Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
As GPs we have just agreed a paycut (no uplift on our global sum out
of which we will have to fund extra activity under new targets set for us,
as well as the generously awarded pay increases for our staff).
I understand this is because the BMA agreed to the tenant of the
government position that our significant pay increase over the last 2
years that related to significant over-performance against tight targets
was somehow unjustified.
at the same time our consultant colleagues were awarded an equally
generous pay-increase which did not relate to performance.
I am unsure about national figures but locally we now have twice as many
consultants as we had 10 years ago and the numbers are rising, Junior
staff can barely be counted. yet there are no efficiency savings here.
Needless to say the number of GPs has remained static and where we
have branched out into other secondary care like run services such as the
prisons have delivered massive savings.
Locally the 3 prisons used to have one senior medical officer and 3
medical officers, they now get 12 GP sessions and within a year have
chronic disease management clinics and systematic medication reviews,
based on electronic and summarised records with falling OOH activity and
falling hospital referral activity.
May I suggest that the hospitals look at a similar system? Pay relates to
improved efficiency - not simply more work?
It might go a long way harnessing the immense creative potential of
hospital doctors, which currently is at least partially spent on finding
ways round "management".
the market focus is less likely to deliver this.
If I understand the Kaiser-Permanente system correctly it in essence does
this. it frees up existing moneys through improved efficiency and re-
invests it in patient care and staff, everybody knows what the score is
and all work for one organisation, perverse incentives of the not my
budget type are avoided.It is also willing to fund genuine new
developments where they can be shown to have overall advantage.
If you ask doctors whether they have spare capacity they will probably say
no, attach it to their income in a fair and realistic way and it will
come.
ultimately the answer might have to be (as possibly proposed) that
specialists move out and work within larger policlinics alongside their
Generalist colleagues and under the same ethos.
the goverment seems unsure where to go and is dithering around issues of
full on privatisation through United Healthcare and the likes.
this is where the BMA should draw the line. in essence we either have a
professional led healthcare system where the main-performers accept the
need to make the money go round and deliver good care or we will be
employed to the benefit of share-holders and political wheezes.
in full support
As GPs we have just agreed a paycut (no uplift on our global sum out
of which we will have to fund extra activity under new targets set for us,
as well as the generously awarded pay increases for our staff).
I understand this is because the BMA agreed to the tenant of the
government position that our significant pay increase over the last 2
years that related to significant over-performance against tight targets
was somehow unjustified.
at the same time our consultant colleagues were awarded an equally
generous pay-increase which did not relate to performance.
I am unsure about national figures but locally we now have twice as many
consultants as we had 10 years ago and the numbers are rising, Junior
staff can barely be counted. yet there are no efficiency savings here.
Needless to say the number of GPs has remained static and where we
have branched out into other secondary care like run services such as the
prisons have delivered massive savings.
Locally the 3 prisons used to have one senior medical officer and 3
medical officers, they now get 12 GP sessions and within a year have
chronic disease management clinics and systematic medication reviews,
based on electronic and summarised records with falling OOH activity and
falling hospital referral activity.
May I suggest that the hospitals look at a similar system? Pay relates to
improved efficiency - not simply more work?
It might go a long way harnessing the immense creative potential of
hospital doctors, which currently is at least partially spent on finding
ways round "management".
the market focus is less likely to deliver this.
If I understand the Kaiser-Permanente system correctly it in essence does
this. it frees up existing moneys through improved efficiency and re-
invests it in patient care and staff, everybody knows what the score is
and all work for one organisation, perverse incentives of the not my
budget type are avoided.It is also willing to fund genuine new
developments where they can be shown to have overall advantage.
If you ask doctors whether they have spare capacity they will probably say
no, attach it to their income in a fair and realistic way and it will
come.
ultimately the answer might have to be (as possibly proposed) that
specialists move out and work within larger policlinics alongside their
Generalist colleagues and under the same ethos.
the goverment seems unsure where to go and is dithering around issues of
full on privatisation through United Healthcare and the likes.
this is where the BMA should draw the line. in essence we either have a
professional led healthcare system where the main-performers accept the
need to make the money go round and deliver good care or we will be
employed to the benefit of share-holders and political wheezes.
Competing interests:
GP involved in PBC
Competing interests: No competing interests