One in four NHS trusts has cut spending on out of hours care, new figures disclose.
At least 20 trusts have reduced their budgets for doctors to visit patients in the evenings and at weekends by a total of £4million.

The cuts in after-hours budgets led to warnings of a repeat of the case of Daniel Ubani, the incompetent German locum who killed a Cambridgeshire man with a morphine overdose in 2008.

About 78 of England’s 152 primary care trusts released information on their out-of-hours spending after Freedom of Information Act requests by the magazine GP. Twenty said they had cut their budgets.

The cuts, made in the trusts’ 2010-11 budgets, come before the start of the next four-year spending round, which will require the NHS to find efficiency savings worth £20 billion.

Across the remaining trusts that released information, total spending on out of hours care rose by only £3.6 million.

Health experts said some trusts might have been able to make savings without affecting services, by renegotiating inflated contracts.

However, doctors and patients’ groups said that in many cases lower spending would add to concern about the quality of care.

A study commissioned by the Department of Health last year found wide variations in the quality of care provided by out-of-hours contractors, including GP groups and private health care firms.

Katherine Murphy, the chief executive of the Patients’ Association, said the latest cuts would reduce the quality of care, risking “a repeat of the case of Dr Ubani”.

She said: “By pressuring providers to look for ever cheaper options, the Government is forcing them to enter a race to the bottom.

“Out-of-hours services need to be staffed by doctors who are as trained and experienced as their colleagues who work during the day. Cutting funds to pay for them will mean fewer and possibly less able doctors.”

Dr Fay Wilson, who chairs an out-of-hours group in Birmingham, said cutting out-of-hours care was a “false economy” for trusts because more patients would be forced to seek care from accident and emergency wards.

“If you are going to reduce the cost, then you will be reducing the number of clinicians you have on,” she said. “That leaves gaps. You also don’t get the same level of supervision and support.”

Richard Vautrey, of the British Medical Association, said cutting costs could harm services.

“There is a concern that you can pare a service down to such a level and reduce funding to such a level that you put patient safety issues at a higher risk,” he said.

The Department of Health said the Coalition was improving out-of-hours care. A spokesman said: “This is not about cutting costs – we are investing an extra £10.7 billion in the NHS – it’s about ensuring GPs, not bureaucrats, are responsible for securing safe and appropriate out-of-hours care.”

The BMA also published a poll which it said showed that most GPs opposed government plans to give them control over £80 billion of NHS budgets.

About 65 per cent of family doctors believe competition between providers, including NHS and private companies, will reduce the quality of patient care, while 61 per cent said the Government’s reforms mean they will spend less time with patients.

The Department of Health said the survey showed some doctors had “misconceptions” of the planned reforms. Andrew Lansley, the Health Secretary, said there was no alternative to his reforms to make the health service more efficient.

“Unless we modernise, every year the relative costs of running the NHS will go up,” he said. “Demand will grow, the bureaucracy will expand and inefficiencies will become entrenched.

“There is no easy option. Sticking with the status quo and hoping that a bit more money will be enough to meet the challenges ahead is a complete fiction.”

From: http://www.telegraph.co.uk/Patients-at-risk-as-health-trusts-trim-out-of-hours-care

GPs and Doctors are to be given sole responsibility for overseeing front line care to patients under Coalition plans described as the biggest revolution in the NHS since its foundation 60 years ago.
About £80 billion will be distributed to family GPs in a move that will see strategic health authorities and primary care trusts scrapped.

The plan, contained in a white paper to be published this week, is designed to place key decisions about how patients are cared for in the hands of doctors who know them.

Tens of thousands of administrative jobs in the health service will be lost as a result.

At present, funds are given by the Government to primary care trusts, which pay for patients from their area to be treated in hospital.

Under these plans, GPs — who are currently not responsible for paying for hospital referrals — would receive the money instead and pay the hospitals directly.

The Coalition hopes the new system will be less bureaucratic and give doctors and patients more control over treatment.

GPs will also have to organise out-of-hours services, which may see family doctors offering 24-hour care once again.

The decision represents a victory for Andrew Lansley, the Health Secretary. He has been backed by David Cameron in his fight with the Treasury over his decision to give taxpayers’ cash directly to doctors.

George Osborne, the Chancellor, raised serious concerns about putting such a vast sum of money, thought to be between £60 and £80 billion, back in the hands of GPs.

Health spending has been ring-fenced by the Coalition and will not be subject to the severe cuts that will hit other Whitehall departments.

However, it is understood that Mr Osborne has been assured by Mr Lansley that there will be safeguards in place to ensure GPs do not “waste” the money.

The acting chief executive of the NHS Confederation, Nigel Edwards, warned that the changes will be difficult to implement: “In transition to this new system there are some quite significant risks,” he said.

“Obviously it is going to take time to implement this and the PCTs at the moment are the people who keep the lid on the performance and financial management of the system.”

The move to scrap the 150 primary care trusts and strategic health authorities, which cover a range of NHS trusts and supervise local NHS services, will come as a shock to Conservative and Liberal Democrat MPs.

The Coalition agreement explicitly vowed to “stop the top-down reorganisations of the NHS that have got in the way of patient care”.

Rather than talking about scrapping trusts, the document explained the role they would continue to play.

However, Mr Lansley will point to the commitment in the joint Tory-Lib Dem document which states: “We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.”

Commentators are calling the changes “the most revolutionary in the NHS since 1948”. Mr Lansley hopes to have the changes in place by next April, although NHS managers believe that may be over-ambitious. Under the reforms, primary care trusts will not be scrapped immediately, but will be phased out as power is passed to doctors.

A new contract which makes GPs more accountable is likely to be part of the package of measures included in the white paper.

Responsibility will be handed to GPs working in local groups, who will commission services or provide them by working in rotas through co-ops. Mr Lansley believes that if GPs are responsible for their own budgets and have to commission out-of-hours care, most will decide to go back to offering weekend and evening cover themselves or in local groups.

The loss of jobs, which The Daily Telegraph has been told will run into tens of thousands, is also likely to lead to outcry from public sector trade unions. Ministers are already braced for industrial action over plans for severe cuts in the Whitehall workforce.

The fierce dispute over the plans has led to a delay in the publication of the white paper. However, it has been resolved in the past 48 hours.

A source said: “In the end, the Prime Minister clearly said to George Osborne that this was not one he should go to war on.”

Handing over so much power to GPs will revive memories of reforms by the last Conservative government to give control back to the local level through GP fund-holding. Labour, under Tony Blair, attempted a similar plan but fell short.

However, a senior government source told The Daily Telegraph last night that the Coalition’s attempt will succeed because of the political will behind it.

The source said: “GP fund-holding was voluntary. This is going to be compulsory. This is pushing through the whole lot of policy that either Tory or Labour governments have tried in the NHS’s history but have never gone through with properly.”

The reaction of GPs to the changes will be crucial if the Coalition is to avoid confrontation. Ministers will hope that they embrace the opportunity, but some are likely to oppose the moves. Labour failed to drive through public service reforms in the face of opposition from unions and vested interests, as well as opposition from the party’s own MPs.

But Mr Cameron is determined to put his stamp on reform. In a speech to civil servants yesterday, he said his time at No?10 would not be defined solely by cuts and the deficit reduction plan.

From: http://www.telegraph.co.uk/Biggest-revolution-in-the-NHS-for-60-years

Britain’s highest paid GPs have broken through the £300,000-a-year barrier working for the National Health Service.

One of them, Suppiah Ratneswaren, 61, who is linked to four separate NHS practices in the south London borough of Greenwich, has admitted he is earning between £300,000 and £400,000 a year, 90% of it from the health service.

The respected GP spoke out after The Sunday Times obtained figures which revealed that one GP operating in the Greenwich area had earned £378,000 in a year solely by working for the NHS. Another earned £270,000 and six others have pocketed more than £190,000 in annual earnings.

The figures, disclosed under the Freedom of Information Act, relate to 2007 and 2008, the most recent year for which data are available.

Ratneswaren insisted that he was not the highest-paid doctor in Greenwich: “I don’t want to be seen as a money-hungry doctor because I am driven by the quality of work and I work very hard. I have got nothing to hide.”

Pressed about his yearly earnings, Ratneswaren said: “It’s closer to £300,000 than £400,000.” He said 90% of his earnings were from the NHS, while the rest was generated through private services such as treating the relatives of patients who might be in Britain on holiday.

He said his practices received about £90 per year for each patient signed to it and insisted that doctors should not feel guilty about their earnings.

He also earns performance-related pay that rewards him for meeting a series of administrative and clinical targets such as measuring cholesterol levels among patients at risk. He said the country was benefiting from performance-related pay, “because I will argue that we have improved the quality of services to the patients”.

He defended doctors’ right to high earnings: “Medical professionals always put themselves in a different context to lawyers and other professionals such as City boys, and that’s why I suppose there’s a difference in the pay and the way they are perceived in the community.”

A second GP in the trust area, Hany Wahba, 56, has also been named by colleagues as one of the country’s highest-paid doctors. Wahba, who heads a practice in Plumstead, one of London’s poorest areas, and sits on the local committee of the British Medical Association (BMA), said: “I am not in a position to discuss anything. I don’t want to be dragged into something I don’t want to say.”

The disclosure that GPs in one trust are earning so much will raise concerns about NHS contracts introduced in 2004. These allowed GPs to opt out of night and weekend work while fuelling a surge in their earnings.

About half of a practice’s current income is now a flat rate based on the number and needs of their patients, calculated on factors such as age, gender, levels of morbidity and mortality rates.

The average GP’s salary has risen from £70,000 to £104,000 in six years and 300 senior GPs in England and Wales now earn more than £250,000 a year.

Critics say the contracts work to the advantage of practices with large populations in urban areas such as south London. Ratneswaren has 13,000 patients across his four practices with 9,000 at one in Greenwich — almost 50% higher than the average for England.

At the same time the change has left many areas short of night-time cover. A report by the Patients Association, published yesterday, found that one in six patients in some trusts regarded out-of-hours provision in their area as poor or very poor.

Richard Vautrey, deputy chairman of the BMA’s GP committee, has defended the payments system: “This was a deliberate attempt by the government to ensure GPs’ pay was increased because it had lagged behind other professionals.”

NHS Greenwich said practices were private contractors that could pay their staff as they chose, adding that the highest-earning GP undertook a variety of work for the NHS.

From: http://www.timesonline.co.uk/tol/life_and_style/health/article7060978.ece