focus on one aspect on this thread.
Andrew Lansley was just on Newsnight saying they definitley WILL save money as PCT wasted so much money, example being £150m on consultants when PCTs were meant to be so called experts.
As I understand it a lot of these PCT people will now move onto working with these GP consortia.
indeed. the good ones hopefully. seriously, have you any idea how many people the average PCT employs? GPs wont employ 5 people to do something one person should be doing alone.Andrew Lansley was just on Newsnight saying they definitley WILL save money as PCT wasted so much money, example being £150m on consultants when PCTs were meant to be so called experts.
As I understand it a lot of these PCT people will now move onto working with these GP consortia.
Mojooo said:
The other issue is that GPs will end up with lots of work they possibly don't want/understand. If that is the case surely they will just end up having to spend huge amounts of money not only on employing managers and possibly said PCT people but they will also probably end up employing consultants anyway.
Will they just end up with less money to spend on consultants and be forced to go without?
again see above. The point really is that at the moment someone interferes with ALL health decisions. GP consortia may well decide they want (for example) a finance manager, and a social services consultant etc.... i.e. getting in specific skills they don't have. but they wont have a load of people making the same decisions twice in all the 'normal' areas - which is both annoying and costly. Terms like Management seem to automatically conjure up a random picture which MUST involve people in suits 'doing those sort of things' - but most management in healthcare is making sure patients come in, get diagnosed, get treated/referred, are made well and are done. And that's what GPs are already responsible for doing. PCTs basically just did it as well (and took care of lots of things which will indeed still be outsourced, but will now saves money and bureaucracy and therefore time Will they just end up with less money to spend on consultants and be forced to go without?
)the burning question i spose is can those things really be done with significantly less people? especially when they cover less number of population - you are right that a GP practice will not employ all those extra people - will they crumble under the burden?
i spose 1 massive bodge up at a PCT mgiht be easier to rectify than 20 bodge ups at 20 different GP thingys dotted aroudn the country.
i spose 1 massive bodge up at a PCT mgiht be easier to rectify than 20 bodge ups at 20 different GP thingys dotted aroudn the country.
It is going to be a distaster in the short term. Some of the Doctors are capable of organising the finance side but there are thousands who are not.
There are so many things to go wrong, when you arfe faced with an old patient, will some Drs be tempted to not spend the money. At the moment they can blame nice for not funding expensive drugs, but when it is their budget will they take the hard options.
All the PCT's will go in 4 years, and many of the staff will still be involved in the commisioning of services and overseaing the budgets as before, except they will be working for Doctors. The excesses of the NHS will still exsists, they will still have 10 personnel managers for every one a normal company will have, they will still have managers but now they will be c hasing the Doctors for the cash, good efficent hospitals will grow and bad ones will get less patients, this will not give paitents the service they need but it will be cheaper.
There are so many things to go wrong, when you arfe faced with an old patient, will some Drs be tempted to not spend the money. At the moment they can blame nice for not funding expensive drugs, but when it is their budget will they take the hard options.
All the PCT's will go in 4 years, and many of the staff will still be involved in the commisioning of services and overseaing the budgets as before, except they will be working for Doctors. The excesses of the NHS will still exsists, they will still have 10 personnel managers for every one a normal company will have, they will still have managers but now they will be c hasing the Doctors for the cash, good efficent hospitals will grow and bad ones will get less patients, this will not give paitents the service they need but it will be cheaper.
one of the things i nave noticed about NHS changes over the last 22 years is that when these "radical" changes occur very few personalities actually dissappear, they may move to a different office and have a different job title but apart from some folks who decide enough is enough and walk away there is not much of a staff reduction.
The providers of the services will still have levels of management to govern how the organisation works, the GP's are a good influence as they are essentially small business people who understand buying what you need from the best suppliers.
The major winners in nhs reorganisation are the local printing companies and those folks who make name badges, office signs and design logos, all of whom will be kept bust for a while.
The providers of the services will still have levels of management to govern how the organisation works, the GP's are a good influence as they are essentially small business people who understand buying what you need from the best suppliers.
The major winners in nhs reorganisation are the local printing companies and those folks who make name badges, office signs and design logos, all of whom will be kept bust for a while.
Mojooo said:
the burning question i spose is can those things really be done with significantly less people? especially when they cover less number of population - you are right that a GP practice will not employ all those extra people - will they crumble under the burden?
i spose 1 massive bodge up at a PCT mgiht be easier to rectify than 20 bodge ups at 20 different GP thingys dotted aroudn the country.
It will not be single practices but groups. i spose 1 massive bodge up at a PCT mgiht be easier to rectify than 20 bodge ups at 20 different GP thingys dotted aroudn the country.
Can't really see how this is going to save money as most GPs don’t have the time, inclination or knowledge to commissioning services themselves. All that will happen is that the GP Practices, as part of their 'Clusters' or consortia, will employ the commissioners from the defunct PCTs to do this work on their behalf, but because there will be more clusters than there were PCTs even more 'Managers' will need to be employed..... and then once this has been going on for a few years they will see how large the management costs are and set up cluster-wide commissioning units, then county-wide etc et voila you effectively have PCT commissioning again in all but name. This has happened before with GP Fundholding which then changed to Primary Care Groups and then PCTs.
I can see how quality of care might improve as GPs will be able to commission more local and relevant services for their patients, but as for saving money, I'm not quite sure.
Another thing to consider is that it could make practice budgets very sensitive to expensive/ill patients. Just one newly ill individual could effectively take up the entire budget for a practice such as haemophiliacs, people with renal failure requiring dialysis or cancer patients requiring chemotherapy and expensive drugs. In the last few years, GP Practices have had budgets but these were only 'pretend' budgets as it was the PCT that would benefit from an underspend on services or cough up the extra money needed for an overspend. I wonder how GP Practices or Clusters would/could deal with this.
Oh and the BMA and the GPs will have to renegotiate their contracts to reflect this extra responsibility should the GPs actually work on commissioning health services themselves and I can't imagine that GP's time is particularly cheap to buy......
I can see how quality of care might improve as GPs will be able to commission more local and relevant services for their patients, but as for saving money, I'm not quite sure.
Another thing to consider is that it could make practice budgets very sensitive to expensive/ill patients. Just one newly ill individual could effectively take up the entire budget for a practice such as haemophiliacs, people with renal failure requiring dialysis or cancer patients requiring chemotherapy and expensive drugs. In the last few years, GP Practices have had budgets but these were only 'pretend' budgets as it was the PCT that would benefit from an underspend on services or cough up the extra money needed for an overspend. I wonder how GP Practices or Clusters would/could deal with this.
Oh and the BMA and the GPs will have to renegotiate their contracts to reflect this extra responsibility should the GPs actually work on commissioning health services themselves and I can't imagine that GP's time is particularly cheap to buy......
Edited by Royster on Tuesday 13th July 09:56
fatboy b said:
Mojooo said:
example being £150m on consultants when PCTs were meant to be so called experts.
These weren't the consultants doing the operations were they 
Edited by fatboy b on Tuesday 13th July 07:34
but no, he was referring to management consultants
Royster said:
Can't really see how this is going to save money as most GPs don’t have the time, inclination or knowledge to commissioning services themselves. All that will happen is that the GP Practices, as part of their 'Clusters' or consortia, will employ the commissioners from the defunct PCTs to do this work on their behalf, but because there will be more clusters than there were PCTs even more 'Managers' will need to be employed..... and then once this has been going on for a few years they will see how large the management costs are and set up cluster-wide commissioning units, then county-wide etc et voila you effectively have PCT commissioning again in all but name. This has happened before with GP Fundholding which then changed to Primary Care Groups and then PCTs.
It will save money as it will initially lead to the removal of vast numbers of irrelevant and useless managers. There will be fierce competition amongst current PCT staff to be employed by new GP consortia to help them manage. Crucially, the head of these consortia will not be a faceless manager with no clinical experience, but a GP who understands the health needs of the local area, which means that funding will be appropriated more sensibly.Royster said:
Another thing to consider is that it could make practice budgets very sensitive to expensive/ill patients. Just one newly ill individual could effectively take up the entire budget for a practice such as haemophiliacs, people with renal failure requiring dialysis or cancer patients requiring chemotherapy and expensive drugs. In the last few years, GP Practices have had budgets but these were only 'pretend' budgets as it was the PCT that would benefit from an underspend on services or cough up the extra money needed for an overspend. I wonder how GP Practices or Clusters would/could deal with this.
GPs will run as consortia hence they will have a pooled budget which will encompass the very ill patients. They are under obligation to care for these patients in best practice guidelines and cannot make decisions to the detriment of such patients for the sake of cost. Royster said:
Oh and the BMA and the GPs will have to renegotiate their contracts to reflect this extra responsibility should the GPs actually work on commissioning health services themselves and I can't imagine that GP's time is particularly cheap to buy......
I'm not sure that will be the case as GPs already form the PCT committees, so I don't think it will necessarily change their roles.Edited by Royster on Tuesday 13th July 09:56
968 said:
GPs will run as consortia hence they will have a pooled budget which will encompass the very ill patients. They are under obligation to care for these patients in best practice guidelines and cannot make decisions to the detriment of such patients for the sake of cost.
Yet they can't overspend - so when Great Aunty Mable needs a very expensive life saving operation at the end of the financial year, what happens?The thing is, this 'vast number of irrelevant and useless managers' will all need to be made redundant which can't be cheap in itself. Also, the movement of commissioning responsibility to the multiple clusters or consortia from the single PCTs would create more jobs for commissioning managers, not less, as the GP practices would need to hire them in to 'help them manage'.
Whilst I think that more clinically-led commissioning could be a good thing in terms of patient care, I'm not sure it's the best in terms of value for money. What's best; a clinician with limited Commissioning/NHS Finance understanding in charge of purchasing healthcare or an NHS Commissioner/Finance-type with limited clinical understanding purchasing the healthcare? I don't know, really.
I understand that the GP practices will run as consortia, they already do to some extent as clusters and super-clusters, only this time the money will be real and they will be much smaller than PCTs and therefore more sensitive to overspend. A haemophiliac costs about £1m a year to look after; so if a child was born with said disease within a consortia made up of small, perhaps single GP practices, this could have a huge effect on referring patterns for their other patients as they may think that they need to save money in other areas to compensate. I understand that there is a code of best practice and that there is an obligation to treat patients, but if a patient presented at their GP complaining of frequent sore throats or ear infections, a GP whose budget was being compromised by an expensive patient *may* just prescribe some generic antibiotics or painkillers to temporarily treat the condition, whereas a GP at a practice without such constrictions may refer the patient on to an ENT acute service. Could be the same with mental health, I suppose; would it be 'here, have some happy-pills' for the overspending consortia or 'let's get you some CBT treatment' for the within-budget consortia. I think it could just be a case of the postcode lottery as per the PCTs only at consortia level.
In terms of the GPs, I can't believe that they will take on the responsibility for commissioning without wanting to renegotiate their contracts to reflect this. The healthcare needs of just a single practice population are so vast and varied; I can't see that this can be done without recruiting a whole swathe of commissioners/ finance people for each consortium to do this work for them.
Whilst I think that more clinically-led commissioning could be a good thing in terms of patient care, I'm not sure it's the best in terms of value for money. What's best; a clinician with limited Commissioning/NHS Finance understanding in charge of purchasing healthcare or an NHS Commissioner/Finance-type with limited clinical understanding purchasing the healthcare? I don't know, really.
I understand that the GP practices will run as consortia, they already do to some extent as clusters and super-clusters, only this time the money will be real and they will be much smaller than PCTs and therefore more sensitive to overspend. A haemophiliac costs about £1m a year to look after; so if a child was born with said disease within a consortia made up of small, perhaps single GP practices, this could have a huge effect on referring patterns for their other patients as they may think that they need to save money in other areas to compensate. I understand that there is a code of best practice and that there is an obligation to treat patients, but if a patient presented at their GP complaining of frequent sore throats or ear infections, a GP whose budget was being compromised by an expensive patient *may* just prescribe some generic antibiotics or painkillers to temporarily treat the condition, whereas a GP at a practice without such constrictions may refer the patient on to an ENT acute service. Could be the same with mental health, I suppose; would it be 'here, have some happy-pills' for the overspending consortia or 'let's get you some CBT treatment' for the within-budget consortia. I think it could just be a case of the postcode lottery as per the PCTs only at consortia level.
In terms of the GPs, I can't believe that they will take on the responsibility for commissioning without wanting to renegotiate their contracts to reflect this. The healthcare needs of just a single practice population are so vast and varied; I can't see that this can be done without recruiting a whole swathe of commissioners/ finance people for each consortium to do this work for them.
Edited by Royster on Tuesday 13th July 12:29
968 said:
It will save money as it will initially lead to the removal of vast numbers of irrelevant and useless managers. There will be fierce competition amongst current PCT staff to be employed by new GP consortia to help them manage. Crucially, the head of these consortia will not be a faceless manager with no clinical experience, but a GP who understands the health needs of the local area, which means that funding will be appropriated more sensibly.
A bit unfair (and dare I say Daily Mail) to label the 'managers' in that way. In many cases its the Govt initiative or programme (which lead to their recruitment) that was crap and ill-conceived. And I take issue with your assertion that GP's 'just know' what their population needs. Proper health needs assessment provided by Public Health (a branch of medicine in itself of course) is required before GPs can commission properly. There is also an epidemiological aspect which many GPs are not necessarily skilled to do. For example, we're currently trying to get to the bottom of an anomalous spike in winter deaths in a localised area which just shouldn't generate it, comparitively wealthy, well doctored, good housing, not a 'frost pocket' etc. -Local GPs were unaware.
There is a public misunderstanding around the likely size of consortia too. As I understand it the guide size in terms of population is 200,000. That will be too big for a handful of GPs and a couple of managers to handle. Many consortia might play it safe and jointly agree to use a scaled down 'PCT' syle organisation with a proportion of the same existing staff and infrastructure, if the price is right.
My worry is that treatment may be based on what funds that particular practice has available and not region/country specific like we have at the moment.
Also the practices will need to take on account managers. As Doctors will not have the time to do this.
What happens if they have an underspend. Would the practice get a bonus? If they overspend what happens?
Also the practices will need to take on account managers. As Doctors will not have the time to do this.
What happens if they have an underspend. Would the practice get a bonus? If they overspend what happens?
captainzep said:
968 said:
It will save money as it will initially lead to the removal of vast numbers of irrelevant and useless managers. There will be fierce competition amongst current PCT staff to be employed by new GP consortia to help them manage. Crucially, the head of these consortia will not be a faceless manager with no clinical experience, but a GP who understands the health needs of the local area, which means that funding will be appropriated more sensibly.
A bit unfair (and dare I say Daily Mail) to label the 'managers' in that way. In many cases its the Govt initiative or programme (which lead to their recruitment) that was crap and ill-conceived. captainzep said:
And I take issue with your assertion that GP's 'just know' what their population needs. Proper health needs assessment provided by Public Health (a branch of medicine in itself of course) is required before GPs can commission properly. There is also an epidemiological aspect which many GPs are not necessarily skilled to do. For example, we're currently trying to get to the bottom of an anomalous spike in winter deaths in a localised area which just shouldn't generate it, comparitively wealthy, well doctored, good housing, not a 'frost pocket' etc. -Local GPs were unaware.
Unsurprisingly I disagree, and frankly I don't think that managers would be more likely to discover such public health issues, indeed they would be more unlikely to fund a public health physician, whereas GPs generally do know their limitations and will contract the right colleagues to perform those analyses. Oh and I repeat, I'm not a GP, I'm a surgeon.captainzep said:
There is a public misunderstanding around the likely size of consortia too. As I understand it the guide size in terms of population is 200,000. That will be too big for a handful of GPs and a couple of managers to handle. Many consortia might play it safe and jointly agree to use a scaled down 'PCT' syle organisation with a proportion of the same existing staff and infrastructure, if the price is right.
No one knows how big the consortia will be, indeed the White Paper has been out for 1 day. Such details will be worked out over time. It is likely that PCTs will dissolve and reorganise but chaired by groups of GPs who will then employ managers to manage, rather than make clinical decision.968 has a grip on this. My wife is in the finance of a PCT at a high level, today she had a meeting with some of the local GP's. The enormity of the task they now face is sinking in. They know what treatment the want for patients but they now see that they will have to work with some of the people the press has made out to be useless. What will happen is they will need those who know commisioning and the NHS reporting as no goverment will allow budgets the size they will work with to go unchecked. What they will get is to not have to deal with people who think they know more than Doctors who happen to be in charge of things they should not be.
This is a huge gamble for the goverment but if the GP's lead well it could be better.
This is a huge gamble for the goverment but if the GP's lead well it could be better.
spaximus said:
This is a huge gamble for the goverment but if the GP's lead well it could be better.
I bet GP partnerships, who of course are private organisations contracted to the NHS, are rubbing their hands together at the prospect of this. Like evrything else GP's do, they're not going to do this for nothing and I'll bet some of the practices will make enormous amounts of profit from carrying out this work.Gassing Station | News, Politics & Economics | Top of Page | What's New | My Stuff