News / News review - GP earnings, IT, mutually agreed resignation scheme and car parking

After plenty of activity over the summer, September was relatively quiet as responses to the white paper and consultation documents were formulated and ministers toured the country meeting NHS staff, patients and the public to discuss their proposals.

Having launched its legal challenge to the white paper on the issue of insufficient consultation last month, Unison’s head of health Karen Jennings (right) said the union had moved a step closer to getting a judicial review, though it has yet to be given permission to proceed to a substantive hearing. The union also unveiled its response to the white paper. General secretary Dave Prentis described the planned shake-up as an ‘£80bn gamble with no evidence base’

GP earnings could enter the spotlight in the coming months as the British Medical Association and the Department of Health negotiate a contract that will put GPs at the heart of commissioning care in England. There are currently two types of contract – personal medical services (PMS) and general medical services (GMS). With many primary care trusts paying PMS GPs a premium in return for having greater direction over their services, it comes as no surprise that PMS doctors earn more than their colleagues with GMS contracts. The NHS Information Centre said average income for PMS doctors in 2008/09 was £116,300, compared with £99,200 for those on GMS contracts (most GPs). There was a wide variation in their average income – with around 7% (presumably part-time) earning less than £50,000 before tax in 2008/09 and an estimated 0.8% earning more than £250,000 before tax.

The BBC revealed the NHS has the greatest number of staff earning more than £100,000 (compared with other parts of the public sector). More than 26,000 NHS employees earn six figures, while almost 6,500 earn more than the prime minister’s £142,500 a year. Seven in the NHS pay list top 10 are GPs, while the highest earner is a family doctor on £475,000 a year.

In the lull before the white paper consultation period ends, the focus has remained on lower spending. The Department announced the health service in England will release £700m to reinvest in patient services following the decision to scrap the National Programme for IT. The Department’s decision follows an internal review of NPFIT, which concluded a national approach was no longer needed. NHS organisations will now be responsible for IT procurement, with the emphasis on incremental change and the assumption of ‘connect all’, rather than ‘replace all’. Existing national infrastructure will be retained, including applications such as choose and book and the electronic prescribing service, but they will now be managed locally.

It is clear that some efficiency programmes, such as the one above, will save a large amount, while others will save much less. One example is savings of up to £1m a year after the government relaxed rules on Criminal Records Bureau (CRB) checks for junior doctors. Chancellor George Osborne (right) said health service employers could take a more ‘common sense’ approach so junior doctors are not checked repeatedly over a short space of time as they move between jobs. Mr Osborne said the idea was one of three that will be used from those submitted by the public and public sector staff to the government’s spending challenge.

The Department of Health was warned it had achieved only 20% of its savings target at the halfway point of the Treasury’s three-year value for money programme. According to a National Audit Office report, this was partly a reflection of ‘significant data lags’ in the measures of savings reported by the Department and other large spending departments. The NAO said these departments were likely to generate higher savings in the second half of the programme. But it added the £5bn increase in savings targets announced in the 2009 Budget reduced the contingency available and many departments would have to identify additional savings.

Wages are a large cost for the NHS and it seems inevitable jobs will be lost in England at least. However, NHS Employers and the Social Partnership Forum have developed a mutually agreed resignation scheme (MARS) to help manage cost reductions and workforce issues arising from service redesign. It allows individual employees to leave their job, with the agreement of their employer, in return for a severance payment. MARS applies to special and strategic health authorities and all trusts except foundation trusts. It will run to the end of October 2010 and it is expected local schemes will also be developed.

With the uncertainty over the future of the NHS in England, in Scotland employment has increased over the last year. According to figures published by the Scottish government, while overall public sector employment fell by 1.3% between quarter two in 2009 and 2010, in the NHS it increased by 0.5% (800 staff). If public sector financial institutions such as Northern Rock and the Royal Bank of Scotland are excluded, the fall in public sector employment is 0.9%.

The National Institute for Health and Clinical Excellence (NICE) announced that 20 of its 32-member Citizens Council believe incentive systems could be an effective way of encouraging people to change unhealthy lifestyles. NICE is urging members of the public to comment on the views, from which the government was quick to distance itself. The Department said: ‘The coalition government has committed to protect health spending but every penny must be spent more effectively. We do not believe giving people financial or paid for incentives is a desirable use of NHS money and agree that such systems should only be used as a last resort and if properly evaluated.’

And finally, NHS bodies could be allowed to subsidise the cost of car parking. In the Department's response to its consultation on parking charges, it rejected calls for free parking at NHS facilities but said it was examining freeing the NHS from the requirement to break even on parking. The move would require legislation.

The month in quotes

‘Is this restructuring not just a rebranding to make the government look as if they are being innovative in healthcare when in fact they are pouring money down the drain and conducting a restructuring that we just do not need?’

Labour MP Caroline Flint asks whether GP commissioning consortia will really be different from PCTs…

…Health minister Simon Burns responds

‘This is a great change from the PCT system, because it will basically ensure that commissioning will no longer be remote but be carried out by GPs at the forefront of dealing with patients’ needs and care, who know best how to ensure that patients get the finest and best healthcare possible.’

‘We believe that the involvement of all levels of healthcare professionals, general and financial managers, as well as patients and the public, in decisions on reshaping local services is essential and can achieve improved patient care.”

Professor Sir Neil Douglas, chairman of the Academy of Medical Royal Colleges on  publication of a joint statement with the HFMA on the need for joint working

‘People are being charged for care they would have got free from the NHS 20 or 30 years ago. In effect, there has been a change in the definition of what constitutes NHS care and that has happened without proper debate.’

Stephen Dorrell, former health secretary and new chair of the Commons health committee tells the BBC vulnerable elderly people are being forced to pay for healthcare.