Another nail in the coffin for the NHS

Think your missing the point.

The rental increase was only announced in April 2016

I agree, not much physically is going to change – but financially, this is like shooting yourself in the foot, to see if it hurts..

The rental increase was only announced in April 2016

No it was known from the outset.

For the last couple of years or so Trusts having been asking NHS Prop what they will be charging, so that in hand the Trusts can go to their commissioner to ask for more funding, so that in hand the CCGs can go to DoH to ask for more funding.

I don’t know about how the big trusts manage their estates, but I do know of at least one small rural GP practice that has had to close one of its branch surgeries due to rent increasing. So the policy has reduced access to healthcare for the elderly patients who are already isolated with poor public transport etc. This practice already provides a minibus to bring patients in to the main surgery but that can’t service the whole area.

The idea of commercial rents for a service that is provided on £130 a year for an average of 6 appointments per person doesn’t really stack up. How much would that service cost a commercial organisation to provide?

Here’s a clue. Took dog to vets for routine booster last week. £38.

but I do know of at least one small rural GP practice that has had to close one of its branch surgeries due to rent increasing.

Tell me I’m wrong, but aren’t they a private business anyway and are just following standard ‘commercial’ practice?

A private business that is given a fixed contract sum to provide a service? yes.
In an open market where the provider of the service has any say in how much the sum is? No
Is the provider able to look elsewhere for a better deal in the market, amongst other commissioners of health care services? No
Is that sum the commercial value of the work that is done? No
See above. The total budget for primary care works out at around £130 per head per year. 340 million consultations a year and increasingly complex year on year.
You can pretend that NHS gp’s are private providers of healthcare if you like.
Doesn’t make it true though.

For the last couple of years or so Trusts having been asking NHS Prop what they will be charging, so that in hand the Trusts can go to their commissioner to ask for more funding, so that in hand the CCGs can go to DoH to ask for more funding.

Who can go to the government, who can just take it from the tax payers… ??
& not PropCo Ltd since they are £260million overspent already

You can pretend that NHS gp’s are private providers of healthcare if you like.
Doesn’t make it true though

Eh? But on the whole GP’s are private businesses, and do have control of their own budgets – just that the majority of their income comes from the Govt (obviously ignoring the ‘Harley Street’ types).

Ah, you’ve since edited your post – makes more sense now in what you are saying, but they’re still private and no doubt make decisions based upon finances not just for ‘social’ reasons.

For the majority of GPs their employment status is “self-employed”. This doesn’t mean that they have much choice with regards who their clients are. The NHS has, for all intents and purposes, a completely monopoly over their clients. And the NHS stipulates what their prices are.

In that respect they are no more of a “private business” than a self-employed bricklayer who works for a bricklaying sub-contractor is a “private business”.

Being self-employed rather than directly employed simply means than GPs can, if they so wish, and there is the demand, do a bit of private work.

But other than that the self-employed tag is something of a red herring.

b r
I didn’t edit my post.
I can control what I spend money on. Whether I employ more doctors and less nurses, and vice versa etc. Who I use for telephone services, cleaning, maintenance etc. Just like a private business.
I have no control over how the government decided to fund general practice.
There is an absolute maximum income that is set by commissioners. Unlike private business. I can’t just give everyone 2 flu jabs and upswell them a shingles jab at the same time.
The vast majority of the income is fixed in the contract sum that is £x per patient.
Increasing costs to commercial levels when income is fixed reduces the resource that is available to be spent on providing the service.
It’s pretty simple really.
Having said all that, U.K. General practice has been very cheap historically because GP’s are able to manage their own resources.
For instance a recent audit of the primary care estate where I work showed that practices in “lift” buildings (national project, management company, no control over costs etc) cost 4 x as much per square metre than gp owned or privately leased premises.

The vast majority of the income is fixed in the contract sum that is £x per patient.

Of course of you’re good at playing the QOF game a bit more money sloshes around.

“Playing the qof game”? Nearly spat my Moët out there!
If only it was a game, as opposed to being part of the income stream that general practice relies upon to deliver a decent service.
We get about 20% of the value of the contract sum from qof, and we miss very few points.
Sure we could decide not to play the game, but we’d have to lose 3 full time GP’s if we didn’t get any qof income.
And it’s included in the £130 per patient per year I mentioned earlier. It’s not extra. You know, 2 months sky TV subscription for a year’s worth of general practice….
And there is a maximum, controlled by government. That we rely on getting year on year out.
But every part of the NHS has quality payments. Cquins for trusts, quipp plans for CCGs. They’re mostly about saving the NHS money rather than delivering improvements though.

so we need less hospitals and less beds in hospitals.

Not in acute care, we don’t (still less mental health). ITU is like a nightclub on a friday night – one in, one out. Bed occupancy-wise, hospitals should be running at something like 80% capacity (i.e. with some degree of flexible slack) – and not rammed at 100%, like every major city infirmary is, right now, all across the country. And not all those sardine-like in-patients are “medically fit” elderly with nowhere to go for want of social care provision (though that is a very real problem) – they are acute admissions who need to be there.

What the NHS does need to get rid of, however, is revolving-door management consultancy con-artists. 👿

From private eye…

Worth a read, I hope

NHS Manager Blog

Very surprised that there’s been no comment here on the expose by The Times journalist Billy Kenber concerning dodgy dealings in the NHS:

https://twitter.com/billykenber?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor

Edited to say that his reports are behind a paywall.

dodgy dealings in the NHS:

you mean the drug companies hiking prices?

Agreed it’s a scandal, but someone has to look out for the shareholders!

This Peter Smith bloke is a bit of procurement guru and he’s rightly angry, that the NHS has been so passive, given its virtual monopoly of demand..

Purchasing Blog[/url]

The thyroid world I live in has seen many patients write to their MP and the Health Secretary to point out that due to such massive cost increases in one product (Liothyronine) the CCGs are telling practices not to issue prescriptions.

This means that patients who’ve been successfully using this product to make them well are now forced to buy from overseas. There is no NHS substitute or alternative to this product. I recently bought some from overseas at a cost of £106 and that will only last a few months.

Will try and dig out some interesting links.

Procurement, yes indeed yet another problem. If you don’t mind me saying a classic issue with over large bureaucratic state controlled organisation with a monopoly position. No one in admin is worried about the “company” going bust and them losing their job, no one is thinking about cost control as it doesn’t matter – they’ll just ask for a bigger budget and they know their customers have no choice so who really cares if the service provision deteriorates – its not their fault – it’s the government not spending enough money.

Just seen this

inconceivable that jambalaya would support raising taxes to pay for free universal healthcare.

100% I would support substantial increases in taxes to pay for a better health service. However I also 100% believe that giving more money to the existing setup is NOT the way forward.

As I posted I knee ACL replacement surgery in both knees but NHS will not do it (trying very very hard not to) as I’m 53 (too old basically, was do you need ACL for, just walk slowly, don’t run or do any active sports etc). I was warned about this by a lady which had dual replacement at 50 about how hard she had to fight to have it done.

cinnamon_girl – Member

The thyroid world I live in has seen many patients write to their MP and the Health Secretary to point out that due to such massive cost increases in one product (Liothyronine) the CCGs are telling practices not to issue prescriptions.

Yup. Liothyronine has a monopoly supplier in the UK; they were bought out a couple of years ago and the new owners have used a loophole in the law to bang up the price by 5000%. No doubt this is the NHS’s fault.

Maybe it should not be a monopoly supplier then ?

@samunkin thanks for that link – very interesting. Where I think it’s spot on is that NHS will be there in your hour of need – it’s an emergency service / critical care provider. The rest, not so much. As the piece says its about matching the money with the aspiration and that’s what we should have a serious discussion about.

“inconceivable that jambalaya would support raising taxes to pay for free universal healthcare.”

100% I would support substantial increases in taxes to pay for a better health service. However I also 100% believe that giving more money to the existing setup is NOT the way forward.

Well of course not………free universal healthcare? ……..that’s communism isn’t it?

As a staunch free-market Tory I’m sure you would much rather private healthcare provisions. And if any government spending is required at all that it should go to private healthcare providers.

Because that idea works so well in the US of A.

Well when I say “works so well” I of course mean it is fabulously profitable. As we all know medical bills are the biggest cause of bankruptcy in the US.

jambalaya – Member

Maybe it should not be a monopoly supplier then ?

You’re suggesting that the market has failed to deliver maximum value via competition? Inconceivable!

That surely depends on how you do the accounts. If construction of the multi-storeys is funded from selling off the land currently used for car parking for housing development (which is what seems to be the suggestion) then I doubt there is any problem with breaking even.

Interested to see that £130 per patient figure – I’ve gone years without getting my money’s worth, though doing my best to make up for that this year (there’s another accounting issue here – have been spending lots of time at the GP for an issue following surgery in the hospital which could probably have been solved in less than half the time if I’d had a follow up appointment with the surgeon – 9 months on I’m finally seeing the consultant again this week).