p to now I have refrained from commenting on the New Contract. I am no longer in practice and would not wish to influence anyone one way or the other, also because there are a number of details still to be decided. Now that the Contract has been accepted in principle there are a few items, which have caught my attention, and on which I think I can safely have a view now. Having had some experience of formulae over the years wrestling with the Inducement Scheme and the Rural (mileage) Fund etc.. I was aware of their complexities even on their localised scale. With the help of Dr. Paul MacKenzie I even re-organised the distribution of the latter Fund to make it more “Rural Friendly” and what a headache that gave us.
When I heard that Professor Carr-Hill had produced a formula for distributing GMS Funding, which “Fits All” practices - “I just could not believe it” - I was not in the least surprised therefore when on the formula’s initial run it produced some wildly divergent practice incomes. I have always maintained that even the existing distribution schemes, while they may or may not have been suitable for urban areas, they were quite inappropriate for Scotland, particularly rural Scotland. Thankfully, I understand that for Scotland the formula has had to be modified, re-arranged, adjusted, call it what you will, in order to make good the promise that no practice would loose out a “Minimum Protected Income Guarantee” (MPIG) is to be provided for those practices under threat. Hold on, is that not the old inducement “Yardstick” by another name? Er, not quite, the yardstick was a fixed figure M-PIG which will vary from practice to practice based on it’slast year’s figures. Hold on, that’s very close to the old Highlands and Islands Grant Scheme dependent on the practice annual report and on RMO’s visit. If so, it’s very close to the Health Service in the Highlands and that’s where I came in!!
To be fair to the Carr-Hill Formula it says in the New Contract “Although we believe the formula to be robust, given the available data it will inevitably not be a perfect model of the future workload and of the costs that practices may face” 1
Will it therefore meet the “five conditions” I propounded some 35 years ago for an adequate remuneration system for Scottish Rural and particularly Highlands and Islands general practice, namely?
1. A good standard of medical care and an Incentive to Improvement.
2. Proper premises and equipment.
3. An inducement to Doctors to come to and stay in the Highlands & Islands (the whole area, not just part of it).
4. Recognition for the workload, the extent of responsibility, the numbers involved and the area covered.
5. A reasonable income for the Doctor. 2
Will it insure that “the 3 cardinal features of service in rural areas (“Essential, Emergency Response Time and Adequate Quality of Care”)” be met? 3. Only time will tell.
Ref.:
1. New Contract? (The Blue Book) p.38/5.19
2. General Medical Services in the Highlands & Islands (The Birsay Committee) p.94
3. hoolet “Apocalypse Now?” 30.10.01
FOOTNOTE:
Somerled Fergusson is the last surviving member of the Birsay Committee - Professor Esmond Wright died 09.08.03 aged 87.
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