I’m used to reading NHSE documents, and I know that sometimes you have to read between the lines. That doesn’t appear to be the case this time around. I feel terrible that I’m so suspicious, but the release of documents late on a Friday, with big changes compared to almost every other year’s documents, made me raise an eyebrow – and there does seem to be some form of “hiding things in plain sight” going on and hoping you won’t notice.
With GP at Hand looking to sell the business or looking to wind up operations, it’s clear that the model of larger companies taking ownership of practices isn’t quite the gold mine that the companies themselves expected. Of course, it’s not news to those of us who have been in practice management for years. I’m trying to find every crumb to cover the cost of salary rises and don’t get me started on the DDRB recommendations; I’ve started to sound like a broken record – “No, I don’t know”, “We haven’t been told about the funding yet” have been my mantras of the week.
So, with some trepidation, late on Friday night, I read the flu spec.
In what has become fairly typical of NHSE, the flu documents were launched late on Friday, and there are some clauses in the agreement that don’t reflect the normal flu contract.
What on earth might they be doing, adding different timings for sign-ups depending on whether you’re doing flu, or flu and Covid, with two days between the two?
Why might they be highlighting the COVID-19 jabs so much in the flu spec? That makes no sense. It also makes it a really challenging read.
Why might there be clauses that describe changes to announced and authorised cohorts and dates, and changes to the spec itself?
Then, they’ve brought the start dates for both flu and Covid specs to 1st September, and reduced the payment for COVID-19. What might they possibly be up to, I wonder? Could they be pushing me to make the decision that I have to co-administer, because the COVID-19 vaccines don’t make financial sense at the lower rate?
I heard a little whisper that they’re planning to delay the GP flus until October to align with the COVID-19 vaccinations. That same little dicky bird also mentioned that the pharmacies are going to be allowed to carry on the flus from 1st September. The IGPM have even written a letter to Dr Kiren Collison, GP and Interim Medical Director for Primary Care at NHS England about it.
The real cynic in me wonders whether they’ve left themselves two days between the two so they’ll know how many practices aren’t going to do the COVID-19 vaccinations, then they’ll be able to judge if they’re going to have a big problem. It gives them two days to get a plan/adjustment to the spec out.
I know I’ve ordered flu vaccines for this year, but as a practice, I’m tempted to just lose the money and say stuff them. I’m going to lose a load of my vaccinations to the pharmacies if I end up with a 4-6 week delay, because they’re at pains to tell me that they won’t pay me for any vaccines I deliver before they announce and authorise the cohorts and dates. So, if I’m going to lose some of the money, the extra doesn’t seem like an insurmountable issue.
My fridges are always full to bursting at flu time, and the COVID-19 vaccinations make that issue even worse. So, I’ll then have to delay my second and third flu deliveries. How much fridge space do we think the vaccine companies have to accommodate all the practices across the land deciding they can’t take their flu deliveries, and do we think they’ve thought about that if they’re considering delaying the GP start date? Or do we think the vaccine companies already know?
The difficulty with all of this is: I’m tired of playing the game, tired of fighting a system that wants to fight me. I don’t think I’m the only one who feels like this either. Some of the wonderful GPs I’ve worked with over the years have retired in the last year because they just don’t want to deal with this anymore, and they’re joining an exodus.
I want support; I don’t want “Them v Us”. Everything these days feels adversarial. It’s not how I operate my practice, and if they want to look at workforce and wellbeing, they might want to look at bit closer to home to work out why they’re struggling to recruit GPs.
August 11, 2023 at 7:52 am
We have been told from our ICB that we can’t claim for flu vaccines until October. Yet our ES & DES 23/34 contract says campaign can start in September, we are being rebellious and we are going to continue our plans to deliver our flu vaccines to patient in September, our flu vaccines are due to be delivered the week of the 9.9.23 why would we not vaccinate when we can, we will fight our corner! with regards to the Covid vaccines its not viable £7.00 per vaccine with a loss of between 50-60 patient appointments whilst we deliver these vaccines at our local fire station, the admin involved, the salaries for additional staff to help out, the locum costs, the e-learning training for all vaccinators when they decide what Covid vaccine is being used it just really not worth the hassle.
August 11, 2023 at 7:57 am
HI Paula
Couldn’t agree more. I think as practices across England we need to stand together and tell NHSE that we are going ahead with the plans we have already made to run our own Flu Campaigns anyway. If we all do it what can they do? And I personanlly would be willing to challenge them in the small claims court for the IOS fees. It really does not serve us well to be organised and efficient when they then treat us all with such contempt. I completely agree with what you say at the end of your article about staff leaving the NHS because they are so fed up of this petty bureaucracy. Let those of us on the ground in General Practice who are in the know do things the way we do them best – but instead these people in their ivory towers at NHSE think they know better. This really is a new low from them that they are threatening us with a withholding of income if we don’t comply.
August 17, 2023 at 1:36 pm
Painful isn’t it!
August 11, 2023 at 8:09 am
I believe they’re relying on our good will and commitment to patients so as to squeeze us for every penny.
Couple that with the narrative of GP Land being awash with money (hence having to publish GP earnings), policies made for clickbait, and we have the shoddy healthcare that this country has let itself put up with.
No wonder people are leaving the NHS in droves, and I personally am counting the days to retirement (currently 3,323 days).
August 17, 2023 at 1:38 pm
Money certainly won’t be a primary motivator in most cases. It’s just eroding the goodwill.
August 11, 2023 at 8:11 am
We are going ahead with flu from the first day, they are physically in the building w/c September 4th. We need to get our patients vaccinated before the pharmacies get their supplies, and have Saturday, early morning and evening clinics planned. We aim to be through 75% of our supply before the end of September. If we are efficient we can still make a small profit on COVID vaccinations, but patients without mobile phones and e-mail may miss out. The COVID price doesn’t cover the cost of staff members individually phoning patients.
August 11, 2023 at 8:23 am
Ditto. You have hit the nail on the head. We missed out a lot of flu last year to the pharmacists, so we have been busy booking flu. They have so many Interim Directors of this and that in NHSE, you would think (especially with some of them being GPs) that they would know the potential impact this could have on practices. What really pees me off is that they always begin their letter with a sycophantic ‘thank you so much lovely GP practices’, but then proceed to dump on us. Of course, this could always be a badly worded letter with poor grammar (not the first fro the Comms Team at NHSE) 🙁
August 11, 2023 at 8:52 am
Hi Paula,
I too read the spec three or four times, if you want to do both vaccines, you have to enter both vaccines on the outcomes for health platform and not through your normal practice IT.
As we all know, the issues with that is the delay for payment for flu vax we have bought and has to be distributed to practices via my PCN. More work to make sure each jab is paid for and we always had issues with other providers not recording, or recording in error – so it throws the reporting out.
Also who in their RIGHT mind would sign up for Covid at a reduced cost of £7.52… random number… when the vaccine itself is hard to administer/prep, harder to store, harder to answer questions about? I don’t know any business that would ever sign up for more work for 25% less????
I think that the sentiment right now from many people is not to order flu for next year either, though if you don’t then the patients are not happy and the Daily Fail vilify us.
We too had the 1st Oct rumour and I see from the spec it now says 1st Sept, and just for fun I read the Pharm offer (yes I am nuts) – they are 1st Sept too.
The point is they say they can change the spec whenever they want if you have signed up for it. I don’t know about the rest of you but I feel my trust is now broken with these specifications changing almost daily and no real concrete answers to questions raised through our LMC colleagues or GPPB.
Please don’t get us all started on the 6% for all and no way of knowing what your 6% is for your staffing so how can they fund it because 6% on GMS will NEVER pay for the expected rise from staff added to which unions are telling their members to insist on it from their employers.
All very negative, on the plus side the sun is shining so – the Q word on demand has been said today!
Everyone keep your chins up and as they say, now is the time to stand as one.
August 11, 2023 at 9:28 am
Thank you Paula – you are not alone.
Oh how right you are – Ive been in Practice for nearly 20 years and have seen the change from a supportive framework to adversarial. A job I had once loved has now become a job of “I’m retiring next year”.
I know the BMA have taken on this latest flu/covid vaccine debacle but sadly we have a government that doesn’t want to listen to good sense and that has filtered down to NHSE, ICBs and in some cases PCNs who just want to tow the line.
The medical profession is fragmented and GP Partners do not have the tools in their arsenal to stand up to this. Anything they do punishes their loyal workforce as well as themselves. The only thing they have left is to retire – punishing their loyal workforce.
It has never been as bad as this – and my fear is that its going to get worse. A drive for a private healthcare system by stealth – Watch this space!!
August 11, 2023 at 11:40 am
So our ICB assures us via email today :
“Payment for vaccinations will ordinarily only be made following the service commencement date. However, we understand that some firm commitments and appointments have already been made, so where this is the case and the patient wishes to receive flu vaccination in September, NHS England will permit payment claims to be submitted”
Still left an unpleasant taste and needed challenging though!!!
August 14, 2023 at 9:46 am
A huge underlying problem here now is that PMs are losing the will to fight, everything now seems to come with conflict and once the will to fight is gone, the PM invariably is heading closer to the exit door – whether thats retirement or to another sector. We are a rare breed already, under a 1,000 posts exist I believe, I am afraid they may not realise what they are losing til we are gone – but then the ICS/ICB and even NHS England, view us as ‘independent contractors’ who will have to take or leave their offers. Any talk of helping us with resilience is just that, meanless talk.
OOH cost the NHS a fortune but they were so sure they could do it cheaper than primary care. History lessons not learned I am afraid…
August 16, 2023 at 9:31 am
If the contract date is changed in the next two weeks to 1st Oct while the pharmacy contract remains at 1st Sept, surely there should be a formal challenge asking why and to what good purpose (has someone got a friendly local MP who would frame it as a PQ?). If changed after the current start date of 1st Sept when practices have already begun vaccinating patients, it must be open to a legal challenge – ?!