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Crich Patient Participation Group.

Safeguarding Patient Care in the Crich Area
Colin Hoskins, Interim Group Chair


Chatting with one of my fellow patients the other day, it became obvious that this particular person had very little idea about how local GP practices are run and financed. And as I tried to explain it to him, I realised that I’m a bit vague about it as well. Trying to research it all for this article, I decided to forgive myself for my vagueness, as I concluded that the NHS is to financing what the Indian railway is to timetabling – it works, but very few understand how.

I simplified it in my own mind thus: NHS England has money (from our taxes). They pay money to GP practices to provide care to you and me. Translate that into health service language, and you begin to sound like an expert – NHS England commissions primarycare services, primary-care meaning the first point of contact with a health professional.

A great deal of commissioning goes on in the health service. Anyway, we all know that GPs can’t fix everything and that sometimes we need to be referred elsewhere, most likely to a local hospital. To enable this, the GP practices band together into a larger group, and NHS England gives that group even more money, and the group uses it to buy services for us from the hospitals, or mental health services, or other clinics. In health-service language again, GP-led Clinical Commissioning Groups (CCGs) are responsible for the planning and commissioning of health-care services for their local area.

Our CCG is the Southern Derbyshire CCG and is responsible for securing health-care services for 552,000 local people. Overall, CCGs account for two-thirds of the total NHS budget.

But what of the GP practices? My fellow patient assumed that these are owned and run by the NHS and that the GP’s pay packet comes from the NHS. In fact nearly all are independent partnerships commissioned as described above. So the GPs run the practice – they pay themselves a salary, they employ the staff, they arrange for out-of-hours cover. They might also employ other doctors, called salaried GPs to distinguish them from GP partners, and be involved in doctor training. Our practice has a GP registrar, a qualified doctor who is training to be a fully qualified GP (GPs are the equivalent of hospital consultants in ‘status’).

So when people talk about the potential for privatisation of the NHS, the possibilities go beyond it just becoming an insurance-based system like the USA. The NHS is something we’re all proud of – consider the London Olympic opening ceremony – but opinions differ about how the care – free at the point of delivery – is delivered and by whom.

Everyone has an opinion, the writer included, but you can see from the explanation of the NHS structure above how there is scope for privatisation of the free health-care services. CCGs have to get value for their money (and to provide a degree of patient choice), and if the best offer they get is from a private provider they are more or less obliged to go with that provider. It is this aspect of the health reforms of 2013, more than anything else, that caused and is causing most controversy. And of course, our own GP practice is a private entity, whilst not being a private practice.

Not simple, is it?

Keeping Standards High


It’s also worth explaining how standards are maintained in local practices at a high level. The GP practice as a whole is inspected regularly by the Care Quality Commission (CQC). They send an inspection team into the practice from time to time and focus on five key questions: are services safe? Are they effective? Are they caring? Are they responsive to people’s needs, and are they well-led? The practice in Crich is currently rated as “good”, which is the second highest rating after “outstanding”. You might argue that that’s the best rating as it gives them something to work towards!

Individual GPs also have to maintain their skills at a high level. They have to be “revalidated” to confirm the General Medical Council’s (GMC) continuation of the doctor’s licence to practise.

Revalidation is based on a local evaluation of doctors’ practice through appraisal. Through a formal link with an organisation, determined usually by employment or contracting arrangements, each doctor relates to a senior doctor in that organisation, the responsible officer.

The responsible officer makes a recommendation about the doctor’s fitness to practise to the GMC. The recommendation will be based on the outcome of the doctor’s annual appraisals over the course of five years, combined with information drawn from the organisational clinical governance systems (I’m guessing that means the computerised records).

Following the responsible officer’s recommendation, the GMC decides whether to renew the doctor’s licence.