Paul Conroy
66 comments By Paul Conroy
Given that a key element was around dispensing of 28 vs 30 day drugs, could we not just standardise to 28 day on all items and remove this nonsense?
And the whilstle-blower? How will they be protected when the list the MPs raise is handed back to the trust so that they can be witch-hunted?
Divide and rule. We fall for it every time.
Losses are not always what they appear in corporate affairs. Generating a loss allows you to lend money to an entity to offset the loss - which is a much more tax efficient a way to shift money back in the form of repayments and interest, than simply paying over the profits in the first place, and tends to attract less scrutiny from tax authorities.
I suspect if you were able to look carefully at the detailed accounts you will find the loss is generated from significant cross charging of elements to parent companies higher up the structure, and then these losses incur high interest on debt - often in the hundreds of percent so that the debt is smaller than the repayments on it.
Even if that is not the case, frequently corporates will run at a loss to eliminate competition in the area, particularly on the first contract round when they cut down to win the bid, before cranking up prices.10:56 - GP activity has doubled in the last decade whilst costs have gone up 28% and funding fallen by about 20%, ie doing twice as much for half the money. It should also be pointed out that GPs have some of the highest rates of burnout, divorce, suicide and mental health issues of any profession and are the only ones in the whole system with personal skin in the game - ie they put their homes on the line if it all goes wrong financially for their practice.
Is it then any wonder they don't fancy risking everything to go heroically to do all the work dumped on them by other parts of the system who are paid to do what they are dumping on them?
Asking if they can do more is like asking if A&E is doing enough.
DOI/Experience: GP Practice Manager, former director of a GP Provider Co, Super-partnership manager.If the likelihood of HMG going bust wasn't so strong then issuing bonds would be the sensible approach - or would have been when rates were lower. Now, private finance is not the answer to any question other than how best to make a quick buck out of the public purse.
GPs are more than able to raise their own finance whilst reimbursement is in place, and if HMG allowed a shift in the premises directions this could expand further. Rather than looking on at failed public sector approaches we should look at what the legal, accountancy, dental, ophthalmic, vetinary and pharmacy sectors have to tell us about the future of the GP model. Ie it will be deregulated, corporate, joint venture partnership with venture capital or IPO and separate capital/property investment arms.So true Rick. Management by fad. A new fad has taken precedence.
The process for allocating resources in the Health Service is this;
1. Promise more money.
2. Promise the same money again with more strings attached.
3. Promise the same money again with even more strings, a faddy aim and an impossibly short deadline to get a highly complex bid together and get quotes against a vague and poorly explained criteria. Promise cash to the good boys and exclude anyone on the naughty step from inclusion, but let them do the work anyway.
4. Make the timescale to spend the money impossibly short and shorten it further by delaying the decision because you didn't realise how many bits of the NHS needed more money, didn't plan people to assess the bids or decide how you would do so or on what criteria. Then shorten the timescale further by delaying actual payment of funds until after they are needed.
6. Criticise everyone for poor delivery of the stated aims and whip them with conference calls, spreadsheets and performance plans as to how they will get back on track.
7. Collect together all the unspent money and splurge it on all the overspend that has resulted from not adequately resourcing the right core things in the first place.
8. Discover that if you had planned that spend it would have cost half as much and you would have had spare for the shiny fads you planned the cash for but didn't get to spend it on.
9. Blame the lack of cash on the NHS not adopting enough of the fads you had told it were needed and provided cash for, whilst restating the money in both the place you originally promised it and where it was actually spent so it appears twice in the press release. Quietly apologise for the error on page 23 a month later whilst continuing to quote the same numbers in speaches.
10. Its a new financial year, wait a few months for the obvious priorities that urgently needed proper prior investment and planning to be beyond redemption, and then start again at step one.15:35 - But clearly it doesn't work very well, or we wouldn't have a growing list, a bunch of hospitals to who can't report it, a load of over year waiters, frequent hospital gaming and a national breach.
Just because it worked to some extent, doesn't mean we can't improve it by discussing what could be better.Well done for the courage to say no.
That anonymous comments lack the imagination to see the mess we're in as more offensive than the language used to describe it simply tells me how profound the lack of hope is.
Given the proportion of admissions that are in vulnerable (eligible) groups (80%ish) I don't this is miles off Matt. Uptake remains stubbornly poor - not helped by the loss of national media campaigns promoting it.
Penny rich, pound poor.
But why has it taken us so long to learn from other industries? In insurance the situations can be complex, but careful case management and assigning a named individual has long been established practice to help claimants manage their way through a situation. Why have we been so obsessed with the lessons to learn from F1 and acute care management, but not learnt from the rather less flashy, but equally important ways we can clear those beds ready to be used again?
Surely this headline should read 'A&E the last place mental health patients should end up'? Services should instead be adequate, accessible and appropriate to keep them from ever presenting there.
Its called a Real Estate Investment Trust (REIT). No reason it can't be done with an established trading history, an IPO and the necessary investment and return criteria.
Absolutely the right approach. But why have trusts taken so long? Op-Co Prop-Co deals are common in the private sector, or strategic estates partnerships.
The greater challenge is the sustainable revenue to fund the leases on it. Expect a growth in green door private activity to back this.Move over Lord Carter of Bogroll. Arise, Risebrow of Centrafuge. Bravo.
Much needed common sense.I'm with the mutual idea, but I think it will move too slowly for that. It would be a good model to allow in primary care however, with patient co-operatives able to take the contract over and hire GPs to fulfill it. The potential to de-risk the GPs in the process would make hiring easier, and might make patients appreciate just how tough the job is.
The list looks remarkably similar to the 20 worst offenders on RTT in Gooroo's last article. Presumably there are some common issues?
Anonymous 9.11, in support of Mark Bridgeford's comments - very little data suggests this to be true. Less than 10% of patients attending A&E have ever presented to primary care, and a significant proportion of additional resource in GP-land remains unused at peak times.
The issues are with flow, prevention and acuity.
Commented on: 23 February 2018
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