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BIG DEBATE: Tough rules could mean GP practices losing NHS contracts

PUBLISHED: 00:01 20 August 2014

East London's GPs protesting at Downing Street over surgery funding

East London's GPs protesting at Downing Street over surgery funding

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GP practices with "inadequate care" are being given deadlines to shape up—or face losing their NHS contracts and closure. Special measures have been proposed to bring them into line with hospitals regulated by the Care Quality Commission. There are 22 surgeries in east London out of 98 across the country under threat. But east London GPs who protested in Downing Street earlier this month claim the surgeries in Newham, Tower Hamlets and Hackney are being hit by changes to NHS funding which they say puts practices at a disadvantage in deprived areas with lower life expectancy. Are they doomed to fail in a "no win" scenario?

CQC's Prof Steve Field (left) and Dr Gambiz BoomlaCQC's Prof Steve Field (left) and Dr Gambiz Boomla

FOR tough measures:

Prof Steve Field, Chief Inspector of General Practice, agrees “most GP practices provide good care”, but...

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We cannot allow those that don’t to continue to let their patients have inadequate service.

"We’ll call ‘time’ on practices that don’t improve—6 months, or lose your NHS contract"

Prof Steve Field

I want to do all I can to drive up standards in those surgeries not providing the service people deserve.

We need to have a clear framework and a process to respond to those GP practices providing inadequate care to ensure that they can’t continue to doing so indefinitely.

Special measures will firstly promote improvement—but where practices do not improve, we will call ‘time’ on them. Special measures will be the final chance for a practice to improve.

Our inspection programme is not just looking at inadequate care. We are also looking for examples of outstanding care to share across the NHS.

"Surgeries will fail if changes to NHS funding puts east London at a disadvantage"

Dr Gambiz Boomla

But when organisations fail the people they provide health and care to, it’s important that failure is identified quickly and action taken to ensure services improve. That sits at the heart of special measures.

Our proposals mean special measures will allow the Care Quality Commission’s regulator and the NHS to set out expectations for improvement, with a timescale to sort out problems.

Where a service is rated inadequate, practices will have six months to improve.

If they fail, they go into special measures.

But if after a further six months they are still found to be inadequate, they have their registration cancelled and/or their NHS contract ended.

In some cases, a GP practice will have such significant problems that patients are at risk, or there will be sufficiently little confidence in the ability for the practice to improve—so it will go straight into special measures.

Some practices have been providing poor care for too long.

Everyone should be able to receive good care from their GP practice, whoever they are and wherever they live.

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AGAINST:

Dr GAMBIZ BOOMLA is an east London GP and leading light in the Save Our NHS Surgeries campaign launched in May to fight the threat to practices facing funding cuts which could force them to the wall...

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Many surgeries in east London won’t be able to provide proper care because they are being starved of funding over next seven years.

The surgery contracts started in 2004 were good because we had control of our budgets and used them to improve patient care.

But now a new funding formula based on how many years people are from their estimated death, not how many from their birth, is heavily weighted towards surgeries with older patients who consult doctors and use more appointments than younger people.

East London has a very young population, with life expectancy 18 years less on average than more affluent areas, because of deprivation and poverty. If you die at 70, illnesses occur in the preceding 20 years from age 50. That’s not being taken into account.

Deprived populations are less healthy because they’re poorer—income determines health.

Surgery funding is now being weighted towards affluence areas where there are more elderly people because they’re living longer.

Funding should be calculated on the shorter the distance from death, the more medical resources are needed, as with surgeries in deprived areas like east London where people start getting ill earlier in life.

Surgeries will fail if the government changes the funding formula because it will put east London at a disadvantage with its increasing health needs of our deprived population.

Surgery closures would leave thousands of patients without a GP and the remaining practices, already overstretched, would be unable to take them on. They would turn, instead, to hospital A&E.

The NHS is the best loved institution in Britain, the envy of other nations. It is one of the most cost-effective health services in the developed world—there is plenty of money in society to pay for it.

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