Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 120 - 139)

THURSDAY 1 DECEMBER 2005

SIR NIGEL CRISP, MR JOHN BACON, MR RICHARD DOUGLAS AND MR ANDREW FOSTER

  Q120  Dr Taylor: Do you think GPs—and I will not say with their 9 to 5 job, because I think it is 8 to 6.30 now—are paid higher than they should be?

  Mr Bacon: I think the method of paying them more accurately reflects the value they add to their population.

  Q121  Dr Taylor: What an answer!

  Mr Bacon: It would be rather difficult for me to speculate on whether they are paid too much or too little.

  Q122  Dr Naysmith: Is it not the case now that they are the best paid—and I know it is difficult to find equivalence—in Europe for the service they provide?

  Mr Foster: You made the point yourself: it is extremely difficult to compare. You are not comparing like with like. There is no country that has a system like ours with the roles and the responsibilities the primary care practitioners take on, not just in delivering services but in organising services on behalf of patients. So it really is very difficult to answer that question.

  Q123  Dr Naysmith: But there are such things as primary care physicians which may or may not be identical—well, they are not identical, we know that, but they are similar—and in that kind of league our GPs do work very hard.

  Sir Nigel Crisp: Anecdotal evidence suggests that is right. We have not done a study on it but that suggests that they are well paid.

  Q124  Dr Taylor: Finally, going back to out-of-hours care, the £300 million that John Hutton suggested that must have been based on some sort of analysis. Could we have sight of that analysis, whatever it was.

  Sir Nigel Crisp: I am sure we can look that up.

  Q125  Chairman: I have just a couple of questions on consultation. You mentioned, I think, Birmingham, where it came out that people would like to see a GP at the weekend. Was it "a" GP or was it "their" GP at the weekend?

  Mr Bacon: It has rarely, if ever, been the case—and certainly not in recent times that you could expect to see your GP at the weekend, so I think you have to compare what we are now offering and what we may propose not with some sort of halcyon day of this but with what was practically the position before we introduced the contract changes. It is practically impossible to take the view that your GP will be available 24/7, 365 days of the year. It has always been the case that you would have to in certain cases. Out-of-hours/weekends, you would see an available GP. That is still the offering. It is just practically not possible to expect to see your GP whenever you want them 365 days a year, 24 hours a day.

  Q126  Chairman: On that specific, I think you are right. But is it putting the cart before the horse to have the consultation and everything the year after the new GP contract had come in?

  Sir Nigel Crisp: A very significant part of the GP contract was specifically about the precise clinical care that is being offered by GPs, so actually it is the monitoring of cardiac patients or the monitoring of people with diabetes and interventions there. That is where that was geared towards.

  Q127  Chairman: There was an issue about time or when they would work, and whether they gave up the option, as it were—which has always been around—to work at the weekend.

  Sir Nigel Crisp: Yes.

  Mr Douglas: But it is also the case that the GP contract is reviewed on a regular basis—as indeed it is being done so now—so it has the flexibility to respond to new policy direction.

  Q128  Mike Penning: You can imagine the reaction of GPs if you reversed it back. That would certainly be very interesting. Could we move on to the wonderful European Time Directive. With the European Time Directive coming into force and other changes which will reduce the hours presumably of what most people can work, will there be an increase in agency staff required within the NHS?

  Mr Foster: I am very pleased to say that the latest set of figures we have on agency staff shows the first significant reduction that there has been in recent times, and that is against the background of us achieving compliance with the Working Time Directive. So, no, I do not think there is any evidence that the Working Time Directive causes increases in agency staff.

  Q129  Mike Penning: Can you assure the Committee that you are not using bank staff as a screen to indicate that you are not using as many agency staff? Because they are both the same in real terms, are they not?

  Mr Foster: No. The particular pressure that the Working Time Directive brings is on doctors. Although we do transfer some of the workload to advanced nurse practitioners, the particular issue has been to address the working hours of doctors in training.

  Q130  Mike Penning: The second part of the question I asked you is this: You clearly use bank staff as well as agency staff—and to the layperson they are basically the same thing: they are people who are brought in—have you had an increase in bank staff?

  Mr Foster: Yes.

  Q131  Mike Penning: While you have had a decrease in agency staff.

  Mr Foster: Yes, indeed.

  Q132  Mike Penning: That is exactly where the correlation goes.

  Mr Foster: That is exactly what we would want to achieve because bank staff are ordinary NHS staff, voluntarily doing extra time at a normal NHS rate, whereas agency staff are paid very substantially higher.

  Q133  Anne Milton: Could I come in here. I should earlier, but I did not, Chairman—my apologies—have declared an interest, because my husband does work for a PCT. What about NHS Professionals?

  Mr Foster: NHS professionals has played a valuable role in enabling us to achieve what has been described, to have more sophisticated operations of bank staff, not just within an existing NHS organisation but the ability to share bank staff between neighbouring organisations. It has had the ability to do that, which has brought down the expenditure on expensive agency staff.

  Q134  Anne Milton: There was some scandal about a year ago about NHS Professionals contracting staff from the agencies.

  Mr Foster: It is not a scandal at all. NHS Professionals effectively operates as an agency and its first port of call is to offer staff from existing banks. If there is then a demand that it cannot satisfy, it goes to agencies with whom it has a contract, and it has brought down the contracts that it pays to agency staff as well.

  Q135  Anne Milton: My understanding was that the trust who is employing the NHS Professional staff would then be paying more money than they would have done if they had employed the staff directly from the agency themselves.

  Mr Foster: No.

  Q136  Anne Milton: Because they are having the costs of the agency and NHS Professionals.

  Mr Foster: No.

  Q137  Anne Milton: That is not the case.

  Mr Foster: I do not know which individual case you are talking about, but the general rule is that there is a standard price at which NHS organisations buy extra capacity from NHS Professionals and that price is not varied. NHS professionals then has to purchase those staff, as I have said, either from existing NHS or, where it cannot, from agencies, but at a lower price than hitherto.

  Q138  Anne Milton: NHS Professionals will always cost NHS less than employing people directly from agencies.

  Mr Foster: That is not exactly what I said. NHS Professionals has a set price, agencies can vary their price up and down, and there have been some examples of agencies trying to effectively get back into the market by reducing their prices, but then that is what you want, is it not?

  Q139  Mike Penning: Can I move up and back slightly into the areas where trusts are in deficit, which I am sure you will be pleased to come back to. Is there a correlation between the amount of agency staff which are used within the NHS and deficit trusts—in other words, where trusts are in deficit do they use more agency staff than they do elsewhere—because it seems from evidence that we have that they do and, if so, why?

  Mr Douglas: I would not be able to say whether there is a correlation—I have not done the statistical analysis on it—but a lot of the organisations with deficits, I know, do employ high levels of agency staff, but I would be quite happy to do the statistical work to see.


 
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