Today is one of those days I’d love to be a cartoonist. I would
then provide you with a simple image to show my reaction to some of the
National Audit Office’s (NAO) report on the GMS contract.
Amongst the criticism of the deal and the DoH’s failure to
ensure value for money, the NAO points to what it describes as a ‘fall in GP
productivity’ of 2.5% per year. It bases this calculation of the fact that GPs,
having dropped out-of-hours, are working a mere 52 hours a week and are
therefore seeing fewer patients while their income has increased.
If you take this simplistic measure, of course GP productivity
would fall under the contract – it was designed to give them a pay rise and
reduce the hours worked.
However, this is a poor measure of productivity. If we were
examining a factory we would also consider the outcome of the changes. In other
words was it now producing more or better quality goods in the time worked?
The NAO measure fails to take into account how GP time is used.
It doesn’t address the health outcomes, the savings to other parts of the NHS
if conditions such as CHD or diabetes are dealt with early, nor the types of
conditions seen. It also fails to consider whether there has been a change in
patients seen – ie are the right patients been seen?
Perhaps to impress the NAO in the future GPs should adopt a new
approach. So now imagine that cartoon I failed to draw: patients on a conveyor
belt through the surgery as GPs automatically hand out antibiotic and statin
scrips as they roll by.