Preamble(Note: this happened in 2004)A
news story has broken in the Mail, Express, Western Daily Press, Bristol Evening
Post and North Somerset Times along the lines of "One Doctor for 200,000
patients at night scandal". I was quoted in some. This is a clarification
which I have sent to the papers: I would be
grateful for the opportunity to set the record straight on the matter of out-of-hours
cover in North Somerset. There are two doctors, not one, on call at night for
the 190,000 residents of North Somerset, with a backup group to call on if the
duty team becomes overwhelmed. That may still not sound a lot, but we have been
managing with that sort of ratio for a ten years now in Weston, and it has been
working well for the past two weeks. The
impression has also been given in some accounts that all calls are dealt with
by an untrained receptionist. In fact, all patients who need to can speak to a
doctor. The impression is also given
that whereas previously there would be one doctor on for say 10,000 patients,
the number has now jumped to 200,000. This is not a true comparison. The 10,000
doc would be in bed asleep, at risk of being woken. The 200,000 doc is awake and
working continuously all night. Clearly,
it would be better for all concerned to have more than two GPs on call at night,
but unfortunately the funding for North Somerset is £10 million short every
year. Weston has been underfunded by about £3 million per year for many
years, but when North Somerset Primary Care Trust was formed, it was handed a
debt arising from mistaken decisions made by managers of the now defunct Avon
Health Authority. I have always argued strongly in committees that we should have
rejected at least one of those debts out of hand. The Bath debt had nothing to
do with us. What North Somerset needs is for Government to cancel the debts laid
on the Primary Care Trust so that we can get on and develop a decent service for
our patients. To achieve this we will need a sustained campaign on the part of
the people of North Somerset to get back our fair share of the new money coming
in to the NHS. Dr Richard Lawson
Now
to the real story behind the story: Introduction
North Somerset PCT, the authority that commissions health services
in our area, is trying to cope with a deficit of £10 million per annum.
This is having adverse effects on service development, service delivery, and staff
morale. This briefing paper attempts to set out the cause and cure of the situation
in a way that is both fair and comprehensible to the people of North Somerset
who are affected by the problem, and who may be able to take action to improve
the situation. In the process many complexities have been made to seem simple,
but this is as far as I understand the salient facts.
History
For the past four decades there has been a pervasive belief among medical directors
in the Weston area that we are under funded.
In the
1990s as chairman of the then Weston Locality Commissioning Group I noticed that
our per capita funding was distinctly lower than that of other areas within the
old Avon Area Health Authority. I made enquiries, and the AAHA sent an accountant
in to look at the figures. After several months' investigation, and applying various
weightings that tended to bring us more in line with the Bristol localities, he
concluded that we were under funded to the tune of £3 million per annum,
and had been so for some time. It was intimated to
me that I should drop the topic, as there was no way we were going to take money
from Bristol, and, regrettably, I did so and left the chairmanship. On
top of this, debts were imposed on all the Avon PCTs formed after the breakup
of the old AAHA - debts from Bath and North East Somerset (BANES), North Bristol
Health Trust and from the BRI (UBHT). The net effect
of this, together with other factors, leaves us with a funding shortfall of £10
million pound per annum - which is about 5.8% of our annual budget (£170,771,000
in 2003/4).
These debts are having a stifling
effect on health service development (improvement) in North Somerset. It contributes
to the fact that we are a no-star PCT - and that in turn means that we get no
money. Similarly, Weston hospital gets no stars and therefore
no money. And GPs get no money for Enhanced Services under the new contract, and
so are legally entitled to walk away from services like prescribing rare drugs,
helping MS sufferers, treating minor injuries - and even diagnosing and treating
depression. Most local GPs are continuing to provide these services unpaid, as
a labour of love.
This situation must change. The
new chair of the PCT is righly working to straighten out the reputedly muddled
financial books of the PCT, because we will never stand to get our debts reviewed
until the books are straight. But if we leave it to the official channels, the
situation will drag on without end. We must mobilize
the power of democracy, get people to stand up and campaign for a just allocation
of funds. It is fundamentally unjust that on top of the deficit that I identified
in the 1990s, we should be saddled with the debt of BANES - where we have next
to no "activity" (that is, patients from North Somerset treated). Our
part of the NBHT and UBHT debts should also be reduced in proportion to our activity.
In addition, the cause of those debts should be examined more closely. If incompetence
or even misappropriation occurred, the debt should go to the administrators responsible,
and if they are bankrupt, it should be written off as any commercial debt is written
off. The present situation
On October 4th, Rosie Winterton MP, Minister of State for Health Services in the
South of England, wrote to both MPs for North Somerset - Brian Cotter and Liam
Fox. She said that the formula for resource allocation has
been reviewed, and that "progress has been made in moving North Somerset
PCT closer to its target share of resources". There is an implicit admission
here that NSPCT is below its target share, so the next questions are, "By
what amount is it falling short, for how long has the shortfall been happening,
and when will it come to parity?"
The answers
to these questions will be clad in terms of the "pace of change" policy,
which depend on priorities set. There is an opportunity here for us to make our
case for being set a high level of prioritization due to the crippling effects
of the £10 million per annum shortfall that we are labouring under, much
of which is the result of an odious debt from BANES, and also the historic underfunding
of our area. In addition to the campaign to get our
fair share of the funding allocation, there are many other measures that the people
of North Somerset can do to improve the health services in North Somerset, which
I will develop later. I suggest that a public information
campaign around these matters should be created. Maybe we should call a public
meeting, or series of public meetings. The Unpaid Leave Story
Another story has hit the headlines concurrently: a letter sent
on Oct 21 2004 from the NSPCT to staff inviting people to take unpaid leave until
the end of the current financial year. My response is that this is a reasonable
attempt to solve an impossible financial sitation, but that it must be limited
to non frontline staff only. Doctors, nurses, paramedics, professions allied to
medicine, filing clerks, porters and cleaners and anyone else whose work directly
should not go. This effectively leaves the managers in the PCT itself as candidates
to take unpaid leave. In particular, Service Development Managers should be invited
to leave. Since there is no reasonable prospect of improving services in the present
financial climate, there is no logic in retaining Service Development Managers.
This is unfortunate for those who hold those posts, but desperate situations call
for desperate remedies.
Richard Lawson 23.11.04 | 