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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