Family doctors in Northumberland are threatening a vote of no confidence in the directors of a debt-ridden health trust. A swathe of budget cuts is on the cards as bosses at Northumberland Care Trust wrestle with a £14m debt and try to save a further £11.9m to break even. Here Dr Iain Mungall a retired GP from Greenhaugh, Hexham, who served one of the rural communities which could be most at risk from cuts, gives his opinion on the impact cost-cutting could have on the county’s small rural practices.
I NEED to declare an interest first. I was a rural GP in Bellingham for 33 years until 18 months ago, ( whose practice covering 800 square miles, coincidentally would suffer the biggest cuts of all, of £129,000 ).
Also, I have a longstanding interest in rural health issues; I co- edited a textbook, Rural Healthcare.
I sit on the rural practice standing group of the Royal College of GPs, have chaired a group at the Academy of Medical Royal colleges looking at rural access to healthcare ( www. ruralhealth.co.uk) – most importantly, I am a rural patient.
What has happened?
Northumberland Primary Care Trust (PCT) has had an enormous debt, many, many millions of pounds, which they have struggled to deal with over quite a number of years. Now, all practices have received details of their proposed budgets for the next two financial years. It is clear that virtually all practices will have cuts, of a few percent.
The small rural practices exclusively will have massive funding cuts , of anywhere between 15 and 24% after April 2009, but with a maximum 9.1% cut in the first year. A spokesperson for the PCT was quoted as saying that the GPs may have misunderstood, but from the letters I have seen, there is no possibility of any misunderstanding. They have also stated that there is no intention to close any practice, but from viewing these figures, this must be disingenuous.
Such sized cuts would have an enormous impact on the service being provided. There is no possibility of preventing a big reduction in quality, as GPs and staff would have to be laid off.
It is possible that whole practices will close. The budget cuts would have a progressive, domino effect, in that income would then fall progressively as quality standards could no longer be achieved.
This would be heartbreaking for the GPs, who have been encouraged to practice to the highest standards, and have devoted themselves to building up their practices. (Northumberland used to have a reputation as the best authority in the business). But I suggest it will be much worse for the patients, after all, highly motivated GPs can find work elsewhere without too much difficulty.
Destabilising these small practices will of course increase the costs to the patients, with travelling costs and time, as well as adverse health effects: but, distressingly, they will probably increase the NHS’s costs as well. If General Practice is not resourced, much of the work is transferred to the more expensive hospital sector. The way to increase NHS efficiency is to invest in Primary Care. Has the Government learnt nothing from its many billions of investment over recent years, very largely into hospitals, with generally agreed disappointing results.?
Why the bias?
So, why the enormous bias against these rural patients?
This is just incompetence. Someone forgot to account for the effect of rurality in the formula used to produce the budget figures.
This formula seems to be a closely guarded secret. It has been well understood for years that it is more expensive to provide quality care for small and scattered communities. There can be no economies of scale, more time is spent in travelling, remote practices have to provide a wider range of services; and so on.
The government has stated clearly that government departments should "rural- proof" all proposed legislation to minimise its adverse impact on rural areas. It must be admitted that this is still often overlooked. I know that Northumberland PCT has been given information on rural proofing. Yet when the people of Bellingham were informed that their ambulance would be removed last year, they were told in a meeting that a delayed ambulance did not matter once a paramedic is with you. This of course is simply untrue, and demonstrably so.
Northumberland is of course one of the most sparsely populated counties in England. Northumberland PCT in fact, though still the legal entity, no longer exists, and instead is run as a consortium of three former PCTs. Thus, they may have less understanding or feeling for the needs of these small communities.
This is a "flag-raising" exercise, to gauge the reaction. If the doctors protest, that is only to be expected, but let us see how the patients respond. If there is little reaction, we can save a lot of money by having everyone travel to the large centres, such as Hexham.
Several years ago, there were those in the Health Authority who proposed that the new Hexham hospital would be an ideal base for GPs, (as it will, but not for those from the far outlying villages). There is currently a review taking place into the future shape of the NHS, by Lord Darzi ( a London based surgeon as well as a minister of Health) and there is speculation that he may recommend that General Practice should be provided from large "polyclinics".
Is Northumberland trying to earn brownie points by leading the way? In my opinion, there is no way that such a centralisation could ever take place in rural Northumberland without an enormous and unacceptable reduction in standards. A recent study from North Yorkshire shows how the outcomes of cancer treatment get worse the further away you live from your General Practice.
The government has been putting pressure on PCTs to introduce competition into traditional General Practice. Perhaps Tesco or Northern Doctors Urgent Care ( NDUC), who provide the out of hours care, could provide some of the services more cheaply and "efficiently"? I am willing to bet that it would be a disaster to follow this route for the patients of these small and remote practices.
The PCT is right, and these small practices have been grossly overpaid. I can tell you from personal experience that this is not the case, and the GPs I know about generally earn less than average pay
For people living in an affected area, unless the PCT consortium persuade you that these budget cuts are a good thing, than I feel it is vital to somehow register your dismay, by writing or phoning: Chris Reed, Northumberland Care Trust, Merley Croft, Loansdean, Morpeth NE61 2DL
I really feel that this is important. If there is universal condemnation, it will not happen. Remember that the NHS nationally is currently sitting on a surplus of over a billion pounds.
MP calls for surplus cash to be spent on strugglers
AN MP is calling on North-East health bosses to use a predicted multi-million pound surplus to help a debt-ridden health trust.
Berwick MP Alan Beith held a crisis meeting with concerned doctors from the county who face having £1.6m wiped from their budgets by Northumberland Care Trust as it wrestles with a £14m debt.
The trust must save £11.9m to break even in April and is making cuts to primary care services across the county to claw back money.
Doctors have spoken of their concerns for patient care and many rural GPs fear their practices may have to close or lose staff as a result of the changes.
The trust is struggling to balance the books and has brought in cost-cutting measures across the board as the Strategic Health Authority NHS North-East is sitting on a surplus of £113m forecast for primary care trusts across the patch.
Doctors held an urgent meeting with Mr Beith over the weekend and he is now writing to the chairman of NHS North-East Peter Carr with his call for action.
“The Strategic Health Authority needs to intervene to stabilise the financial situation of the trust while better alternatives are sorted out,” he said.
The region’s strategic health authority says Northumberland should live within its means.
But Mr Beith said: “As far as the public is concerned the money is from the same NHS pot and they don’t want to see services cut while one trust has money and the other hasn’t.”
Doctors from across Northumberland including practices in Berwick, Amble and Alnwick called the meeting.
Their fears include cut backs on nursing staff and branch surgeries as a result of the cuts from their budgets of up to 24% in some parts capped at 9% for the next financial year.
Mr Beith criticised the trust for not taking into account the circumstances of a scattered rural area where staff have to cover large rural distances and that fact that over the years the practices have taken on more work from the hospitals. He is calling for wider public consultation by Northumberland Care Trust.
“It doesn’t seem that the patient groups have been consulted at all about these drastic changes.”
But a spokeswoman for NHS North-East said: “Any surplus that exists does not belong to the Strategic Health Authority but to Primary Care Organisations in the region whose priorities are to focus on delivering valuable health services to some of the most deprived areas in the country.
“Therefore it is not appropriate to redistribute the surplus from these organisations to Northumberland to enable resolution.” She said Northumberland has over 88.1 doctors per 100,000 population, the highest proportion in the whole of the UK.
MP calls for surplus cash to be spent on strugglers