Switched on and ready to go – New payments, new computers?

Switched on and ready to go – New payments, new computers?

(Published 26 June 2006)

Switched on and ready to go – New payments, new computers? by Michael Sobanja, NHS Alliance Chief Executive and Director of Health Direction

Is your GP worth £250,000? was the question posed by the Guardian on 19 April following widespread press coverage over the new contract and the rewards that the Quality & Outcomes Framework can bring. Who are these high fliers? Does it matter?

Let's get the facts right first – the original information was attributed to the Association of Independent Specialist Medical Accountants - a network of 70 firms of accountants throughout the UK who are all specialists in working for about 7,000 doctors in 2,000 Practices in the UK- so about a quarter of all GPs in the UK.

The results of the AISMA survey were based on the income of 4,736 family doctors in England, Scotland and Wales - which represents 11% of all practices and 14% of all GPs.

It showed that 43% of family doctors earned more than £100,000 which represents a 20% increase on the previous 12 months. The number of family doctors earning more than £150,000 during the same period doubled from 3% to 6%. But for GPs who work under the personal medical services (PMS) scheme - where their contract is negotiated locally with their primary care trusts - those hitting the £150,000 mark now reaches 12%, the survey showed. So where did the quarter of a million come from? – well it appears that the National Director for Medical Services for one firm of accountants said she knew one PMS GP that earned the magic £250,000

Don’t we want our GPs to be well rewarded? – and the money still has to be earned and it's getting harder. Let’s remember that £95,000 a year represents an hourly rate of around £40 – not exactly super league – my plumber charges me more than that!

So where does the QOF take us? Now all the lobbying has settled down, and we all know about the redistribution of points and, more widely, the new one year Directed Enhanced Service for Practice Based Commissioning, it seems clear that QOF pay will fall in 2006/7 as the targets shift around and more difficult areas are included – the renal target for instance. In fact, AISMA uses the rather dramatic phrase (at least for accountants) “QOF pay set to dive”! as QOF points values and global sum payments were frozen.

Surprise, surprise! Now there are those who think that the whole of the GMS contract was all about shifting GP pay onto a performance related activity and to do that, you need to entice them into new arrangements. It is clear now that the Government, whilst short-changing Primary Care Trusts by about £300 million in the first year of the contract, have achieved their aim of getting more control over clinical behaviour in Primary care.

Thinking of the bigger picture the same principles have been applied to other payment areas, including hospital consultants and pharmacists. It is clear that “Payment by Results” is more than a means of paying hospitals, even if it is really “Payment by Activity”. There are even those who claim the whole “Is your GP worth £250,000” storyline originated in the dimmer halls of the government machine as a means of destabilising the famous doctor-patient relationship – others simply claim it to be an April Fool’s joke – we will see in time.

All of this, of course depends on activities over at Connecting for Health – the organisation charged with delivering the National Programme for Information Technology aimed at connecting up some 30,000 GPs and three hundred hospitals in England. The part dealing with GP pay is the Quality Management and Analysis System, known as QMAS, which has been one of the (few?) success stories of the programme allowing the contractual changes to be made and providing a rich source of data, for NHS employers, Practices and commercial organisations with an interest in pinpointing exactly what is happening and where.

Of course the real value in this is being able to tie up QOF data, with local plans across commissioners and providers to see what makes a real difference to patient outcomes and clinical practice on a day to day basis – but for this we need a more broadly based intelligence tool which crosses the domains and one which allows the input of locally harvested information to be matched with the broader picture.

Connecting for Health of course has a much wider remit than GP pay of course – so how is that going? If we think of the key parts of the National IT programme which include:

Choose and book - A system to allow patients to book nearly 10 million hospital appointments at a place, date and time of their convenience. Yet The BBC published a survey on 30 May 2006 which said that nearly 50% of GPs reported that “choose and book” systems were “poor or fairly poor”, and anecdotal evidence is that the system has not achieved wide respect yet.

NHS care records service - The electronic database of patient medical records which will allow NHS staff across the country to access information on a “need to know basis”. Recently, there have been reports that the records system is more than two years behind schedule, and there are now suggestions that the full record will only be available locally – not much of an improvement if you are taken ill on holiday!

Electronic prescriptions - By 2007 the paper based system was to be replaced with an electronic version, dealing with more than 325m prescriptions each year. Some 4,778 pharmacists are registered to use the Electronic Prescription Service (EPS) and 1,128 GP practices have had EPS software upgrades of which 348 are using the service. It is widely predicted that the target will not be met with only one pharmacy system supplier currently offering a compliant system and only 4% of practices currently using the service. Meanwhile the Pharmaceutical Services Negotiating Committee (PSNC), the negotiating body for pharmacists, and the National Pharmacy Association which represents more than 6,000 pharmacy owners representatives have told pharmacists that there is no deadline to implement the electronic prescription service (EPS) in fresh advice issued in May.

If all this sounds a bit downbeat – it is worth remembering that this is the biggest IT programme ever attempted in the world and the NHS is sometimes being dragged, kicking and screaming into the 21st Century. The programme is being implemented and information is coming on line which outstrips any other health system in the world. The Prize on offer is priceless – a real time patient support system that provides information enabling high quality care AND high quality information for planning and management purposes.

Imagine a world where your customer knows more about the impact of medicines that you do… that’s the National Programme for IT – coming soon to a local health economy near you - take note! Do you know what’s happening in your local health economy?