The new GMS contract promised to reward doctors who provided extra services for patients.
Various health ministers preach that healthcare should be moved out of hospitals and back into primary care. But what happens when the chips are down, and PCTs are short of a few million?
Last year we knew that the PCT was in debt, and practices in this area made changes aimed at cost-effective prescribing.
High-referring practices examined their referrals and in many cases made significant reductions. We were all sent a letter thanking us for our cooperation.
Unfortunately the savings were cancelled out by the high cost of management consultants who were paid to advise the PCT how to save money.
Then, about a week before the start of this financial year, we were sent a letter informing us that severe restrictions would be made on payments for minor surgical procedures in our area.
A limit was placed on claims for joint injections, and most cutting procedures for skin lesions were disallowed. Vasectomies continue to be limited. Compared to overall practice costs, the possible savings are trivial. There was no attempt to discuss these measures in advance.
The new rules are unlikely to lead to savings, since they will lead to an increase in referrals, which are more expensive than enhanced service payments.
What they will lead to is frustration and bitterness among GPs and patients.
Dr Edmund Willis
Brigg, North Lincolnshire