Moneo writes: A messy proposal
Last week I noted an article outlining plans put forward by Sajid Javid, the Secretary of State for Health and Social Care, to end the system whereby community GPs work under an NHS contract as independent contractors.
Javid describes this system as having ‘considerable drawbacks’. He has planned a review of primary care services to look at how better to integrate GPs with hospital care to improve services and health outcomes overall.
We again find the NHS at the mercy of a Secretary of State who doesn’t seem to have a clue as to how it works. We have someone in post who seems to think the NHS consists only of doctors, nurses and hospitals. Is he not aware that primary care is vastly wider than just GPs? Is he even aware that clinicians, such as optometrists, dentists and pharmacists, also operate under independent contractor status? Is it his intention to take away the right of independent contractor status from just one group of NHS contractors and leave the rest to carry on as before?
If he thinks that ending independent contractor status for GPs will improve links with hospitals and reduce referral rates to the secondary sector, what does that mean for the other independent contractors who refer patients directly to the secondary sector, such as optometrists? Or maybe he is saying it is only GPs who get this wrong and need to be brought under closer control.
I see little or no hope of him breaking down the independent status of primary care GPs. This status has existed from the outset of the NHS. It is only because this status was created as a compromise by Nye Bevan to bring GPs on board at the start that the NHS, in its current form, exists to this day.
At the time, the same status was conferred on other contractors, such as ophthalmic opticians. It is already envisaged that this move will provoke great resistance from doctors who very strongly believe that the independent contractor status boosts innovation and offers good value for taxpayer’s money. That the NHS gets good value for taxpayer’s money when it comes to eye care services can hardly be in doubt given it has grossly underfunded those services deliberately for decades.
Where exactly does that leave optometry? I hope our representative bodies are seeking urgent talks with the Secretary of State to clarify the position with regard to the other independent contractors in primary care, particularly optometry. We have seen, in recent years, a major rewrite of the NHS contract, so are we about to see another one? It has been made clear that any negotiation to change things will impact on a nationwide level under the new Health and Social Care Bill and so any change will impact us all.
Changing from independent contractor status to an employed contract will have major implications for business owners. What about those practices that have an NHS contract and are owned by a lay person? There are many questions that arise from this announcement. It may well be that the Secretary of State intends to set up a very complex system whereby some services in primary care can only be accessed via NHS employed staff while other services will be accessed via independent contractors. I cannot see how this could possibly work when you have someone like an optometrist referring patients directly to an eye department and effectively spending part of the GP practice budget by making that referral. Meanwhile, the NHS-employed GP in that practice has no say over whether that referral is deemed appropriate or not.
To put it bluntly, this proposal is a total mess. It has been thought up by someone from the bright ideas squad who seems to have no idea of how primary care operates and it is therefore doomed to go the way of so many other half-baked ideas. Sadly, it will not go that way until many hours have been wasted and further large sums of taxpayer’s money have been wasted also.
Our representative bodies need to be all over this right away. They need to be finding out what is proposed for NHS optometry and what the implications are for optometrists and business owners.
With this proposal and the news that there is still no positive outcome to the request for optometry representation within the structures of the Health and Social Care Bill, I wonder whether this government actually wants primary eye care services to be a part of the NHS.
Time is approaching when we should have an announcement on the GOS fees for the coming year. With inflation running at the level it is, it will be interesting to see how our masters of negotiation at the Optometric Fees Negotiating Committee have performed this year. The fee settlement will send us a clear message of intent on what this government really feels about the role of optometry in the NHS.