Misplaced Pages

#293706

58-540: Normal working hours of 8 am to 6.30 pm Monday to Friday are specified in the contract. National contracting of general medical (general practitioner) services can be traced to the National Insurance Act 1911 which introduced a pool (similar to today's "global sum") to pay GPs on a capitation system building on the traditions of the friendly society . The scheme was administered by local insurance committees covering counties and conurbations which held

116-458: A patient participation group According to Jeremy Hunt the right to a named GP turned into a tick-box exercise as there were not enough GPs. GP practices in England will receive £85.35 per weighted patient under the 2017 Contract, an increase of 5.9% from 2016/17. The 2019 contract will run for 5 years. £405 million of funding has been confirmed for 2019/20. The contract provides changes to

174-568: A combination of inflation and the clawback of pay rises. At the same time the Government introduced the Quality and Outcomes Framework (QOF) which was designed to give GPs the incentive to do more work and fulfil government-set requirements (146 indicators) to earn points (varying amounts per indicator) which translate into greater income. The money for the QOF was taken out of the "Global Sum", so

232-527: A list of more than 1000 patients, and pension provisions. Fees for service were introduced for interventions related to the prevention of disease. There was considerable pressure from doctors for the introduction of charges to patients but the Minister, Kenneth Robinson and the leadership of the BMA resisted this. Despite some changes, the capitation principle and the pool survived. The new payment system, known as

290-514: A panel of doctors prepared to work under the scheme. The panel doctors were subject to "terms of service" which were later lifted directly into the NHS GP contract. Lloyd George 's "nationalisation of club medicine and local insurance in 1912 was the progenitor of the NHS in 1948". Lloyd George, when proposing to increase from 6 to 9 shillings per head the proposed annual payment to panel GPs insisted: "If

348-610: A permanent option in April 2004. The health care professional/health care body and the primary care trust (PCT) enter a local contract. The main use of this contract is to give GPs the option of being salaried. Alternative Provider Medical Services (APMS) are primary care services provided by outside contractors (like US health companies). A study, published by the Journal of the Royal Society of Medicine in 2015 found that 347 of

406-533: A secretary or nurse was paid no more than others who did the minimum. The main problem, however, was in comparison to the pay and status of hospital consultants. The career earnings of a consultant at that time were 48% higher than those of a GP. The Socialist Medical Association complained that the role of the family doctor as the lynch-pin of the NHS, as intended in the NHS Act had not been fulfilled. The reverse position had gradually developed, and general practice,

464-675: A separate contract with negotiations taking place which would come into force from 2017/18. It is proposed that they should give up employing practice staff and move 'as far towards salaried model as possible without losing independent status'. The Beveridge Report of 1942 gave the impetus for White Paper under the Conservative Health Minister Henry Willink that supported the idea of salaried GP services in health centres. The 1946 National Insurance Act under Labour Health Minister Aneurin Bevan , which laid

522-613: A single national organisation in the healthcare field (the National Health Service ) which, among other things, fulfilled the role of the Approved Societies; Approved Societies thus became redundant, and ceased to exist in 1948. The National Insurance Act Part II provided for time-limited unemployment benefit for certain highly cyclical industries, especially the building trades, mechanical engineering, foundries, vehicle manufacturing, and sawmills. The scheme

580-455: A year. The money would be collected from labour exchanges . By 1913, 2.3 million were insured under the scheme for unemployment benefit and almost 15 million insured for sickness benefit. A key assumption of the Act was an unemployment rate of 4.6%. At the time the Act was passed, unemployment was at 3% and the fund was expected to quickly build a surplus. Under the Act, employees' contributions to

638-633: Is affiliated to the Labour Party as a socialist society . The Socialist Medical Association was founded in 1930 to campaign from within the Labour Party for a National Health Service in the United Kingdom and absorbed many of those who had been active in the State Medical Service Association , which collapsed as a result. The inaugural meeting was convened by Charles Wortham Brook , a doctor with links to

SECTION 10

#1732780723294

696-599: Is associated with the campaigns against health inequality. It attempted to build an international movement. In October 1962 David Stark Murray went to the University of Chicago to talk to students about the fight for socialised medicine. It changed its name in May 1981 to the Socialist Health Association to reflect increased interest in public health . It is a socialist society affiliated to

754-542: Is not really new extra money. Participation in the QOF is voluntary but since the standards change each year, practically all practices participating have to do more work each year for the same income. However, the substantial additional workload of QOF has led to substantial improvements in the screening for risk factors in the community by primary care, particularly for older patients with cardiovascular disease. The Working in Partnership Programme (WiPP)

812-762: Is rising 5% year on year as GP income falls – concealed largely by the rise of "half-time GPs" working 40 hours a week which makes pay look artificially high. The contract changes for 2015/16 in England were announced in September 2014 and formulated in the National Health Service (General Medical Services Contracts) Regulations 2015 (SI 2016/1862). Main changes included a named, accountable GP for all patients, publication of GPs' average net earnings and expansion and improvement of online services. Practices have to help anyone who wants it to sign up for patient-facing services. All practices were required to have

870-476: The Thatcher government 's general enthusiasm for competition – an enthusiasm which was not shared by many GPs. The number of professional members on the family health services authority was considerably fewer than had been the case with the family practitioner committee . The terms and conditions of primary medical service delivery were closely specified. The 'Red Book' (Statement of Fees and Allowances) detailed

928-594: The "ninepence for fourpence"). Under the Act, workers could take sick leave and be paid 10 shillings a week for the first 13 weeks, and 5 shillings a week for the next 13 weeks. Workers also gained access to free treatment for tuberculosis, and the sick were eligible for treatment by a panel doctor. Due to pressure from the Co-operative Women's Guild , the National Insurance Act provided maternity benefits. In parts of Scotland whose economy

986-487: The 8,300 general practices in England were run by under 'alternative provider medical service' contracts. The study found the introduction of the alternative contract had not led to improvements in quality and may have resulted in worse care. The results showed that APMS providers performed significantly worse across 13 out of the 17 indicators (p=<0.01 in each) in each year from 2008/09 and 2012/13, and were significantly worse than traditional general practice in three out of

1044-482: The BMA the deal will guarantee a minimum 2% uplift for GP and staff pay and expenses this year. Capitation payments, which make up about 60% of a typical practice's income, are calculated using a formula developed by Professor Roy Carr-Hill. "This formula takes into consideration, along with other practice characteristics, individual patients' age, gender and health conditions and calculates a "weighted" count of patients according to need. This means that two practices with

1102-934: The Labour Party who was a member of the London County Council (LCC) during the period when the LCC developed its municipal hospitals . Brook was the first Secretary of the Association, remaining in office until 1938. Many of those involved in the Association volunteered for the Spanish Medical Aid Committee in the Spanish Civil War. Somerville Hastings was founder President of the Socialist Medical Association (SMA) 1930–1951. He served in

1160-484: The Labour Party. It was active in the campaign against the Health and Social Care Act 2012 . Alex Scott-Samuel , a public health physician and retired lecturer in public health at the University of Liverpool , was elected Chair in 2017 and held the position until 2020. On behalf of the Association he proposed a resolution at the 2017 Labour Party Conference confirming Labour's opposition to Conservative policies for

1218-492: The NHS, with a greater role of the private sector, and for limiting health spending and it was not afraid to take on the doctor's trade union, the British Medical Association (BMA). The 1990 contract which was imposed by Kenneth Clarke after it was rejected in a ballot, linked GP pay more strongly to performance. More money was attached to capitation and less to the basic practice allowance, in line with

SECTION 20

#1732780723294

1276-719: The National Insurance Fund than they took out. In 1925, and then 1931, further Acts were passed which reduced the government contribution to the fund: the government pressured the backers of Approved Societies (the insurance companies, trade unions, and so on) to take on the financial burden themselves. Together with increasing government control on which treatments they were allowed to fund, this led many Societies to complain that they had become little more than branches of government, and membership attendance at society meetings dwindled away, becoming virtually non-existent by 1940. The National Insurance Act 1946 introduced

1334-789: The Royal Army Medical Corps during the First World War, followed by work as an aural surgeon at the Middlesex Hospital. He was a Member of the London County Council for fourteen years. In 1945 there were nine members of the association in the House of Commons . They hoped to influence the plans for the development of the National Health Service (NHS). The Association had held a Health Workers’ Convention at Conway Hall , London in 1943, which

1392-489: The country, others may be homeless or simply unaccounted for in government statistics, and we would be concerned at any suggestion that any discrepancies are down to wilful deception by hard-working GPs." Apart from GPs in the GMS, primary care is also provided through Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts. Personal Medical Services (PMS) were first tried in April 1998 and became

1450-399: The current workload, and tying existing pay to new targets (adding new QoF indicators, making them harder to meet, extending working hours). This combined with the other workload factors (increasing consultation length, increasing consultation frequency, ageing population (see Office for National Statistics) increasing medical complexity, and transfer of work from hospital means that GP workload

1508-579: The details after inspecting the German system. The medical profession and the British Medical Association were angry with the law, despite support from some prominent leaders such as Victor Horsley . Some critics on the right such as Hilaire Belloc considered the Act to be a manifestation of The Servile State , which Belloc criticised in his book of the same name. Collection of contributions began in July 1912, and payments on 15 January 1913. The bill

1566-506: The elderly have higher weights than young men because they cause a greater workload). Furthermore, the practice gets an adjustment for rurality (greater rurality causes greater expenses), for the cost of employing staff (the "Market Forces Factor"), which captures differences in pay rates between areas, (e.g., it is more expensive to hire a nurse in London than in Perth), the rate of "churn" of

1624-454: The example of Germany, which under Chancellor Otto von Bismarck had provided compulsory national insurance against sickness from 1884. After visiting Germany in 1908, Lloyd George said in his 1909 Budget speech that Britain should aim to be "putting ourselves in this field on a level with Germany; we should not emulate them only in armaments ." His measure gave the British working classes

1682-527: The first contributory system of insurance against illness and unemployment. The Act only applied to wage earners—about 70% of the work force—their families and the unwaged were not covered. After first praising the proposal, the Conservatives split, and most voted against it. But when returned to office they did not change it. Some trade unions who operated their own insurance schemes, and friendly societies who had their own schemes, at first opposed

1740-495: The five years for a further two indicators. In 2013/4 the average gross earnings of a single handed GP was £107,200. In practices with six or more GPs the average was £99,100. National Insurance Act 1911 The National Insurance Act 1911 ( 1 & 2 Geo. 5 . c. 55) created National Insurance , originally a system of health insurance for industrial workers in Great Britain based on contributions from employers,

1798-459: The foundation for the NHS, reduced the clinical role of GPs in hospitals and their involvement in public health issues. The capitation fees was based on the number of patients the GP had on his list. Proposals to make GPs salaried professionals were rejected by the profession in 1948. In 1951 the capitation started to be based on the number of doctors, rather than patients. From 1948 to 2004 the contract

General medical services - Misplaced Pages Continue

1856-575: The government set standards (all calls to be answered within 60 seconds etc.) that cannot be met by individuals. The inevitable consequences of systematic underfunding of primary care OOH services and their provision by the cheapest bidder came to a head with the Dr Ubani case , although there have been many others. It should perhaps stand as a warning of the risks inherent in the "lowest bid cheapest provider" model of medical care. A series of amendments have followed each year – each time reducing income for

1914-404: The government with 7 O'Brienites against it. It became law on 16 December 1911, and went into effect on 1 July 1912. The National Insurance Act Part I provided for a National Insurance scheme with provision of medical benefits. All workers who earned under £160 a year had to pay 4 pence a week to the scheme; the employer paid 3 pence, and general taxation paid 2 pence (Lloyd George called it

1972-781: The government, and the workers themselves. It was one of the foundations of the modern welfare state. It also provided unemployment insurance for designated cyclical industries. It formed part of the wider social welfare reforms of the Liberal Governments of 1906–1915, led by Henry Campbell-Bannerman and H. H. Asquith . David Lloyd George , the Liberal Chancellor of the Exchequer, was the prime moving force behind its design, negotiations with doctors and other interest groups, and final passage, assisted by Home Secretary Winston Churchill . Lloyd George followed

2030-543: The importance of their autonomy. GPs' contract arrangements were originally made with local executive councils , and then their successors family practitioner committees , family health service authorities and primary care trusts . In England the contract is now between the GP practice and NHS England . In Scotland GP practices are contracted by the health boards. It was agreed in August 2014 that GPs in Scotland would have

2088-520: The number of newly registered patients, numbers of residential and nursing home patients, rurality and the cost of living, particularly in London. In 2019 GPs were paid around £150 on average for each patient on their list. In 2018 3.6 million more patients were registered in England than the population. The NHS Counter Fraud Authority is to investigate where registered patients have not visited their doctor for five years. Richard Vautrey said "Some of these will be people that have recently died, or left

2146-624: The patient list and for morbidity as measured by the Health Survey for England. The application of the formula to this reduced "Global Sum" would have resulted in great changes in GP income and income loss for many GPs and through their representative organisations the GPs were able to extract a concession. They received a "Minimum Practice Income Guarantee", which temporarlily protected the previous income levels of those who would otherwise have lost out – that guarantee being withdrawn over time by

2204-471: The payment tariffs for each individual treatment. Targets were set for cervical smears and immunisations. GPs were required to give health checks to new patients, patients over 75 and those who had not seen a GP for 3 years. The GP Fundholding scheme gave them a budget for commissioning for the first time. The government also introduced a new locally negotiated personal services contract for general practitioners in 1997, permitting them to be salaried, paid by

2262-407: The proposal, but Lloyd George convinced most of them to support it. The friendly societies and trade unions were given a major role in administering health insurance. Covered workers outside those agencies dealt with the local post office. The government picked up responsibility for the basic benefits that the unions and societies had promised, thus greatly helping their financial reserves. The Act

2320-656: The red book, allowed doctors to claim back from the NHS 70% of staff costs and 100% of the cost of their premises. Maternity Services and contraception were optional services which attracted additional payments. GPs were allowed to practise privately, to hold part-time hospital or other appointments within the NHS, to work in industry or for an insurance company, although few did very much private work. In 1976 parliament approved legislation requiring doctors who wanted to become principals in general practice to complete vocational training. The Conservative government under Margaret Thatcher from 1979 onwards looked for ways of changing

2378-451: The regional hospital organisations and criticised the segmentation of the service as a barrier to integrated services. The first anniversary of the NHS was celebrated by the Association with a meeting of 300 attendees at Conway Hall Ethical Society . The association was active in campaigns against NHS charges, smoking and tuberculosis , and for adequate nutrition, the establishment of health centres and salaried general practitioners . It

General medical services - Misplaced Pages Continue

2436-446: The remuneration is increased, the service must be improved. Up to the present the doctor has not been adequately paid, and therefore we have had no right or title to expect him to give full service. In a vast number of cases he has given his services for nothing or for payment which was utterly inadequate. There is no man here who does not know doctors who have been attending poor people without any fee or reward at all". In 1924 agreement

2494-421: The rurality index payment and London adjustment payment, so that rurality index payments will only apply to patients living inside a GP's catchment area and the London adjustment payment will only apply to patients actually living in London. Babylon Health complained that this penalised their GP at Hand operation which had invested in technology in order to serve patients over a wide geographic area. According to

2552-474: The same number of patients may have very different weighted patient numbers due to widely varying patient characteristics and health conditions, and as a result, these practices which may seem to be similar in terms of list size, could receive very different levels of funding". This includes patient age and gender which is used to reflect frequency of home and surgery visits, Standardized mortality ratio and Standardised Long-Standing Illness for patients under 65,

2610-551: The scheme were to be compulsory and taken by the employer before the workers' salary was paid. Amended by National Insurance Act 1913 c. 37, draft regulations were published in November 1913. Socialist Medical Association The Socialist Health Association ( SHA , called the Socialist Medical Association before May 1981) is a socialist medical association based in the United Kingdom. It

2668-424: The session, or work as locums. The new GMS contract came into force in April 2004, abolished the "Red Book" and led to a significant but temporary increase in some practices' income. Every practice gets a share of a total amount of money allocated towards primary care in GMS practices (the "Global Sum"). This share is determined by the practice's list size, adjusted for age and sex of the patients (children, women and

2726-596: The societies. The 1911 Act only allowed Approved Societies to collect the contributions of their members; they could not keep the money, but had to forward it to the National Insurance Fund. The societies' own expenditure, such as the cost of treatment for their members, would be reimbursed by the Fund, on a six-monthly basis. The government did not reimburse any "improper" payments, such as "treatments" that did not comply with government regulations, or corrupt payments. Any organisation could become an Approved Society, as long as it

2784-573: Was an individual one. Virtually every doctor working in general practice had a personal contract with the local NHS and patients were registered with a named doctor. There was a clause which stated "a doctor is responsible for ensuring the provision for his patients of the services referred to … throughout each day during which his name is included in the … medical list". In 1953, general practitioners were estimated to be making between 12 and 30 home visits each day and seeing between 15 and 50 patients in their surgeries. The College of General Practitioners

2842-475: Was attended by health workers and union representatives. A further event, also at Conway Hall Ethical Society , took place in 1946, delivering 14 lectures and an exhibition as part of a Health Services Week. There were communications with Aneurin Bevan but his relations with the group were not particularly close. The Association was keen to press for doctors to be salaried and work full-time in health centres . They wanted teaching hospitals to be integrated into

2900-487: Was based on actuarial principles, and it was planned that it would be funded by fixed payments from workers, employers, and taxpayers. It made no provision for dependants. Part II worked in a similar way to Part I. The worker gave 2 1 ⁄ 2 d (i.e pre-decimal pence) per week while employed, the employer 2 1 ⁄ 2 d, and the taxpayer 3d. After one week of unemployment, the worker would start to be eligible to receive 7 shillings (i.e. 84d) per week for up to 15 weeks in

2958-410: Was founded in November 1952, and became an increasingly important player in negotiations about the GP contract. It became a driving force in developing postgraduate training for doctors wishing to enter general practice. In 1965 GPs demanded a new contract and threatened mass resignation from the NHS. One of their complaints was that there was no provision for improvement of practices. A GP who employed

SECTION 50

#1732780723294

3016-465: Was introduced by Lloyd George to Parliament on 4 May 1911. On the Third Reading, the government was victorious by a huge majority. Most Unionists abstained, although 11 voted against the bill and 9 in favour of it, while the Labour Party was also split, with 32 Labour MPs supporting the government and 5 from the party's socialistic wing voting against. In addition, 58 'Redmonite' Irish voted with

3074-407: Was launched under the 2004 contract to support doctors in general practice by providing them with innovative ideas on how to improve services for the public. The new contract forced almost all GPs to opt-out of weekend and night out-of-hours service provision – largely because the cost of providing a good quality service was roughly double the funding allocated to it by the patient, but also because

3132-503: Was now frequently described as a "cottage industry". The BMA formulated a Charter for the Family Doctor Service. It demanded: "To give the best service to his patients, the family doctor must: The resulting 1966 contract addressed major grievances of GPs and provided for better equipped and better staffed premises (subsidised by the state), greater practitioner autonomy, a basic practice allowance for any GP principal with

3190-666: Was psychologically important, as it removed the need for unemployed workers to rely on the stigmatised social welfare provisions of the Poor Law . This hastened the end of the Poor Law as a social welfare provider: the Poor Law Unions were abolished in 1929, and the administration of poor relief was transferred to the counties and county boroughs. Key figures in the implementation of the Act included Robert Laurie Morant and especially economist William Braithwaite, who drafted

3248-587: Was reached between the British Medical Association and the Ministry of Health that capitation fees would comprise 50% of a GPs income but only occupy 2/7 of his time, the remaining income being generated privately. The meaning of independent contractor in respect of GPs has not always been very clear, but was generally tied to their rejection of salaried status. It has been argued that their behaviour has rarely been that of self-employed entrepreneurs, but rather that of salaried professionals who emphasise and defend

3306-637: Was registered under the Act, and complied with the Act's obligations, including to operate on a not-for-profit basis. As well as societies created by the trade unions and friendly societies , commercial insurers also established Approved Societies, such as the National Amalgamated Approved Society (created by Pearl Assurance and others); the largest Approved Societies were the four operated by Prudential , which collectively looked after 4.3 million members. Many Approved Societies were nominally profitable, contributing more to

3364-572: Was still largely based on subsistence farming , the collection of cash contributions was impractical. The Highlands and Islands Medical Service was established in the crofting counties on a non-contributory basis in 1913. Though the fund was held centrally, and the obligation to pay into it was a nationally imposed one, access to the scheme was via "Approved Societies", who collected the contributions, paid out for treatment, and provided day-to-day administration. A worker could choose which Approved Society to belong to; this stimulated competition between

#293706