Monday, 16 February 2015

PMS Slash: A Postscript

We met with our local area team reps about the so called ‘Review’.

Seems the spreadsheet was not as misleading, as some of the compensatory money for our PMS slash comes from others’ loss of MPIG being re-injected into global sum; so as beneficiaries of others’ worse misfortune we apparently should be grateful. There was no answer to my charge that the rest of it was misleading. But there were more reasons to be grateful that the practice which I have spent 22 years of my life building was about to be destabilised. At least there was a locally agreed transition arrangement and we might be able to get the money back through (an as yet an unspecified means of) reinvestment: MPIG practices had no such luck. Which do you prefer; at least a chance of avoiding death or disability by annual cuts over 6 years or instant limb amputation?

And the pain management service we have provided since 2002, currently at double the number of patients we're contracted for? As I predicted they had no idea, none at all, at just what they were about to 'review' out of existence. And they saw my point re our growth element to address inequalities but... 

The last drops of goodwill and trust are thus squandered. But it's worse than that. I now know that there is no point in trying to create innovation within NHS structures because future iterations of these sociopathic, demented entities will capriciously squish it. Reality is: 'cynically take advantage where you can, realising it may be transient'. This is absolutely not the lesson needed at this critical juncture and is completely at odds with the stated aims of the review. The positive words about PMS in the announcement of the review are entirely contradicted by NHSE's behaviour, at least locally. A proper PMS review was never done and there was never the least intention of doing so. They had concluded that they could get away with giving practices a Hobson's choice and effectively bully them into GMS contracts.

In the end the meeting was not about 'reviewing' anything (well we knew that really), this was a done deal; they were there to tick the 'Met with practice' box. The localism that PMS was supposed to be is revealed as a lie; so what does that tell us of what the centre really thinks of that other manifestation of localism, CCGs? A quantitative easing in the NHS with the currency of contempt?

They had nothing to offer and displayed the body language to match; minimal eye contact, except as demanded by a measured politeness, and a kind of corporate weariness. (Please this is not a personal criticism; the cogs in a bulldozer are just that.) It became clear why.

In 6 weeks it's no longer their problem. That's when co-commissioning kicks in. If you, like me, thought the 'co' participle implied joint working, that was in no way the impression conveyed. But in line with the above experience, we can no longer assume that what's said relates to what will be. There was an unmistakable sense of signing off of responsibility which was to land squarely onto CCGs. So folks the commissioning of most secondary healthcare and now primary care rests with an organisation of which I am obliged to be a member and thus accept responsibility for, despite having no control at all over the amount of funding (unlike local councils) and with ineffective representation. If secondary care fails it's GP commissioning failure and soon the same is true of primary care. The sting is ready, the denouement awaits the election result.

At the same time as passing primary care commissioning to CCGs NHSE has acted in a way that curtails their freedom of action by ensuring most PMS return to GMS. The centre will continue to control the agenda as they.have for the last 10 years. This charade 'review' wasn't about saving money or cost effectiveness but about retaining central power over core GP contracts. CCGs are denied the option to fund GP contracts properly via PMS. They can only repeat the history of the IOS Red Book failure in the form of damaging short term LES proliferation/fragmentation. The bung to CCGs to accept this has been paid for by PMS practices. In my practice the losers will be people in pain and the disadvantaged, as well as increasingly demoralised partners.

I genuinely do try to adopt St Maureen's positive spirit and I'd love to report something good but it's so, so hard when I find my every cynical thought backed up by evidence that that very path has already been laid. It's like seeing a patient where you immediately think 'cancer' and where, to your growing horror, every red flag symptom you ask about turns out positive. I wonder if I'm paranoid but if I am, then, at the very least, there has been massive communication failure by NHSE to GPs. I didn't get the impression they cared a jot.

The challenge now is to carry on even though we know we can't trust anyone outside our organisation. To judge from comments at the end of Pulse articles many already have decided it's no longer a challenge for them. Not long until Good Friday.

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