There’s a fashion sweeping GP funding schemes – gotta getta shiny new hub. Chrome, alloy, spokes – what’s yours? Hubtastic!
“Hub” is all over the review of PMCF wave 1, 44 mentions no less, in hallowed tones. But let’s look at some of the numbers which squeeze into the narrative.
£45m spent. £3.2m savings identified.
£30-£50 per available GP slot, only 75% utilised.
Dear friends, excuse my elementary maths but at a time when the NHS needs to make every penny go further, this is an abject failure.
It’s worse, because the hubs are shown to have increased inequality of access, and we’ve seen evidence that around a third of patients seen are redirected to their own GP. This is the cost of rework when continuity is cast aside.
The good life we enjoy in our times is founded on relentless pursuit of higher quality at lower cost. Plainly these hub designs have given us lower quality at higher cost. They are unsustainable.
Response to the evidence? Manchester announces 15 hubs which will sink £5.4m. You’ll know that supply-induced demand is the unintended consequence which dogs so many NHS intitiatives. Nothing unintended here: they are advertising the new supply to persuade patients to go there. You couldn’t make it up.
Resources are needed in core general practice, where they are three to five times more productive. We already have an out of hours service. Fancy funding schemes are directed outside core GP, and powerful interests are shouting about them. Three things are needed to turn this around:
- The method to increase capacity in GP
- The funding mechanism to reward GPs for dealing with all demand
- Imagination, resolve and leadership to make the change.
We know the method and the new thinking: Enabling Demand-Led General Practice
Dr Ed Diggines comments in the report on his own practice case study, “the fact that NHS does not reward increased productivity is a frustration.” So far. But we are building a mechanism to enable the funding to follow the patient. By keeping it in core GP where it is most productive, everyone wins. Intrigued? Drop me a line.
Leadership lies with you. Don’t just be a follower of fashion.
Save the date: we are announcing a new webinar series on the demand-led system, starting at 8-9pm on Thursday 4/2. Unlearning the supply allocation system.