Speech from the Chairman of the Professional Fees Committee
Dr Peter Holden
Thursday 1 July 2004
Chairman
This year has seen 100% turnover of the staff in the Professional Fees Committee and I must start by thanking them all for their help, enthusiaism and patience in persuing the committees business. In particular my special thanks go to Stuart Abrahams our new PEO whose enthusiasm and sound political judgement is only exceded by his capacity for grasping a complicated and diverse portfolio very quickly indeed.
Many issues have confronted the committee this session and most of them have been incapable of attempted solution until recent weeks because the former DDRB statements of Intended Average Gross Remuneration (IAGR) are no longer published and IAGR was the inflator base for fees. The consequence of this is that many fees have not been increased yet, particularly for the public sector. New analogues for future indexation of professional fees which are statistically valid and accepted by all parties are being tested and require to be agreed between all parties as fair sound and reliable analogues on which to base future rises. First estimates of such analogues became available only within recent weeks
All parties both public and private have been made thoroughly aware that the profession is in the middle of a catching up and rebasing process after many years of pay restraint and interference with DDRB awards and that as there is a shortage of doctors the market rate for medical services is increasing well ahead of general inflation.
The size of fee rises we are proposing are becoming matters of dispute particularly with public sector agencies most of whom have failed to budget adequately or to realise that
- their old cross subsidy by either the profession, the NHS or both has now ended and
- that they will have to pay the full economic rate for work to be completed or
- face the fact that as there is no contractual obligation for doctors to perform such work means that work will no longer be completed at unsatisfactory or uneconomic rates.
The Employers Organisations of Local Government which covers many fees in the public sector have not fully seized this situation and we are scheduled for a further meeting in the near future.
Our line with all parties continues to be that over the period 31 March 2003 to 31 March 2006 fees must rise by 26.6% i.e. 10% from 01 April 2004, 19% from 01 April 2005 and 26.6% from 01 April 2006 over the 2002/2003 rates. In two weeks time we will be proposing a 10% rise in fee rates for ratification by Council.
The private sector notably the Association of British Insurers has recognised this changed environment and paid 7.3 % on account with rises from next year based on this year’s outturn when known.
Department of Work and Pensions
The Department of Work and Pensions is starting the work to re contract the medical adjudication process for the 7 year period from 2005. The current 1997 contract was initiated without due diligence and was seriously underbid resulting in an effective pay freeze for doctors doing such work – a situation extant since 1993. As a consequence we convinced ministers that all bidders must come and learn the association’s views and this they have done so that they can construct their bids in the full knowledge that there needs to be a quantum leap in medical remuneration for this work. All parties have been warned in no uncertain terms of the consequences of inadequate remuneration packages or inadequate terms of service at times of medical workforce shortage. I am pleased to announce that yesterday we secured an 88% increase in the fees for DLA forms rising from £17 to £32 from October 2004.
VAT
In the wake of the D’Ambreunil judgement we met Customs and Excise last summer. Basically any medical service not directly connected with the treatment of disease or prevention of ill health will become a VATable service. This will have far reaching effects upon the profession which are not fully clear. We will produce guidance when the issues are settled. Time constraints do not permit me to expand here but we are meeting Customs and Excise again shortly.
Access to Health Records
Requests for access to heath records under the Subject Access regulations continue to plague the profession diverting scarce time and medical and administrative support workforce away from clinical activity towards fulfilling these demands. Most of these requests come from a relatively small number of solicitors or medico-legal intermediaries who are abusing the regulations to obtain information cheaply and subsidised by the NHS to determine whether proposed no win no fee litigation is a viable proposition. It is not for the treasury NHS vote to pay for this activity.
Robust representations have been made to the Heatlh Records and Data Protection Review Group at the DoH on this issue and on their proposals to reduce the Access fees to £10 maximum from 2008. Frankly some lawyers are playing fast and loose on this issue and the Law Society shows absolutely no leadership and is passively conniving in this diversion of scarce NHS resources towards giving law firms a cheap litigation viability assessment service at NHS expense. As a result together with the medico-legal committee we held a forum with lawyers, the insurance industry and other interested parties to discuss various issues relating to this. We are meeting the Civil Justice Commission on the topic shortly. It is time to flush out this activity and let the public know what is going on.
Summary
It has been estimated that the committee formally deals with in excess of some 1700 different fee scales in addition to general fee policy formation. Clearly such a breadth of activity cannot be encompassed here or in the summary report tabled with your papers. I am always happy to discuss PFC issues with representatives informally at any time. Finally may I thank my committee for their unstinting support loyalty and wisdom.
I move.