Monday 19 May 2014

GP Funding

As part of the national process to be elected as RCGP Council representative, I was invited to answer two questions. The second, from Lincoln GP Ian Lacy, was:
What plans should the College be developing to meet the impending financial crisis in the NHS, which will provoke political pressure to new methods of funding – including perhaps partial payment and the growth of health insurance?
 This was my answer:
The interim report of the Commission on the Future of Health and Social Care in England (set up by The King's Fund may provide a useful starting point, suggesting, as Dr Lacy does, user charges and other private funding streams.

Optimise value
The first priority, however, within the context of finite resources, is for GPs to focus on that which they uniquely can add the most value. We should start, therefore, by being explicit about those conditions which absolutely require medical intervention, in contrast to those which are self-limiting or which can effectively be managed without medical skills by other sections of society.

Quality assurance
Given that additional funding is likely nevertheless to be necessary, College should have an important role in anticipating the effect of any new funding model on quality GP care. The test for any new funding model should include whether it will:

  • improve access for those whose needs can only be met by medical treatment
  • not disadvantage the less affluent
  • result in better health outcomes
  • not be too costly to administer

Any new model must be compared against projections of how the current system will operate in the face of growing demand, at risk of failing the first three criteria above.

I am not aware of any good evidence that flat access charges meet any of these criteria. In terms of charges, College should seek evidence of benefit of means-tested charges for:

  • GP appointments
  • GP home visits
  • GP services (including referrals)

and prescription charges for:

  • medication available over the counter for the normally well
  • non-drug items
  • medication agreed to be low-priority for commissioning

Careful consideration should be given to the possible benefits of such charges on sharing responsibility for conserving NHS resources not only with patients but also families, communities, employers and schools, third sector organisations, local authorities and other statutory bodies.

Charges relating to the management of chronic disease are likely to be counter-productive.

Partial payment and health insurance
Health insurance has traditionally been seen as a way to relieve pressure on NHS services. However, primary care in the UK generally receives no fees from the insured and often has to do additional work, as referral thresholds are lower. Furthermore, although additional funding sources are welcome, private patients still call upon the same finite pool of medical staff. Last - but not least - we see in the US a salutary lesson of the inflationary effect of health insurance on demand for healthcare.

College may therefore have a role in assessing and planning ways to mitigate the opportunity costs of such systems so that the less privileged with medical needs are not disadvantaged.

Most but not all RCGP members currently choose to work within the NHS, offering services free at the point of use. College must, however, support all of its members and work in partnership with GPC without the prejudice of party political ideology to develop options to improve funding and working conditions in general practice in order to maintain the quality of the care, thus strengthening the hand of those who negotiate on our behalf.

Members can  vote at by noon on Friday 30 May 2014. My original election statement can be found here.

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