Every time a patient visits their GP, we should be paid

http://www.theguardian.com/society/2015/jul/07/patients-visit-gp-paid-numbers-increase

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During the heatwave we have seen a rise in demand for urgent appointments at the surgery, particularly for conditions such as allergic rhinitis and asthma.

An average patient will see a GP around seven times a year, according to the Royal College of GPs. This is a rise from 20 years ago, when a patient would see their family doctor around three times a year. This is partly due to the increase in our frail elderly population, but also increases in mental health problems, alcohol and substance abuse, and obesity.

James, 32, sees me once a fortnight. He has obsessive compulsive disorder and recently lost his job in difficult circumstances – in what he felt was an unfair and discriminatory attitude towards him. We have been considering an alternative diagnosis of adult attention deficit hyperactivity disorder (ADHD), and he is awaiting an outpatient clinic appointment with a waiting list of around 12 months. James has little in the way of social support – he can go days without speaking, or even eating, and coming to the doctors is his only human contact. In the past, we have tried to stretch his visits from two to four weeks, but this has often led to a crisis that has needed intervention from the emergency services.

GP practices receive on average £136 a year for each patient registered on their list (£19 per GP consultation if you assume an average of seven visits a year). This is regardless of how many encounters you actually have with a patient. Some GP practices have historically been poorly funded because, for example, they have more young patients – who receive less funding than older patients, even though younger patients can still have huge health needs – or they were in small premises but have since moved into a larger building where they can deliver more services to more patients. These GP practices may receive less than £50 a year per patient (on average £7 for each of those seven consultations).

We certainly have no capacity to take on more work, such as seven-day working or to act as social workers

GPs are private contractors and there is no nationally set fee. So, for instance, a practice in the south-west, where I work, will be funded differently from one in Lancashire, despite having identical work streams. This is a dated model and does not always appear transparent or fair.

These figures are inclusive of premises and other costs, such as paying and training clinical and administration staff (including GPs), medical and IT equipment, and indemnity fees. Obviously, there is an additional cost to the patient or the NHS if a prescription is issued.

Often the figures for GP earnings that are quoted in the press are gross figures that do not take into account the patient list size for the practice, the practice’s staffing levels and how much extra work the GP does, such as hours of management tasks in addition to the direct patient contact.

Hospitals are paid by the amount of activity they generate, since they do not have patient lists like GPs. A first outpatient appointment at a hospital can cost the NHS anything between £100-£300 (depending on the specialty). A private meeting with a hospital consultant will cost about £180-£200.

We are told that primary care budgets run into billions. This is not because GP practices are expensive, but because of the size of the UK population, fast changing patient demographics, and a drive to move work from hospitals into the community. General practice is one of the few services in the NHS where contracts are grossly based on list sizes and not on workload. There is no uniformity or clarity in general practice funding between the different regions of the country. Also deprivation within a practice population is not always taken into account.

As the number of consultations rise, it’s no longer sustainable for GP practices to be paid by list sizes rather than the hours we work or how many patients we see a day (between 30-40). We certainly have no capacity to take on more work, such as seven-day working or to act as social workers, as the health secretary, Jeremy Hunt, proposes – neither during a heatwave nor at any other time. That is tantamount to a funding cut.