Select Committee on Health Written Evidence

Evidence submitted by Anonymous GP (Def 05)

  The size of NHS deficits is not known because PCTs are unable to accurately report them, having moved virtual money between virtual funds and accounts so often that they do not actually know which are real deficits and which virtual now.

  The reasons include: bodies keeping each other in the dark about how much they will charge at the year end, or when funding will run out; one part of the PCT not communicating to another relevant part that they are aware that the actual amount paid is not in line with the budgeted amount, that the service activity will be overachieved before the end of the year, necessitating an extra cost in paying the Trust to continue the service over the intervening months, incompetence in "corporate planning"—meaning in actually having someone with an overview and charged responsibility to know that one hand knows what the other is doing, and too many people with their own individual agendas: this last point is greatly added to by the continual changes and moving of goal-posts, such that one department thinks it is still trying to achieve last year's target in last year's way with an inflation-proofed budget, when in fact the item was not budgeted and the activity should have stopped. No-one in PCTs seems responsible for ensuring contracts are monitored through the year and promised funding or activity levels continued.

  Another big contributor is that PCT officers do not have sufficient respect for providers. They do not believe estimates and predictions given by GPs and staff. They tend to dismiss our contribution as irrelevant, because practices are relatively small individually, not realizing that we add up to a whole that can achieve a lot if properly motivated with a clear direction, simple plan that involves us and is considerate of our needs and difficulties, and given that we know we have the confidence of the PCT to get on with achieving a clinical goal in the best way we can manage, rather than having to conform to frequently changing directions and unworkable ill-thought-out campaigns that often bear no relation to what reality can expect of the "public".

  Employee relations is the other big failure of PCTs/Trusts at the moment. Far too many staff are employed on huge locum salaries because employers offer only short term contracts with awful terms/conditions, and low remuneration—such that staff will look elsewhere in preference to making a commitment to a fixed job, yet permanent staff with less change would be more efficient in terms of costs of service delivery as well as clinical outcomes!

  There needs to be some external body that looks at the achievement of PCTs and their individual staff and officers, and removes those that are not achieving, replacing them with those better able to do the job needed in an NHS culture, instead of promoting the less able and less-well-liked to positions of greater responsibility and greater salary, then employing an extra person to do the actual work.

Anonymous GP

16 May 2006

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