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BSOL Universal Offer

Please find in the document links below the LMC’s formal response to the Universal Offer engagement. Clearly most of the points made are repeated across the various documents, as the documents themselves are repetitive, though it’s worth noting that the service specification documents includes many additional details and requirements which are not mentioned in the service matrix or member briefing documents. In any case the various comments and concerns raised do , I believe, merit repetition.

I trust that all the comments made on the attached are self-explanatory, but please do not take this list as being exhaustive. I have tried to concentrate on the concerns over fundamental principles that the LMC has; there are many other issues related to the workload implications and probable undeliverabilty of many of the individual clinical areas; these have been brought to the LMC’s attention by numerous individual practices and provider/locality groups, and my understanding is that they are being brought to the CCG’s direct attention through the engagement process.

It goes without saying that the LMC believes that the workload required to deliver the universal offer is immense, and that many requirements are simply undeliverable, either in absolute terms, or without significant detriment to practices ability to safely deliver core contracted services and/or, bearing in mind the paltry resources that the CCG is making available for the universal offer, to practices’ business viability. Moreover the LMCs position is that, regardless of the usual arguments of workload versus resources, there are huge fundamental concerns with a number of the universal offer requirements as currently proposed. These are detailed in the attached comments, and include, inter alia (again far from exhaustive):

When the universal offer was first proposed, in the context of the setting up of the Birmingham and Solihull STP, and the then only mooted CCG merger, all practices were led to believe that the intention was indeed “transformative”, in order both to provide sufficient additional recurrent resources into general practice to enable their ongoing sustainability and viability during the current catastrophic crisis whilst at the same time being able to deliver on an agenda of transformation of practice capacity to provide more care out of hospital and so to generate ongoing additional resources for primary care through the virtuous circle route of invest to save. Sadly these proposals as they stand are going to deliver neither of these aims, and in fact will inevitably have the opposite effect.

The overriding impression of the proposals is that instead they have been drafted first and foremost to save money on CCG budgets in the short term to satisfy the needs of its finance department, and to cut down on secondary care activity, regardless of whether such activity might actually be appropriate and in patients’ best interests. Despite the laudable involvement of CCG GPs, and the engagement of stakeholders to date in helping formulate the draft universal offer, it can be seen that the operational requirements and the clinical priorities have been drafted in isolation from any genuine consideration of the direct and indirect costs of delivery. Instead it is clear that responsibility for meeting all the CCG’s obligations in respect of staying within budget, reducing secondary care activity, and achieving all internal strategic aims and externally-imposed requirements have been shoe-horned into the universal offer with the expectation that already struggling general practices will deliver for the CCG on everything demanded within a wholly inadequate budget that represents all the CCG is prepared to make available from pre-existing enhanced service budgets prior to merger. Indeed the sum available per patient is a reduction, despite hugely increased workload, responsibilities and expectations, on the funding previously available to practices through the pre-existing schemes and LISs. Our understanding is that this is despite a commitment to the contrary given to Birmingham Cross City practices in an open meeting last year when merger was being discussed.

Whilst it might be that some of the workload requirements will be reduced and revised as a result of the engagement process, the LMC is led to believe that no additional funding is going to be made available to fund the universal offer. The position of the LMC is that unless significant additional funds are made available, in addition to significant reductions in the workload and other major changes to the service specifications and other requirements, then the universal offer will remain undeliverable. More significantly, unless all the other areas of fundamental concern which the LMC has, including the elements of the proposals which undermine GP clinical autonomy and professional responsibility to act first and foremost as advocates for their patients, are removed, then the LMC will inevitably have to take the position of advising practices that they should not sign up to the universal offer, regardless of any workload changes made to the specification or any increased funding offered.

Click here to download the document "BSol Univeral offer - DRAFT Service Matrix".

Click here to download the document "BSol Univeral offer - DRAFT Service Specification".

Click here to download the document "BSol Univeral offer - Member briefing".

Click here to download the document "BSol Univeral offer - payment mechanism".

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