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NHS managers lacking 'basic economic principles’, claims Wick GP

By Alan Hendry

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NHS Highland chiefs have been accused by a Caithness doctor of lacking "the most basic economic principles" and being unable to put two and two together.

Dr Ewen Pearson also criticised the health board for allegedly refusing to negotiate with the Local Medical Committee, the representative body for Highland GPs, over an improved contract for providing "enhanced services".

He made his remarks in a letter to the John O'Groat Journal.

Dr Pearson, who runs the Pearson Practice at Wick Medical Centre, wrote: "Since 2005 GPs have provided 'enhanced services' in Highland, for certain things that were not in our contract but that were able to be done in general practice. This was a very cost-efficient way for the NHS to work and also helped free up expert consultant time for the more complicated medical cases.

Dr Ewen Pearson: 'Many practices have had enough.'
Dr Ewen Pearson: 'Many practices have had enough.'

"The contract has been in place since 2005 and there has been no increase in funding since then. Just with inflation the funding should have increased by 85 per cent. NHS Highland has refused to negotiate with the Local Medical Committee.

"General practices have staff costs and increases in utilities the same as everyone else in this cost-of-living crisis. Where funding does not keep up then difficult choices have to be made – this may be by cutting services or by cutting staff.

"One of the most staggering instances is in PSA [prostate-specific antigen] checking and hormone injections for prostate cancer. This should be done by the urology department but has been passed on to GPs with no funding. It has also resulted in frail elderly male patients having to travel all the way to Raigmore for an injection and a blood test every three months which could easily be done here if funded properly. The funding for GPs to do this is £30,000; the cost for NHS Highland to provide the same service is £700,000. This is 23 times as much! The extra £670,000 will be an annual increased recurring cost.

"Many practices have had enough and are not going to be able to provide these services with inadequate funding.

"It seems that NHS Highland does not have the managers or directors or senior board level members with the financial governance skills required to provide services for patients at the lowest cost and best value for money. There seems to be a lack of the most basic economic principles.

"Recently both vaccines and smear recalls have been taken over by the NHS rather than by GPs. The uptake rates are much worse at much higher cost – an extra £2 million per year on vaccines for a worse service.

"Those high up in NHS Highland don't seem to be able to add 2+2."

Dr Pearson added: "The GP recruitment crisis continues, with many vacancies across the county but also Highland. Is it any wonder when they treat GPs like this?"

NHS Highland says it looks forward to continued dialogue with GPs.
NHS Highland says it looks forward to continued dialogue with GPs.

A spokesperson for NHS Highland said: "NHS Highland commissions a range of Local Enhanced Services from GP practices. In North Highland [the Highland Council area] there is an investment of around £3m in the services that are delivered across the majority of GP practices and NHS Highland is committed to maintaining this level of investment.

"NHS boards receive funding from Scottish Government to commission Local Enhanced Services. This funding has not been uplifted on an annual basis for many years. This is an issue applicable across all NHS boards as a result of annual national negotiations between Scottish General Practice Committee and Scottish Government.

"For many years the negotiated agreement between these parties is that the annual uplift is only applied to certain elements of the GP contract, namely Global Sum and the Income and Expenses Guarantee. Other budgets, such as Enhanced Services, do not receive any uplift.

"During 2022/23, NHS Highland reviewed Enhanced Services arrangements in North Highland to provide a framework to support our ambition of delivering care closer to home.

"In December 2023, NHS Highland proposed to GP practices an alternative set of arrangements for the commissioning of Local Enhanced Services. However, this proposal was not supported by Highland LMC, therefore a pause in the implementation was agreed to allow for continued discussion and negotiation.

"These meetings have now commenced and we aim to have a new set of commissioned arrangements in place by April 2025 – or earlier, if continued negotiations achieve this. A letter has gone out to all North Highland practices to propose this and we are committed to ongoing dialogue.

"Delivery of Local Enhanced Services is not a core contractual requirement for GP practices. Some GP practices in the Highland Council area are withdrawing from service provision from April 1, 2024, and alternative arrangements will be put in place where applicable.

"We look forward to continued dialogue with Highland GPs thereafter to reach a satisfactory agreement."

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