Looking back over the last 10y, the DDRB uplift /pay 'award' to UK general practices were:
0% 2012
1% 2013
0% 2014
0% 2015
1% 2016
1% 2017
3% 2018
3% 2019
2.95% 2020
4% 2021
5% 2022
6.5% 2023
So significant erosion of income in the austerity years with increased inflationary costs year on year. In that time the complexity and the volume of the work mushroomed, more work absorbed from secondary care and with an ageing and increasingly metabolically unhealthy population. More expected for less.
Many left the profession to retire early, earn higher wages through career change, agency/locum work, work abroad, private practice or to free themselves of the suffocating bureaucracy that can be associated with substantive NHS posts (including CQC generated targets). Clinicians moved into private practice or moved to 'portfolio careers' (part time working in the NHS) as they can earn more and engender more respect and patient satisfaction when access and continuity of care is no longer an obstacle. Some work from home. Some services like psychiatry seem to be entirely run by a transient locum consultant workforce.
Shifts need to be covered when staff leave. In some areas, workers learn that last-minute shifts attract a higher premium, so this compounds the problem of cost (why volunteer for an out of hours shift months in advance when you could agree to it last minute and earn double the income?). Agency costs have mushroomed as the workforce becomes increasingly fragmented and disjointed:
Meanwhile, NHS nurses and health workers in some areas have resorted to using food banks.
In primary care, unlike private businesses, the GMS contract limits the ways that GP practices can increase practice income. Income earned through 'enhanced services' (minor surgery etc) has been eroded (with 0% inflationary adjustments over a decade), effectively meaning provision of some services come at a loss so practices stop providing. Other 'enhanced service' work became so bureaucratised it created significant extra work with uncertainty about value (eg payments for dementia 'case finding' rather than waiting for people to present with dementia concerns). less time available for the stuff that makes a difference but which doesn't pay extra. Some practices have moved into 'research' to supplement practice income, achieve stability of income and attract staff. Pharmaceutical industry sponsored research is higher paying but also introduces conflict of interest.
There is a tipping point when more and more people choose to leave stable substantive posts (eg partnerships, or even salaried posts), citing reasons of work-life balance, pay and self-protection (mental health).Continuity of care suffers and there is more waste as it takes twice as long to get to the bottom of a problem when no-one takes ownership or when a service doesn't exist any more. For those who remain, this adds more and more stress for increasing financial penalties and facing and increasingly dissatisfied public.
In 2017 there was an election promise to spend an extra £8 billion on the NHS over 3 years and a lot of fuss was made about that, as if it was a great gift after so many years of cuts. And then in 2020 suddenly the coffers were opened again, money was no object and the government began burning its way through obscene amounts of public money in the name of Covid. As an example, by December 2021 they had spent more than £16.6 billion on lateral flow rapid antigen tests (9.5% of the NHS budget or 1.4 x the annual NHS primary care budget equivalent on a single test) and £37 billion budget for NHS test and trace.
And yet the public in general did not question any of this as they squirrelled away these 'free tests' and demanded more to keep them safe as the NHS finally imploded. In the end the NHS broke the NHS in the pandemic years, but it was in very very bad shape already.
I'm guessing the non nhs bodies are private healthcare providers, and I think we all know this happens. From what I know (from my mate) NHS England governs the NHS....so it looks after the staff. Also incorporates NHS Digital. It's a huge organisation and good luck getting to grips with everything it does....I think it needs to be streamlined and simplified.
The UK government allocates (from the day to day spend) about £16 billion to the central budgets of the Department of Health and Social Care and its arms-length bodies. That's roughly 20% of the total NHS Trust staffing budget.
I am not surprised it is difficult to keep track of zeros.
It would be good to know why over 1000 people of an organisation with either 6500 or 10,000 people have exit packages. What is going on? Are they trying to streamline? Reduce headcounts?
I did not see anything particularly alarming in the board members’ interests, and I don’t know these people, so cannot say anything about competency.
Perhaps what is alarming is the fact they actually have other commercial interests apart from what should be their main job. For a £180Bn company you would think the least the directors could do is give it their full attention. Is this lack of focus by the executive a public sector thing?
Trustees, ambassadors, board members of other organisations. Perhaps not all commercial but certainly outside interests which detract from what should be the day job. The chair and deputy chair are directors of other commercial outfits (the deputy chair being a managing partner which sounds like it would need a fair bit of attention). The other deputy chair is the chair of a charity. Perhaps I’m being too harsh since board members don’t appear to do very much anyway so 2nd and third jobs are probably feasible.
Could it be agency costs?
Looking back over the last 10y, the DDRB uplift /pay 'award' to UK general practices were:
0% 2012
1% 2013
0% 2014
0% 2015
1% 2016
1% 2017
3% 2018
3% 2019
2.95% 2020
4% 2021
5% 2022
6.5% 2023
So significant erosion of income in the austerity years with increased inflationary costs year on year. In that time the complexity and the volume of the work mushroomed, more work absorbed from secondary care and with an ageing and increasingly metabolically unhealthy population. More expected for less.
Many left the profession to retire early, earn higher wages through career change, agency/locum work, work abroad, private practice or to free themselves of the suffocating bureaucracy that can be associated with substantive NHS posts (including CQC generated targets). Clinicians moved into private practice or moved to 'portfolio careers' (part time working in the NHS) as they can earn more and engender more respect and patient satisfaction when access and continuity of care is no longer an obstacle. Some work from home. Some services like psychiatry seem to be entirely run by a transient locum consultant workforce.
Shifts need to be covered when staff leave. In some areas, workers learn that last-minute shifts attract a higher premium, so this compounds the problem of cost (why volunteer for an out of hours shift months in advance when you could agree to it last minute and earn double the income?). Agency costs have mushroomed as the workforce becomes increasingly fragmented and disjointed:
https://www.rcn.org.uk/news-and-events/news/uk-32bn-agency-spend-could-have-paid-salaries-of-31000-nurses-051223
https://www.theguardian.com/society/2024/jan/16/nhs-across-uk-spends-a-staggering-10bn-on-temporary-staff
https://www.bbc.co.uk/news/world-europe-guernsey-65028287
Meanwhile, NHS nurses and health workers in some areas have resorted to using food banks.
In primary care, unlike private businesses, the GMS contract limits the ways that GP practices can increase practice income. Income earned through 'enhanced services' (minor surgery etc) has been eroded (with 0% inflationary adjustments over a decade), effectively meaning provision of some services come at a loss so practices stop providing. Other 'enhanced service' work became so bureaucratised it created significant extra work with uncertainty about value (eg payments for dementia 'case finding' rather than waiting for people to present with dementia concerns). less time available for the stuff that makes a difference but which doesn't pay extra. Some practices have moved into 'research' to supplement practice income, achieve stability of income and attract staff. Pharmaceutical industry sponsored research is higher paying but also introduces conflict of interest.
There is a tipping point when more and more people choose to leave stable substantive posts (eg partnerships, or even salaried posts), citing reasons of work-life balance, pay and self-protection (mental health).Continuity of care suffers and there is more waste as it takes twice as long to get to the bottom of a problem when no-one takes ownership or when a service doesn't exist any more. For those who remain, this adds more and more stress for increasing financial penalties and facing and increasingly dissatisfied public.
In 2017 there was an election promise to spend an extra £8 billion on the NHS over 3 years and a lot of fuss was made about that, as if it was a great gift after so many years of cuts. And then in 2020 suddenly the coffers were opened again, money was no object and the government began burning its way through obscene amounts of public money in the name of Covid. As an example, by December 2021 they had spent more than £16.6 billion on lateral flow rapid antigen tests (9.5% of the NHS budget or 1.4 x the annual NHS primary care budget equivalent on a single test) and £37 billion budget for NHS test and trace.
And yet the public in general did not question any of this as they squirrelled away these 'free tests' and demanded more to keep them safe as the NHS finally imploded. In the end the NHS broke the NHS in the pandemic years, but it was in very very bad shape already.
Not sure I can continue reading these figures without feeling sick and my blood pressure rising!
Throwing crockery against walls helps, I find. Drawback: one has to clean up the shards afterwards ...
I wish I could say something witty and perceptive but wow, what a Gravy Train……
I'm guessing the non nhs bodies are private healthcare providers, and I think we all know this happens. From what I know (from my mate) NHS England governs the NHS....so it looks after the staff. Also incorporates NHS Digital. It's a huge organisation and good luck getting to grips with everything it does....I think it needs to be streamlined and simplified.
The UK government allocates (from the day to day spend) about £16 billion to the central budgets of the Department of Health and Social Care and its arms-length bodies. That's roughly 20% of the total NHS Trust staffing budget.
* in England
a big, big trough to get the snout in
I am not surprised it is difficult to keep track of zeros.
It would be good to know why over 1000 people of an organisation with either 6500 or 10,000 people have exit packages. What is going on? Are they trying to streamline? Reduce headcounts?
I did not see anything particularly alarming in the board members’ interests, and I don’t know these people, so cannot say anything about competency.
Perhaps what is alarming is the fact they actually have other commercial interests apart from what should be their main job. For a £180Bn company you would think the least the directors could do is give it their full attention. Is this lack of focus by the executive a public sector thing?
Did you see a lot of commercial interests? I did see shareholdings, but most people with some savings will have shares?
Trustees, ambassadors, board members of other organisations. Perhaps not all commercial but certainly outside interests which detract from what should be the day job. The chair and deputy chair are directors of other commercial outfits (the deputy chair being a managing partner which sounds like it would need a fair bit of attention). The other deputy chair is the chair of a charity. Perhaps I’m being too harsh since board members don’t appear to do very much anyway so 2nd and third jobs are probably feasible.