Dear Patients,

You may have recently read newspaper articles, or seen or heard news items, which have criticised general practices for receiving increased income since the introduction of the new GP contract in 2004.

We are aware that some patients are concerned that we may be planning cuts in our services in order to deflect such criticisms. We would like to reassure you that we have no such plans.

Before the introduction of the new contract, the practice was funded by the NHS in a way that placed greater emphasis on making claims for individual services, such as contraception, than on treating chronic illnesses.

This changed in 2004, and we now have several hundred quality targets to meet in order to earn income for the practice from the NHS.

These targets are very detailed and quite specific, and have required the practice to invest heavily in additional clinical services and recording of computerised data.

Many of the targets are calculated by auditing your medical records. However, this is done by computer, in an anonymised format, without disclosing your personal details.

For example, patients with hypertension (raised blood pressure) have to have blood pressure levels below 150/90, and even lower if they also suffer from diabetes and/or chronic kidney disease.

In addition to several hundred targets of this nature, which range from asthma to thyroid disease, we are also expected to do:

• An annual patient-satisfaction survey;
• Meet appointment targets;
• Provide evidence of organizational and management adherence to predefined standards.

Additional Staff:

In order to achieve all these various requirements, we have had to employ additional staff to help monitor patients with chronic illnesses more closely and also to add data sent to us, on paper, by the hospitals and other healthcare providers.

Sadly, the NHS is not yet able to provide us with the electronic transfer of such documents, and the rising tide of paperwork – resulting from additional referrals and treatments – has to be scanned onto the computer page by page, and manually linked to each patient’s computerised record.

The current situation is providing us with something of a dilemma: if we strive to reduce the practice’s income (because the practice is perceived to be earning too much), we will have to cut some of the new services or standards that we have introduced in recent years.

We regard this as undesirable for several reasons.

Firstly, we feel we should be striving to improve the range and quality of services, not limiting these.

Secondly, the practice’s running costs (for example, staff members’ salaries, building maintenance and utilities, clinical and office equipment, and essential supplies) are paid for out of these earnings. The NHS does not reimburse us for such expenditure and it would be shortsighted to skimp on any of these.

Finally, and perhaps most importantly, we believe that we owe it to our patients to continue improving the practice.

Opening Hours:

Recently, we have been coming under increasing pressure to extend our opening hours. This causes us several problems.

Our practice personnel all have families and lives outside work. There are limits to the demands that we can make on them.

We also have to adhere to the requirements of the European Working Time Directive for our employees. Fortunately for the practice, the GP partners are not confined to remaining within the maximum permitted number of hours that can be worked in a week.

It is difficult to see how we could achieve extended hours (more than we are), even if we ignore calls to cut practice earnings and retain them at their existing levels.

Due to the lack of any uplift in our NHS income in 2006 and 2007 to allow for the effects of inflation, the practice has been funding rising costs, such as staff and utilities, from a declining income.

So it would have difficulty subsidising further increases in staff costs, especially for staff members being required to work so-called unsocial hours.

The other major constraint hampering extended opening hours is that there are no plans to extend the various support services on which our patients rely, such as district nursing, laboratory tests, X-rays and social work. So we find ourselves constrained in every direction.

We continue to have your best interests at heart and will strive to deliver the highest possible standards of quality care, in spite of the current media campaign to the contrary.

We hope that you will support this approach and help us weather this very difficult period that is adversely affecting the morale of all practice personnel.

Thank you