GPs fear hospital deficits are threat to PBC plans

Shortfalls in hospital funding are beginning to affect GPs, finds Joe Lepper.

Health secretary Patricia Hewitt's announcement earlier this year that the NHS was having its best year ever was met with fury from hospital staff, who had experienced cuts to services and seen colleagues made redundant.

Far from the best year yet the NHS has racked up a staggering £512m deficit in England, much of it due to hospital overspends, and an estimated 15,000 jobs, many in hospitals, are now at risk.

But Hewitt's comments were not just met with derision in hospitals, because cuts to secondary care have also started to have an impact on the working lives of GPs in the worst hit areas.

In the south east of England the Surrey and Sussex Healthcare NHS Trust, which manages the Crawley Hospital and East Surrey Hospital, Redhill, is to cut 400 jobs to help address a £41.2m deficit and a £2m monthly overspend.

GPs in the area have also reported cuts to services at the nearby Royal Surrey Hospital in Guildford.

Julius Parker, medical director at Surrey and Sussex LMCs, said: 'We are beginning to see referrals sent back to us, which has an effect on our workload.'

He said that, in the worst case, a GP who had referred a patient to the Royal Surrey Hospital on 23 January was not told until 14 March that the referral had been knocked back.

'The reason given was that "our capacity is exceeded",' he said.

He is now in discussions with East Elmbridge and Mid Surrey PCT to ensure that patients are still seen and that the time taken to inform GPs of knock-backs is substantially reduced.

'We have had a favourable response, but I suspect some solutions may be to treat patients out of the area, which is still a problem because GPs are unfamiliar with those services,' he said.

In areas of Kent, such as Ashford and Canterbury, the spectre of hospital cuts has also started to loom large - East Kent Hospital Trust is considering axing jobs to address a £35m deficit.

Dr Gary Calver, medical secretary at Kent LMC, said: 'At the moment it is just rumours but we understand that there could be cuts at the hospital.

'If that happens then we will have problems with admissions and cuts to other areas such as enhanced services.'

He believed the hospital cuts were part of the inevitable shift from secondary care to primary care, 'but in order to make that work you need to pump money into primary care and that has not happened.'

Norfolk is another area where staff cuts are on the cards as the PFI-funded Norwich and Norfolk University Hospital looks to address a £22m shortfall.

Norfolk LMC chairman Dr Ian Hume said this latest threat is part of an ongoing struggle with finances because of its PFI funding.

'This is nothing new; what has been happening for some time is that to keep the costs down they are looking after more people in the community and length of hospital stay is being cut,' he said.

But it is not just in areas where hospitals are in financial difficulty that GPs have felt the effects. In Central and East London LMC chairman Dr Kambiz Boomla said the hospitals in his area were not battling deficits. However his local PCT, Tower Hamlets, has pledged £11m to help bail out hospitals elsewhere in London.

'That is our growth money, which I would have like to have seen spent on things like practice-based commissioning (PBC). To really make it work there needs to be some initial investment,'he said.

'We want to do things like employ GPSIs but it is difficult.'

This failure to invest properly in PBC in a climate of hospital cuts is also a concern for Dr Peter Smith, group commissioning lead in Weston, Somerset. In his area around 60 jobs and 56 beds have been lost at Weston General Hospital, Weston-super-Mare, in a bid to address a £6m deficit.

'We had lots of plans for PBC such as intermediate care and GP managed beds but it has not happened because the money is not there,' said Dr Smith.

'If PBC does get up and running properly we want to be able to manage services that compliment the hospital.

'The danger is that PBC could end up replacing much of what it does and we don't want to see that happen.'

Dr Smith said that any cuts at hospitals would inevitably have an effect on GPs' lives, and described the local health economy as 'a house of cards'.

'When one piece is taken away the whole thing falls down,' he added.

Perhaps Mrs Hewitt ought to have listened more to those on the front line in both secondary and primary care before she heralded this year as the NHS's best year yet.

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