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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