So this is a thread about GP finance and why funding issues lead to a crisis. The final wrap up payment to Central Lakes included a £12k deduction for overpayments. A quick twitter check & it seems that all local practices had deductions recently - the highest response was £26k

The reason for this was not that they had been paid in error more than they had in previous years. They had been paid the same before the clawback. It was because the activity that those payments related to dropped. And here is the problem

GP funding is made up of lots of income streams - the main one , the global sum , is to cover “most” of the work practices do . Out of which practices must pay their staff, premises, stationery … The global sum got uplifted by 3% last year & the gvrt propose 3% this year

Other income is getting a 0% uplift. Yet cost rises are outstripping that. So who is paying for the increased costs - not us the taxpayer but the partners of the practices. Patient demand is also through the roof so practices may not have the time to chase all the other income

So this spirals down … costs up, income down . Which is what happened at Central Lakes. So what does the £12k clawback mean? Well practices are not going to be able to cut costs because they already struggle to meet patient needs. So partners take it on the chin … or leave

NHS execs don’t pay for the NHS out of their pocket, nor do consultants , nor do politicians . In the business world if demand goes up it generally means you bring more income in so I would not have this issue. So why are we doing this to GPs. It’s poor commissioning.

So when you can’t get appointments or find that your local practice you have built a long standing relationship with closes please realise that it’s the funding system which is leading to this . Smaller practices feel the pain hardest & they are often the ones most connected

So when you complain that receptionists are awful - remember they are low paid despite having skills which may save your or my life one day with a quick decision & are doing their job to try and manage a demand that in many cases can’t be met.

It’s also poor economics because well run local practices reduce costs - they reduce admissions to hospital - they reduce the risk of safeguarding issues - they reduce the risk of a poor outcome for a patients as knowledge and knowing people is important

People and politicians will say a salaried model is what’s needed. It’s not - that will cost more, be less flexible to local needs & doesn’t resolve the problem that if you underfund the service it doesn’t matter what form it’s provided in.

This needs changing and rapidly . ICB’s need to understand funding quickly and the impact cuts have . NHSE needs to understand that without practices you don’t have PCNs … not the other way round. Core funding needs to be moved from PCNs to practices - now without conditions