Who says accountancy and tax are boring? This week, my eye was drawn to a tax case that has some relevance to GPs – in a strange kind of way.

Nadine Quashie was a lapdancer at Stringfellows, and was subsequently dismissed. She had been treated as self employed, and had prepared accounts on that basis, but now brought an action saying that in reality she had been employed all along and was therefore entitled to compensation for unfair dismissal. The case (Quashie v Stringfellows) was heard to establish whether she was employed or self employed. The case has its sordid details, but in his summary the judge said that “On each night she attended, she was obliged to work as directed by the management… if she did not provide free dances or other duties, she could be fined… she could not refuse.”

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There are any number of issues that could come to define the 2012 LMCs conference in Liverpool this week.

An obvious one would be the pensions ballot but of course that does not close until next week so there will be no result to debate or turn-out figures to pick apart.

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I had occasion to drive past the Black Tower last week. I was early finished from surgery, about 6.15. The old battlements looked in good shape, but there was no flag flying, most of the lights were off, no cars in the car park save for the Trabant that Magda the cleaner still drives.
I thought wistfully of those late nights, working on “important” things. Reports needing to be written, governance to be done, details to be checked. I recalled the pride that most of us took in our work, the weight of responsibility for those jobs we had chosen to take on was a burden but also a service.

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The pace is picking up now in terms of establishing clinical commissioning groups (CCGs), with less than 10 months left until the new system goes live in April 2013.

Across the country, groups of practices have been coming together and identifying the shape and configuration of their CCG. It is a fantastic achievement that these geographies are now sorted and we have emerging CCGs covering the whole of England coming forward for authorisation.

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The Yogi and the Commissar is one of the titles from a collection of essays by Arthur Koestler. It examines human behaviour and describes two ends of a spectrum around the introduction or some would say the imposition of change in society.

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In last week’s blog I mentioned the importance of getting the profits right to ensure that the GP got their full seniority, as seniority is now based on achieving a level of income rather than being full time/part time/three quarter time.

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Over the past few weeks I have made a number of visits to the Kremlin, or at least that’s where the taxi driver said he was taking me. Perched on a hill overlooking the city, the building screams of Stalinist tendencies with an aerial reaching skyward from a central tower broadcasting instructions for the proletariat to follow… or suffer the consequences.

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Allow me a brief moment of serious comment. GP needs to change. Not the august journal for which I blog, but the actual General Practice we all know and love. How do I know this fact?

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‘There’s always been a bit of scepticism about working with the pharmaceutical industry but I couldn’t recommend it more highly. It’s worked really well. The clinicians have been in the driving seat here.’

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As clinicians we want to work in the health service to provide better care for our patients. The only way we can do this is by being part of a team. The same is true for our social care colleagues. The relationships we have with other clinicians, managers and health and social care partners are absolutely vital if a community is going to meet the difficult financial challenges ahead and yet deliver the highest possible quality of care.

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The Freedom of Information Act has been a revelatory tool for journalists but should we really expect to read all Whitehall correspondence as a result?

Those pressing for the NHS reform risk register to be published argue not to do so denies the public the opportunity to make up its own mind about whether the risks of health secretary Andrew Lansley’s NHS reforms are those worth taking.

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Alright there have been plenty of patients, loads of prescriptions but since all the “managers” are busy trying to manage themselves into new jobs my desk has been a diktat free zone for ages.Then just like buses three come at once. But unlike buses I don’t want to get on board with any of them.

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Not for the first time, I have had a discussion with a client on how the rise to parity for a new partner should be calculated. Now I am not going to say that my way is right (I did that a couple of years ago and lost a potential client!) but let’s just say that there is more than one way to do the figures.The practice which contacted me last week has offered its new partner a partnership at 80% of parity. Parity will be 25% so in this partner’s first year he will be paid 80% of 25% ie 20%. The other three full-time partners will get the difference so each will get 26.667%. This is the way they think of parity, and forms the basis of their offer. Assuming profits of £600,000, the new partner will be getting £120,000 and the continuing partners £160,000

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He was an elderly chap who wanted to know more about clinical commissioning. He used services regularly, and valued a particular local service which involved social care, community nurses and traditional medical services.

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