Safeguarding patient services, maintaining cost-effectivenes

GPs struggling to balance their books in the face of rising expenses and a zero % increase in funding will have to take tough, business-minded decisions to minimise the effect on both their practices and patient services, advises the BMA's General Practitioners Committee (GPC).

Guidance on how to do this is published by the GPC and called Safeguarding patient services, maintaining cost-effectiveness. It spells out how practices can draw up a recovery plan to reach financial balance while staying within the terms of their contracts with their Primary Care Organisations.

Dr Hamish Meldrum, GPC Chairman, said: "For the second year running, GP practices will have no cost of living increase in resources while facing all the rising costs of running an NHS practice, paying the staff, the utility bills and all the other expenses of providing good clinical services to patients. The decision to give GPs no extra funding at all – in effect a cut – for the year ahead will put practices all over the UK under considerable financial pressure.

"This guidance spells out the realities of working under those constraints. The BMA is not suggesting that practices breach their contracts with Primary Care Organisations or any of their other legal obligations. It identifies the measures practices can take to safeguard their core services to patients and maintain quality healthcare. If implemented correctly, none of the measures suggested in this guidance should adversely affect patient care."

Key points for practices to consider when drawing up a recovery plan are:

• Refuse to accept any new, non-obligatory, under-funded work
• Review involvement in enhanced services
• Consider whether to take on new patients
• Evaluate involvement in practice based commissioning (in England)
• Ensure the practice charges appropriate fees for work undertaken under collaborative arrangements
• Charge appropriate fees for all non-NHS work
• Always ensure, in taking the above steps, that practices continue to comply with contractual and other legal obligations.

The GPC guidance states that: "As practices struggle to balance their books in 2007/08 they will be less able and less inclined to take on work transferred from hospitals or other settings." It states that general practice is often asked to take on such work because hospitals are carrying out exactly the same cost-limiting exercises that the GPC guidance advises practices to take.

On Choose and Book, the electronic referral system, the guidance states: "The GPC is aware that many practices in England are seriously considering their involvement in Choose and Book (C&B). Whilst most practices have tried to use C&B to some degree, fewer than 35 per cent of referrals are currently made in this way as many GPs have found the system an ineffective, time-consuming burden on staff and doctors' time and one that has not improved the service to patients. In some areas there is also evidence that PCTs abuse the system by using it to restrict access to certain services, simply by removing them from the C&B menu….it is likely that many GPs will evaluate their involvement in C&B over the next year, particularly where they feel the use of C&B software offers no real benefit for patients and takes up too much time."

Practice based commissioning (PBC) offers GPs the potential to gain greater influence and control over local health services, says the GPC. However, "With only a few exceptions, PCOs have failed to promote the Department of Health's PBC policy, and Strategic Health Authorities, which are supposed to have performance managed the process, have by and large, been complicit with that failure". Practices will have to weigh up the short-term costs and workload with the longer-term benefits and the risk of allowing commissioning on behalf of their patients to be done by others, including the private sector. If practices decide to engage with PBC their involvement must be matched with commensurate resources.

The GPC has called a special meeting with Local Medical Committee Secretaries for Thursday 19 April to have further discussions on the profession's reaction to the lack of an inflationary uplift to the new GP contract for the second year running. A decision has already been taken to conduct a UK-wide survey of GP opinion.

Dr Meldrum said: "This guidance has been produced in consultation with the BMA's legal advisors to ensure the advice complies with the complex legislation concerning trade union and industrial action matters. GPs are looking to the BMA for clear advice on what they can and cannot do and we are providing that information. I believe they care deeply about their patients and their staff. But they also care about being treated so badly by the government after they have pulled out all the stops to deliver a top quality service under the agreed terms of the new contract. "