Sometimes I really don’t believe that the MPs or the ministers understand the NHS and in particular Primary Care – so a little explanation may help.
Primary care is made up of four groups of independent contractors. These include:
- General Practice
- Community Pharmacy
So usually a healthcare professional stumps up a load of cash, opens a practice and obtains a contract with the NHS. Originally these were little businesses, in the case of General Practice they were limited liability partnerships and for community pharmacy private limited companies. Along the way some have sold out to big business as public limited companies.
So like all little businesses they have income and overheads and then the partners or the owner derives an income from the profit.
For some of these contractors, eg Dentists and Optometrists, the NHS income represents a smaller proportion of their total revenue. So Optometrists sell glasses and lenses and dentists charge for treatments. Their NHS income may be poor, but they cross subsidise and survive. When large companies enter the optometrist field, for example, and sell glasses cheaply then all suffer a little and some go out of business.
General Practice and Community Pharmacy, on the other hand, gain most of their income from the NHS and are not in a good place to cross subsidise. In recent years as the NHS income has not increased in line with inflation these contractors have found things more and more difficult.
GPs have been made to jump through hoops with paperwork, increasing patient demand and at a time when it is increasingly difficult to employ GPs or practice nurses. They have some protection against rent rises, but not against wage rises. And what are patient’s saying – I love my GP, but it is getting more difficult to see them.
On balance it is still worth becoming a partner in a GP practice as long as you can hold that investment for 20 years. There is little wonder that new GPs want a different life and are not so keen to buy into a partnership.
Community Pharmacy has been made to dispense more prescriptions, with an increasing fragility in the supply chain and a greater expectation for a customer facing service, including a major role in public health. With an increasing elderly population they have been expected to deliver medicines to patients with no added remuneration. There is no protection against rent rises nor wage rises.
All independent contractors will have to deal with the implementation of the living wage and other cross government initiatives.
So this year we expect General Practice to get a 1% increase in their contract. It is not enough to cope with all the pressures that they face and to keep the sector engaged and buoyant. They will continue to struggle until a ‘new deal’ with General Practice actually comes along.
Community Pharmacy is expecting a 6% decrease in their contract, which the minister says will put between 1,000 and 3,000 out of business. Forced to close shops that are no longer viable and the owners lose all of their original investment. Those that remain open will need to cut overheads (mainly staff) by sufficient to cover the reduction in income and the increased expenditure on rent, rates, services, living wage and pension arrangements. Anyone who thinks that they will be in a better position to support and help General Practice to cope are just crazy. Holes will appear in the network and patients will have to travel further to get less. But we are told not to worry – technology and mechanisation are on the way – the old fashioned face to face service will be replaced by a computer, an order and a delivery.
You have to be worried about the current policies. Some parts of primary care are about to crumble and be lost for ever. We can’t continue to spend more money on secondary care and ignore the fact that General Practice and Community Pharmacy teeters on the brink.
Healthcare professionals will hang on grimly with their fingernails – it is their vocation – it is their livelihood, but good will only last so long.