Owen Paterson MP was on Any Questions last week - with a decent panel - discussing spending on the NHS. It was like a scripted story with him trotting out - "You can't just keep spending on the NHS, we've tried that,and our outcomes are poor compared - it's the way we organise [the money] it???"
I think it was Lucie Green (Physicist) on the same show who said even though politically we have increased funding. It may not be enough. Seems logical to me.
Owen Paterson and his think tank seem to think we've got to look to Switzerland, Ireland and South Korea for answers.
I haven't read the document but I guess it will just prop up a Neo-Con agenda?
Owen Paterson MP was on Any Questions last week - with a decent panel - discussing spending on the NHS. It was like a scripted story with him trotting out - "You can't just keep spending on the NHS, we've tried that,and our outcomes are poor compared - it's the way we organise [the money] it???"
Well the Tory MP is right - it's not just about money. If it was, the US, which spends way more of its GDP on healthcare than any other country, would have a healthcare system that was the envy of the world, and it hasn't.
It's what you do with the money. For a start don't hand it over to profit-driven private enterprise.
[url= http://www.independent.co.uk/money/loans-credit/crippling-pfi-deals-leave-britain-222bn-in-debt-10170214.html ]Crippling PFI deals leave Britain £222bn in debt[/url]
[b][i]"Treasury data analysis unearths the 'enormous financial disaster' of Private Finance Initiatives"[/i][/b]
Medical consensus changes over time. On Lyme it is doing so. Long term antibiotics have good evidence behind it it you want to see it but you don't
Okay. Show me the trials and the cochrane meta-analysis. If not, put up and shut up.
kimbers the joint MMR vacine definitely negatively impacted the health of our middle daughter (in our opinion as parents), there have been long term issues she suffers from to this day, she is now 26. My eldest didn't have it and we paid for the youngest to have the individual jabs. The joint vacine was a cost saving excersize no one asked for amd which tye medical profession amd various governments have been wedded to imo for fear of admitting any mistake. You can post the "nutter" stuff if you like but there are very many parents who feel this way
This is pure gold, defending the lymies and talking shit about mmr - playing into a stereotype there. World class trolling Jamby, as I don't think you're being serious.
tom - whats your expertise to be so definite about something you appear to know little about? Myself a nurse trained to honours level in research so I can read research and understand its validity
cochrane is OK but is always very conservative and slow to react to changes in the science.
there is no need to be so aggressive and condescending in a debate
Hahahaha - the stats guys consider cochrane to be the gold standard.
But sure, I'll listen to a nurse trained to honours level in research - whatever the **** that is. Cochrane may have its issues, but the standard is still better than everything else.
After the false claims were made by a crooked physician and the private healthcare industry seized the opportunity to exploit confused parents by selling them single vaccines, sometimes in a way that left the child unprotected as they didn't even keep the vaccines cold properly, which the NHS then had to sort out.
You are known for spouting crap Jamba but I didn't have you down as an anti vaxxer too. Dangerous crap to spout.
Remind you a bit of lymes?
Plenty of peer reviewed articles out there if you want to learn. some of us can separate quackery from medicine. I agree there is an awful lot of quackery around Lyme but the current medical consensus is not unchangeable and there is a lot of new data coming in about lyme. Now this is still a controversial point but there is no doubt good evidence is being accumulated and in the medical estblishment people fight hard to hold onto their views which makes the consensus slow to change. But it does change over time.
Conclusions. Prolonged antibiotic therapy may be useful and justifiable in patients with persistent symptoms of Lyme disease and coinfection with tickborne agents.
So Tom - what is your expertise then to be so aggressive and condescending? I could point out to you multiple issues where Cochrane has been shown to be wrong in the light of newer data
But sure, I'll listen to a nurse trained to honours level in research - whatever the **** that is.
thats a nurse who has done their training then done post grad education focussing on research to level 10 / honours level which allows me to have the skills to critically evaluate reseach papers
So Tom - what is your expertise then to be so aggressive and condescending?
I really wouldn't worry too much TJ, it's nothing to do with you, Lyme disease, or his expertise. Tom has excelled at being unpleasant on this thread, he's probably got some personal issues to deal with. Here's an example from earlier in the thread.
Tom_W1987 - MemberOk. Fat, lower tax band, lower NI contributing Northern Brexiteers that shit out too many kids.
Posted 1 week ago #
Lyme disease hadn't even been mentioned when Tom decided to rant about Northern Brexiteers that shit out too many kids.
Raphael B. Stricker
International Lyme and Associated Diseases Society, Bethesda, Maryland
Lolz
Some paradigm shifting research right there, better ignore the rest of the reputable evidence in favour of this authors conclusoon.
So tom - are you going to tell us what expertise you have that allows you to be so definite about this? Or are you going to continue being so unpleasant without anything to back up your assertions?
Well, Im studying a related masters in September. But I don't use appeal to authority to prove my point.
Burden of proof is on the lyme literate not the skeptics. As Hitchens once said, what can be asserted without evidence can be dismissed without evidence. Although in this case the skeptics have more studies on their side.
It's what you do with the money. For a start don't hand it over to profit-driven private enterprise.
Well, contradictions abound as the 'Commonwealth fund assessment of healthcare systems' sort of contradicts the UK2020's study in many ways.
It seems measuring things in different ways is the problem here.
No - you use strawmen and ridicule instead. So in the future you are going to study in the area? I guess then you are recent graduate?
Glad to see you finally accepting that the evidence points both ways with the medical consensus at the moment being against long term antibiotics but that there is evidence the other way - and you are right in that its up to those who promote this view to prove it - and that is what a lot of research is aiming at doing. You are way behind the curve on this and as is often the case with people with such dogmatic attitudes you don't realise the holes in your knowledge.
Me - I have an open mi9nd and will listen to all sources, discard the obvious nonsense and snake oiland then critcally evaluate whats left.
this approach has informed me and I know that Lyme can lead to lifelong effects where the causes are unknown. that the testing for lyme is pretty unreliable and that the lyme bugs are dead sneaky and hide and that the medical consensus does not answer all the questions and that those answers are not certain at all yet.
As you grow you will realise that medicine is not an exact science and tht medical consensus changes all the time in the light of new data
Not exactly a recent grad. 😀
But whatever helps you sleep at night. History is littered with scientific rebels and naysayers who went up against the mainstream and who were wrong - chances are it will be the same with long term antibiotics treatment for lyme.
[i]Large parts of current problem related to social care which is nothing to do with NHS budget.[/I]
I've often thought that since 'bed-blocking' is usually linked to a lack of social care budget, and it is also mentioned that hospital stay costs more than been in a Care Home etc that if it was all under a single budget then management would ENSURE that the patient was in the cheapest place to cover their health needs.
FWIW when I worked in the NHS I saw results of bed audits that reckoned (medically) +30% of patients were bed 'blocking'.
what is it 10000+ NHS beds lost since 2010?
now the decimation of local council budgets means that social care is seeing a greater decrease
This winters crisis was always going to happen, just lucky that its been such a mild one!
out of idle curiosity, would you describe Corbyn as 'far left'...?
He is starting to get there yes, not communist but on his way. Anti-capitalist / Communist distincion is quite slight. McDonnell is a proudly Marxist, he said so himself. That's far left IMO.
TJ I am no where near rar-right. You and others just use that to attempt to discredit me and shut down debate. It is what it is.
@kimbers as I posted before major row in France as Socialist Govt has asked hospitals to delay all non-urgent surgery. Beds situation no different there.
The NHS would be in a bigger mess under Labour.
I am no where near far-right.
You may want to trawl through your posts (not something I would wish on anyone)
You are definitely far right in your stance (in this forum at least)
You and others just use that to attempt to discredit me and shut down debate.
comical
b r our local trust funds rehab beds in the community to get people out of acute beds when the council can't/won't. It shouldn't happen but it does reduce the acute trusts costs. So the ring fenced NHS budget is used to support the social care budget. But the tories won't want to hear that this happens.
Jamba - by any stretch of the imagination you are far right. Its just that where you sit it looks centrist. Now I am centrist and you are far away to the right from me same as Ernie is to the left of me ( I have never forgottten his insult - " some sort of wishy washy pale pink liberal" IIRC. Nothing to do with attempting to discredit at all - just calling a spade a spade
[i]Jamba - by any stretch of the imagination you are far right. Its just that where you sit it looks centrist. [/I]
My wife considers she is slight right of centre, but from my perspective she is somewhere to the right of Genghis Khan 🙂
docrobster - our NHS trust started doing this as well - we are in scotland further along the integration road. Unfortunately the initiative had to close as all that happened was those beds were blocked as well
£78 per 20 mins is the price of private GP consultation as I found out today. I assume it applies to all sort of medical consultation as it just says consultation on their website. Not sure if they are NHS funded but it says private.
I am willing to pay for GP consultation for non-urgent matter but the price at £78 is too much for me to pay. I don't want to use NHS GP if I can afford to but ... £78 per 20 mins ... hmmm ...
£30 to £40 for consultation is fine for me but more than that I really think I am being held "ransom". What's the average income in UK? £28k per year?
Even in the far east with low income or low cost living private GP don't charge people at that rate. i.e. normal for our currency is around 30 to 50 max for consultation. However, the prescription might be expensive if you buy from them otherwise buy somewhere else. (Yes, some unethical ones will get you to buy prescription from them but they will not last long once words get out if they are not good)
I have just made an appointment to see my NHS GP and the only available time is in a month time. In the meantime I have been asked to call everyday at 8am for available appointment if I want to see GP earlier.
Not sure about you lot but I am willing to pay but not at ransom rate ...
For dentist (private) I pay £80 for each visit check up every 6 months i.e. general checkup (15-20 mins max) plus cleaning. I pay extra at private rate if things need to be done. I don't use insurance.
@chew French state pays GP €26 an appointment, they can charge more and patient / their insurer pays the rest. State always pays something. Here £78 / €100 would get you a top consultant.
£78 / 20 mins would be roughly £300,000 pa total revenue, building and staff to pay for too. £78 is £234 an hour, an average solictor is much more than that.
Much more!!!
£78 will not get you a top consultant in the UK and I very much doubt it would get you one in France - its certainly not the full cost by any means
jambalaya - Member
@chew French state pays GP €26 an appointment, they can charge more and patient / their insurer pays the rest. State always pays something. Here £78 / €100 would get you a top consultant.£78 / 20 mins would be roughly £300,000 pa total revenue, building and staff to pay for too. £78 is £234 an hour, an average solictor is much more than that.
Our solicitors at my hometown can charge crazy price that is way much more than GP that I am sure of, but they don't get hourly client to charge that. I don't know what they earn if they average out their charges by comparison to GP. I guess it might simply be an amount that they can get away with I guess ...
Actually my calculation at £78/20mins = [b]£488,592/year[/b].
£78 / 20 mins
1hr = £234
1 day = 8 hr => 8 x 234 = £1,872 per day
52 weekend roughly 104 off day. Therefore, roughly about 261 working days.
Therefore, £1,872/day x 261 working day = [b]£488,592 income per year[/b].
No wonder we say doctors become millionaires rather quickly in our country ...
I want to pay and I assume at one point in future there will need to be some sort of payment for GP consultation. I don't earn a lot but I am willing to pay because it means I can help free up NHS service or fund for much more urgent matter.
However, the current private GP price is somewhat at the premium end ...
~Then you have to subtract the costs and also the support services and you dont get 40 chargeable hours for 40 hours work - you would be lucky to get 25
Cost of running any kind of health premises is vast, it's not just buildings furniture electricity and employees but the business of sntthing medical involving equipment, sterilisation, clinical waste and so on and so forth. With no margin of profit at all, simply the infrastructure around an hour's work from a doctor that is paid exactly the same as a solicitor adds or rather multiplies the cost. In fact chewkw I am surprised you get 20-30 mins of a dentist (or rather the whole team etc behind them too ) for just £80: there must be a few people in the same day paying £45 for a 5 minute checkup subsidising you!
tjagain - Member
~Then you have to subtract the costs and also the support services and you dont get 40 chargeable hours for 40 hours work - you would be lucky to get 25
If you have 4 Private GPs at the practice that will be £1,954,368 per year income combine for the practice. The cost is divided amongst the GPs so how much will that be? Assuming the cost is one third (1/3 or 30% cost = £651,456/year) they are still making £1,302,912 amongst the four of them which is equivalent to £325,728 per GP per year.
Assuming the cost of £651,456/year is for receptionist staff nurses etc ... at £24,000 salary per person ... [b]you are employing 27 staff nurses etc everyday[/b]. The question is do you need 27 staff everyday at GP centre?
....I know that my annual salary is actually a small percentage of the operating costs of my employer to provide a service for the people I see. I am just the person they see in clinic but plenty more people and costs behind me allowing me to do all this. I.e. If we charged at cost to my patients (we don't charge at all of course) then i can well imagine it being 5x my hourly salary without any danger of making a profit.
Even Relate with cheap premises, minimal overheads and support staff, charity status and relatively low wages compared to NHS family and couples therapists need to charge an average of £50-60 an hour just to break even.
julianwilson - Member
....I know that my annual salary is actually a small percentage of the operating costs of my employer to provide a service for the people I see.
I am not against charging etc but if you look my my calculation above what other cost do you think will need to be incurred?
The NHS centre that I am see my GP has 2 receptionist, 4 nurses, 1 manager I think ... which is less than 10 at anytime.
The private GPs must be made more affordable for people if NHS want to reduce the funding burden. However, dictating a price for private GPs is not the solution but there need to something done there ... I want to use private GPs but I want to be able to pay too. Not ransom.
tjagain - Member
- you would be lucky to get 25
Yes, I should have deducted one hour break for the GP above so 35hr week if you wish.
But why is that 25 hour per week for a GP?
Any breakdown?
Even at 25 hr we are talking about £304,200 per year income per GP at private rate. 4 of them combine will be 1,216,800. 30% cost = £405,600 (equivalent to hiring 16.9 staff or nurses at £24,000/person/year). Which means take home pay per private GP per year is £202,800.
I am not against charging etc but if you look my my calculation above what other cost do you think will need to be incurred?
Building costs, electric, heating, medical supplies, non medical supplies, pensions for staff, waste disposal it's around £250 a tonne for medical plus many more items. You're also calculating that Dr's charge for every hour they are at work.
Drac - Moderator
I am not against charging etc but if you look my my calculation above what other cost do you think will need to be incurred?Building costs, electric, heating, medical supplies, non medical supplies, pensions for staff, waste disposal it's around £250 a tonne for medical plus many more items. You're also calculating that Dr's charge for every hour they are at work.
Drac look at the 30% allocation for overhead cost etc. Do they incur 30% cost every year?
For a small 4 private GP do you need to 17 staff/nurses/employees everyday? We are talking about 4 employees to support a GP everyday.
Yes, you can include all pension, building over heads etc from the 30% cost. All included as I am just using the most costly "cost" in that calculation.
Chewkw - you haven't even considered Many costs that I'd expect a bureaucrat like yourself to be aware of; NI, VAT, rates, etc etc
All these numbers make my brain hurt!
Average NHS expenditure is £136 per patient per year for 5-6 consultations and house calls etc for the frail elderly terminally ill. And people wonder it's hard to get hold of a gp.
For a small 4 private GP do you need to 17 staff/nurses/employees everyday? We are talking about 4 employees to support a GP everyday.
Depends what other clinics they run. This GP is in your head so I've no idea.
Yes, you can include all pension, building over heads etc from the 30% cost. All included as I am just using the most costly "cost" in that calculation.
You can't pick random costs.
b r - Member
Chewkw - you haven't even considered Many costs that I'd expect a bureaucrat like yourself to be aware of; NI, VAT, rates, etc etc
30% of the entire "turnover" is for cost ... all cost included.
A shared 4 private GP centre do you need 17 staff at all time? We are talking about GP centre not doing any physical surgery ... those are referred to hospital.
1 Manager/team leader
2 receptionists
4 Nurses - one for each GP.
1 Backup nurse
1 Backup receptionist
Total = 9 employees.
30% cost can easily cover them all with plenty to spare.
Drac - Moderator
For a small 4 private GP do you need to 17 staff/nurses/employees everyday? We are talking about 4 employees to support a GP everyday.Depends what other clinics they run. This GP is in your head so I've no idea.
What can the GPs do nowadays? I think they cannot even "cut" or perform minor surgery so mainly consultation, checking and providing prescription is that not?
What can the GPs do nowadays? I think they cannot even "cut" or perform minor surgery so mainly consultation, checking and providing prescription is that not?
Yeah they probably just sit around checking Facebook and play candy crush it something.
Chewkw you should really just retrain is really easy and you'll make a shit ton of cash
To help with your imaginary practice I'll confirm that of the 42 staff at my practice 11 are gps although only about 8 whole time equivalent. Obvs this is nhs and we are massively understaffed. If private sector we'd have more admin support. Or possibly not as quite a lot of admin time is spent going round in circles with the rest of the NHS and processing endless data for other parts of the System's benefit. Maybe I'd just need one manager one nurse one receptionist. Who knows.
I think that when GPs do a dentist a lot of services will be run by virgin/care uk/boots etc and that they've probably got insurance schemes ready to roll out. The market will decide. Might not be too long if TM carries on the way she is doing.
kimbers - Member
What can the GPs do nowadays? I think they cannot even "cut" or perform minor surgery so mainly consultation, checking and providing prescription is that not?
Yeah they probably just sit around checking Facebook and last candy crush it something.Chewkw you should really just retrain is really easy and you'll make a shit ton of cash
My GP told me that they were no longer allowed to perform minor surgery involving "cuts" (not sure the medical term). They told me they were mainly consultation, referral and prescription.
I will ask him again when I see him ...
docrobster - Member
To help with your imaginary practice I'll confirm that of the 42 staff at my practice 11 are gps although only about 8 whole time equivalent.
4 staff to support one GP?
Is that the average for all GP practices?
If I may ask how many nurses do you have?
How many receptionist or admin staff and manager?
My GP told me that they were no longer allowed to perform minor surgery involving "cuts" (not sure the medical term). They told me they were mainly consultation, referral and prescription.
Other GPs can.
http://www.nhs.uk/nhsengland/aboutnhsservices/doctors/pages/nhsgps.aspx
Drac - ModeratorMy GP told me that they were no longer allowed to perform minor surgery involving "cuts" (not sure the medical term). They told me they were mainly consultation, referral and prescription.Other GPs can.
http://www.nhs.uk/nhsengland/aboutnhsservices/doctors/pages/nhsgps.aspx
I will read that later ... (few mins later) I see ...
" ... carry out simple surgical operations ..." ...
Chew I was being pretty conservative, IMO you can't assume Doctor is fully booked on chargable hours all day.
The French numbers are real ones, Paris based sports knee specialist consultant surgeon for example. Certainly others do charge more, eg my BIL who is a back specialist.
Jamba - by any stretch of the imagination you are far righ
TJ. I think that opinion says more about your circles than mine. If I was far right I wouldn't have stayed in the UK and paid even 40% tax. My job has always been highly mobile. Even US Democrats are to the right of Tories here.
3 hca
2 nurse prescribers
3 nurses
1/4 of a pharmacist
1 manager 3 admin
Lots of receptionists
You do realise you're talking bollocks don't you cheeky?
We're not paid to do much minor surgery any more but still do some when needed
To further answer your inane question, apart from the obvious "90% of patient contact on 7% the budget", today I dealt with a first episode psychosis, home visit to elderly lady with polio paralysis needing home care, regular appointment with a woman who had 2 children due in teenage years and has had her allocated "therapy", a bit of marriage guidance. Told a man where his prostate gland was. Investigate vague symptoms that might be cancer but might be nothing, spoke to the man who I was the first person to find the rectal cancer on a few weeks ago, dealt with ill child and counselled its mother whose husband had died suddenly of heart attack while she was pregnant, directed an young man who wanted help stopping smoking to the relevant service, treated a few chest infections, and the rest I've forgotten (35 consultations today). Filled a couple of dozen results and 35 letters including child safeguarding concerns. Reviewed some spirometry and electronically signed a 100 or so repeat prescription.
Pretty average 11 1/2 hour day
But please carry on imaging how much money I'll make in the brave new workd
jambalaya - Member
Chew I was being pretty conservative, IMO you can't assume Doctor is fully booked on chargable hours all day.
I have reduced that number to 25 hr per week.
Even with that reduction the charge is still premium high.
docrobster - Member
3 hca
2 nurse prescribers
3 nurses
1/4 of a pharmacist
1 manager 3 admin
Lots of receptionists
You do realise you're talking bollocks don't you cheeky?
No, no I am trying to figure out the private practice.
You have 16 above so are they all to support One Gp?
Are them 16 full time staff?
The remaining 15 are also full time receptionists?
I give in. Read the posts. 11 gps, 8 whole time equivalent. Plus two registrars (trainees)
Medical students
District nurses health visitors Macmillan nurse community matron health trainers care navigators
Are you wanting to replicate what we do now or just invent a business model?
A patient once told me he timed his £180 consultation with a spinal surgeon at 8 minutes.
What is the point of this conversation? (I should know better than to ask)
Outside London there is hardly any private general practice. There is one practice in Sheffield serving half a million people. Most private work for gps currently is things like insurance medical occupational health screening etc. Not actually treating patients.
docrobster - Member
I give in. Read the posts. 11 gps, 8 whole time equivalent. Plus two registrars (trainees)
Medical students
District nurses health visitors Macmillan nurse community matron health trainers care navigators
Are you wanting to replicate what we do now or just invent a business model?
A patient once told me he timed his £180 consultation with a spinal surgeon at 8 minutes.
What is the point of this conversation? (I should know better than to ask)
I am just wondering why there are no many private GP practice available because if I am willing to pay for consultation.
Yes, general non-urgent consultation (NOT your spinal surgeon) vs very specialist (yous spinal surgeon) consultation etc ... Specialist consultant can charge you an arm or a leg if they want.
I very much prefer to see more non-urgent private consultation available. I am sure this will free up plenty of the NHS resources.
But what is your exact number of receptionists because you say many?
Outside London there is hardly any private general practice. There is one practice in Sheffield serving half a million people. Most private work for gps currently is things like insurance medical occupational health screening etc. Not actually treating patients.
That is the problem. I want to pay at reasonable price for minor ailments for private GP but I have no way of doing do so apart from being blamed for taking up NHS free resources.
But what is your exact number of receptionists because you say many
Not enough to answer the phones promptly enough for 13000 patients. I can't remember. I don't have exact numbers in my head. It doesn't matter anyway because what you are suggesting won't do what general practice does. It will do a tiny proportion of it. Maybe you ought to look at walk in centres for a better comparison.
Anyway I just read this which is quite a good read
[url= http://www.nuffieldtrust.org.uk/blog/why-extending-gp-hours-wont-solve-ae-crisis ]Why extending GP hours won’t solve the A&E crisis[/url]
Average NHS expenditure is £136 per patient per yea
I go to the Doctor about once every 10 years. Last time I was prescribed any medicine was 30 years ago when I had e-coli. Other vists have been private / paid for by insurance. Obviously at 53.9 that's going to increase from here unfortunately but so far the NHS has got a great deal. Appreciate a degree of good fortune here but you get my point.
Appreciate a degree of good fortune here but you get my point.
No what is your point? That you haven't got your money's worth out of the NHS because you saw doctors privately?
just wait till you are 80
You understand averages yes?
Average 6 consults a year
Some go less
Some go more
Simples
your experience of the system does not represent the whole system
docrobster - Member
But what is your exact number of receptionists because you say manyNot enough to answer the phones promptly enough for 13000 patients. I can't remember. I don't have exact numbers in my head. It doesn't matter anyway because what you are suggesting won't do what general practice does. It will do a tiny proportion of it. Maybe you ought to look at walk in centres for a better comparison.
Anyway I just read this which is quite a good read
Why extending GP hours won’t solve the A&E crisis
The govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year. Now you may say that is too little but I am saying for some GPs that is enough without stress. I am sure if few of them combine to operate a centre they are still able to make a decent income without the current stress.
docrobster - Member
just wait till you are 80
You understand averages yes?
Average 6 consults a year
Some go less
Some go more
Simples
your experience of the system does not represent the whole system
I am saying that some may prefer to stay with NHS but if GPs want to go private govt should make it easy for them.
Which means win win for all. The govt will be able to fund the current GP system, the current GPs get all they want and those who want to run their own practice is able to; and to make a living. Taking the burden off the govt and perhaps even current NHS system. As a patient I am will to pay the rate affordable to me so no need to take up NHS doctor time.
Therefore, for the young, affordable and able perhaps paying a bit to see private non-urgent GP is much better, leaving the NHS for other more urgent matter with people who are less fortunate.
The costs only add up as you age, triple bypass £10k
Cancer treatment £20k a year plus....
Which is why we need young immigrants to balance out all the oldies dragging the country down
No, no, no - the NHS has not worked out profitable for a healthy, rich person, so it must be broke. Obvious.
[i]The govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year.[/I]
On the EU thread I believed you don't have a clue, now you've proved it.
Work on 48 weeks per year, so £48k gross INCOME would equate to about £24k gross salary...
How much do you think you cost your employer, if on a final salary double your salary and then factor in buildings, IT, HR etc.
b r - MemberThe govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year.On the EU thread I believed you don't have a clue, now you've proved it.
Work on 48 weeks per year, so £48k gross INCOME would equate to about £24k gross salary...
How much do you think you cost your employer, if on a final salary double your salary and then factor in buildings, IT, HR etc.
£40 per 20 mins. Not per hour. My late night does not help ...
£120 per hour x 25 hr per week x 48 weeks.
That should be £144,000 per year gross.
Don't forget cqc fees and medical indemnity insurance.
Current full time NHS salaried gp or partner pays about £10k medical indemnity insurance. If it's more than one session per week out of hours then they class that as unscheduled care- higher risk- double the premium (I was told this by my insurer last week).
Private sector unscheduled care no continuity higher expectations maybe? Prob £25k to work full time. So how much would this fictitious go need to earn to make it worthwhile?
Are you any closer to understanding why special things like health care cost a lot of money?
All I've seen so far just tells me that people don't know the value of what they've already got.
Jeremy Hunt's throat
The govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year.
Almost all GPs are private, we don't pay to see them.
Given that our population seem to struggle between deciding what needs and A&E visit and what can be dealt with by the GP, I'm not sure adding on a third tier will help.
We do pay to see them - just not at the point of delivery.
docrobster - MemberDon't forget cqc fees and medical indemnity insurance.
Current full time NHS salaried gp or partner pays about £10k medical indemnity insurance. If it's more than one session per week out of hours then they class that as unscheduled care- higher risk- double the premium (I was told this by my insurer last week).
Private sector unscheduled care no continuity higher expectations maybe? Prob £25k to work full time. So how much would this fictitious go need to earn to make it worthwhile?
Are you any closer to understanding why special things like health care cost a lot of money?
All I've seen so far just tells me that people don't know the value of what they've already got.
You can increase your [b]public indemnity insurance cost [/b]to £20k or £30k per year if you wish because they are all tax deductible. Other fees might also be [b]tax deductible[/b] but I haven't checked.
Assuming non-urgent private GP work for £144,000 gross. The take home pay is about £86,587.
£25k is wrong calculation for private GP at 25hr/week as it is actually £144K.
"Jeremy Hunt's throat"
That got a laff round the office
Look he's typed in bold, that means it's important.
Drac - Moderator
Look he's typed in bold, that means it's important.
Isn't indemnity insurance tax deductible?
Also Pay at point of delivery. If they are private they should not get funding from govt etc so what's the problem?
Well yes.
Yes of course it's tax deductible. It's just another expense to take into account, you know, that reduces profit. Just helping you with your business plan chewkw
Ps it's a special insurance only doctors need, for doing especially risky work, that they can't practice without, and it's on top of public indemnity insurance that all businesses need. Just so you understand.
It's going up about 10% a year and is one of the reasons GPs are not so happy/thinking about quitting. Ambulance chasers etc
Gaining Grip and Control of NHS Expenditure
Page 44 onwards
Ensure that there are tight procedures around payment approvals
Ensure that no payments are made to non-essential purchasers
Consider approaching commissioners to advance funding to temporarily improve cash flow (we have seen commissioners advancing payments over 10 rather 12 months to assist with immediate cash flow problems)
Establish weekly cash committee with operational, financial and procurement representatives present
Consider stretching creditors beyond current creditors days
Review and assess existing debtors ledger and focus on “easy wins” to target for immediate collection
Develop strategy for each debtor – assess risk, ability to net-off if provider to provider debtors / creditors where the trust is in a positive net-off position. Ensure that utilise assistance linked to recovery of income from overseas patients (Cost Recovery Support Team and Overseas Healthcare Team).
Consider process change within the collections team to optimise cash management etc.
Review and recover all private patient non-payments
If possible, discuss further support with commissioners – bring forward date when income received (from 15th to 1st) (in addition to action 1.4)
Immediately assess estates position, if there are any external landlords consider renegotiation of terms to pay in arrears rather than in advance
Assess what assets can be sold
Reduce the number of payment runs to ensure that there is a greater control over outflows
Implement cash focussed KPIs and a reporting dashboard
Ensure that invoices are issued as soon as possible rather in batches
Establish pro-active debt collection - cold call all key debtors before due date to ensure that payments are received
Develop payment plans for key and large creditors where possible to ensure smoother profile and cash conservation
Income
Create commercial board to oversee income opportunities (this should include estates value maximisation opportunities - please link this to a review of estates strategy - 3.21)
Undertake a full coding review (establish working group aimed at improvement of the depth of coding - assuming that there is not a block contract)
Ensure that any changes in coding are clearly communicated to and recorded with the commissioners to ensure that income is received.
Review income contracts with commissioners to highlight any opportunities to maximise income and to reduce penalties.
Review progress on CQUINs, RTT, activity etc. and assess the likelihood / size of penalties for non-delivery or underperformance
Optimise car parking income (if possible)
Ensure fully recovery of any income from 3rd parties (use of facilities, estates, joint appointments, consultants working outside trust, junior doctor training etc.)
Run refresher meetings with consultants and junior doctors to ensure contracts are understood and to ensure that key staff understand what levers to pull to ensure increased revenue
Consider estate rationalisation where possible (rent/sell where possible)
Review any tenant and licence agreements to see if there is any possibility to further maximise income from estates
Cost and expenditure
Finance related controls
Review the approach used by the trust to improving quality and reducing costs across the organisation. Consider alternatives such as lean etc.
Complete a full budget review - identify budget reduction opportunities and target overspend areas, create plans to bring them back in line with the initial budget
Identify the full value of the creditor ledger including unapproved invoices
Review PO system; strengthen or improve if required. Going forward any non-PO purchases should be reported by exception
Reset budget holders if required
Bring all existing orders on the system by creating POs (mainly agency staff, long term call off contracts etc.)
Reset SFIs and delegation authorities if required
Impose stringent controls over expenditure – overspends may need to be linked to disciplinary action
Establish controls over central and corporate expenditure
Review all telephony and large IT contracts - renegotiate where possible
Undertake a user review for IT and telephony - cancel all unused mobiles, telephone lines, dongles etc.
Review, reduce and control all “discretionary” spend such as travel expenses, subscriptions, training, clothing, hospitality, bed hire, office equipment etc.
Identify priory suppliers and confirm that cash is available for priority suppliers
Review all VSM pay costs - consider action (where applicable) on retire & return staff and ensure that the trust complies with guidance on "off payroll" workers and daily rates
No invoices to be paid unless matched with PO
Review scope for savings from making use, or increased use, of NHS SBS (where applicable)
Review scope for savings from making use, or increased use, of NHS Professionals (where applicable)
Review if can utilise NHS BSA to determine potential saving opportunities on 3rd party non-pay spend via NHS Supply Chain (where applicable).
Where applicable, test saving opportunities via use of NHS Core list.
Ensure that Medical Capital Equipment Asset register, medical equipment maintenance schedule and capital medical equipment procurement plans are in place.
Review saving opportunities via use of Crown Commercial Services where applicable.
VAT position has been reviewed and all recovery opportunities maximised
Procurement related controls
Review procurement, understand what contracts are due to expire/when to assess ability to renegotiate contracts or put contracts for tender
(Re)set targets for procurement for contract renegotiations
Procurement - remove rolling, value based purchase orders
Contracting related controls
Understand supplier discounts and penalties for early / late payments - set out plans to recover / avoid
Ensure that all key contracts (including agency staff) are procured via appropriate frameworks. Any off framework arrangements should not be permitted, except in exceptional circumstances.
Review or create list of all key contracts and external suppliers – including start dates, breaks etc.
Look into cost reduction via consolidation of supplier base and invoices
Ensure that the rules around professional fees over £50k are adhered to
Estates related controls
Specifically review and benchmark overall running costs for facilities and estates. Put in place cost reduction plans if above average (see utility and other contract review points)
Undertake a review of estates strategy and confirm if action points, cost reductions etc. have been undertaken. If not implement "low hanging fruit" decisions immediately
Ensure that estates have been rationalised - vacate all unused buildings, switch to rent on daily basis, room rather than floor rent etc. where possible
Ensure that all lights and heat is turned off in unused buildings (ensure that comply with insurance requirements)
Review all utility contracts to ensure that represents best value
Waste disposal is managed and monitored
Other controls
Undertake clinical and non-clinical cost benchmarking
Undertake drug formulary review and medicines management review
Ensure that all overtime and enhanced payments are subject to prior approval and are monitored and minimised where possible
PMO and CIPs
Review the existing PMO structure: is it fit for purpose and is there board support and staff buy-in?
If the answer to 4.1 is no, start working on improvement and strengthening of the PMO office
Review existing CIPs for quality, deliverability and progress
Reset CIP targets for each division / directorate - ensure that these new targets have been prepared by each directorate to ensure buy-in
Review CIP quality approach – maturity level grading (idea, documentation, financial verification, quality approval, DoF CIP executive lead sign off to go live as a scheme)
Undertake series of workshops with the workforce (ensure good crosssection of staff such as clinitian, estates, finance, procurement etc) to generate ideas and buy-in
Ensure that staff receives training to use tools and templates
Establish CIP budget holders in each division / specialty to ensure that each area is accountable
Forecasts. reporting and turnaround plans
Prepare financial baseline
Assess underlying run rate vs outturn positions
Increase finance team bandwidth / review capabilities / align to divisions etc.
Reduce the number of budget holders and reset objectives
Develop turnaround plan (recovery plan)
Develop clinical service sustainability review and strategic plan
Develop structure of daily, weekly and monthly operational performance review
Develop automated key performance reports and KPI dashboards
Business cases / Capital expenditure
Review live business cases and assess what can be deferred or stopped
Review planned capital expenditure what can be deferred or stopped
Ensure that all business cases and capex is procured via appropriate framework
Governance
Create turnaround board or steering committee
Ensure that the committee meets on a regular basis and feeds back to the board and to overall staff communications
Review effectiveness of current management structures - are they effective
Consider utilisation of non-executive directors for certain roles (if the skill set fits) to increase Trust’s capacity
Create a plan to gain and maintain "grip" - including controls and processes. Ensure that the plan has key milestones and assigned responsibilities.
Management and executive board
Review necessity for various management meetings and committees etc. to free up management time
Ensure that there is a greater challenge during board and other key meetings
Establish list of ongoing and planned projects and determine what can be cancelled or delayed to free up people’s time
Establish list of budget holders and determine level of buy-in so far (link with the SFIs reset)
Turnaround board to approve all new projects across the trust (reduce distractions, focus on critical path)
Culture and communications with internal and external stakeholders
Review existing workforce communications plan and improve and change to reflect the key changes in culture and approach
Establish regular contact and communications with the staff to ensure staff understanding and engagement (maybe establish employee forum)
Establish regular workshops to gather cost saving ideas and drop in session to communicate changes
Ensure that the management and the board embraced the "culture of cuts" and of continuous improvements throughout the trust.
Establish regular contact with the trustees and ensure that they understand the key developments and changes
Establish regular contact with external stakeholders such as commissioners, other acute trusts, NHSE, Monitor etc.
Performance management
Reset executive team objectives - ensure that these are geared towards grip and stabilisation
Reset staff objectives and establish process to appraise within three months of year end. Ensure trust objectives are cascaded appropriately into personal objectives
Where possible, identify non-performing individuals across the trust and ensure that they enrol on performance improvement programmes to improve skills (co-ordinate with HR)
Create internal special measures / recovery plans for loss making specialties/directorates
Ensure that service line management is fully implemented throughout the organisation - this will require clear management structures and strong performance management buy-in.
Workforce planning
Establish vacancy control board
Assess recruitment process and establish processes to maintain quality but accelerate on boarding
Implement weekly head count tracker (temporary and substantive)
Assess number of interims, termination dates and daily rates
Consider apprentices to be hired for administration, band 1 and band 2 posts under the Agenda for Change
New recruitment to be considered on short hours e.g. 30 not 37.5
Ward staffing levels v guidance (including uplift)
Impose greater controls over bank and agency – self imposed cap on agency spend
Impose greater controls over locum spend
Review unfunded posts – check if some funds could be recovered
Consider a direct engagement model for medical and medical support staff hired through locum and agency
Consider rostering options and opportunities
Review costs associated with RTT - do the penalty savings outweight the additional spend (if applicable)
Review on-call run rate
Review contract rates ensure that all aligned by band / post etc.
Review any regular overspends on locum and agency staff - impose caps where possible
Review and compare job plans for consultants, specialist nurses - improve if and where possible
Ensure that e-rostering is in use for nurses and benefits realised
Ensure that clear systems are in use for junior doctors, consultants etc.
Monitor absence and sickness on individual, service line and trust level
Ensure that rigorous illness policy and procedure is in place to minimise absence at work.
Ensure that sickness is regularly reviewed at the board level.
Inventory
Establish current inventory levels and stock ordering system
Review stock and reset stock targets by category / area (if required)
Consider collection of excess drugs from wards and return to the pharmacy (if possible and applicable)
If possible, establish automated stock cabinets to improve stock control
Ensure that drug costs are benchmarked against peers
Off contract spend controls and reports are in place and monitored
Wastage and overspend are monitored and reported
Where possible, procurement function is fully integrated into the process and incentivised to reduce costs
Operational grip (including estates)
Ensure that uncoded spells have been minimised or eliminated - ensure that clinicians are included in the process and proper and regular training is in place.
Review and if required enhance capacity planning for each key areas such as outpatients, wards, day cases, A&E, community areas etc.
Ensure that capacity planning is fully implemented across the trust, down to sub-specialty level
Ensure that utilisation data is collected and compared to plan and peers - the data to be made available throughout the trust (board, clinicians, service lines etc.). Ensure that the data creates basis for utilisation improvement initiatives.
Ensure that key management information is shared with the clinicians to ensure that they understand performance and targets.
Review outpatient procedure to ensure that as efficient as possible and any downtime is minimised
Review theatre utilisation against peers and targets, share within the trust (where appropriate) and build into personal performance targets
Monitor bed utilisation, compare to peers and targets
Length of stay performance is actively reviewed and managed
Ensure that clear discharge policies are in place, with clearly defined responsible individuals to ensure that patients are discharged at the earliest opportunity where appropriate
Ensure that staff levels are matched to patient demand patterns to avoid waits and avoidable admissions
What's the actual point of Chewkw's current derail? Is he inventing private healthcare? We have that already.
docrobster - Member
Yes of course it's tax deductible. It's just another expense to take into account, you know, that reduces profit. Just helping you with your business plan chewkw
You get them back in the form of lower overall tax liability. I haven't checked how much you get back but there you go ...
samunkim - Member
[b]With that the entire system is in trouble.[/b]
Northwind - MemberWhat's the actual point of Chewkw's current derail? Is he inventing private healthcare? We have that already.
[b]I am advocating private GP practice where they receive NO funding from govt apart from paying patients.[/b] Why not? If they are no good nobody goes.
I am not sure what yours mean by private health care ... I am advocating GP practice where they do prescription only.
This also takes the burden off NHS. Don't you want others to take the burden off NHS fuding?
You don't have to use them if you have no wish to so what's the problem?
If patients are willing to pay the entire cost private GP (non-urgent) why prevent them?
Shhhh! He's thinking.
chewkw - MemberI am advocating private GP practice where they receive NO funding from govt apart from paying patients.
We already have that too. No?
Northwind - MemberIf patients are willing to pay the entire cost private GP (non-urgent) why prevent them?
Do we?
Northwind - Member
chewkw - Member
I am advocating private GP practice where they receive NO funding from govt apart from paying patients.
We already have that too. No?
Where in GeordieLand you tell me. i.e. Where in North East?
I am Certainly not paying the rate of £78/20 mins but I am will to pay £40/20mins for non-urgent consultation.
I just want to consult get prescription or advice.
Do we?
Why not if you can afford to? I am willing to pay if it makes me well, not to wait for long, happy etc ...
My doctor's appointment is one month wait for non-urgent matter, I am willing to pay but where can I go?
