Dr Peter Holden, Chairman of the Professional Fees Committee
Speech to ARM 2005
29 June 2005
Chairman in presenting my report to the ARM may I take this opportunity to thank the secretariat for their support during the year in particular Stuart Abrahams who has held the show together during a time of considerable staff turnover.
You have had the committee’s initial report tabled with your papers, however since it was written one month ago several crucial key pieces of the committees’ work have progressed significantly.
Because of the new GP contract the DDRB no longer publishes an Intended Average Net Remuneration figure. Therefore the committee has had to formulate a new approach towards the calculation of suggested fee increases for this and future years and our approach is based upon the GP pension dynamising factor which is the nearest proxy for IANR - the old benchmark. Because of the delays in obtaining interim and final dynamisation factors it may not be always possible to run new suggested or agreed fees schedules from April 1st annually in the future
Based upon our new methods fee increases were approved in May resulting in a 12% addition to BMA suggested rates over last year. Negotiations have commenced with the myriad of outside bodies with which we agree fees 1700 fees at the last count. Any suggested or agreed fees which we are permitted to publish under competition rules are now posted on the public section of the BMA web site in the interests of transparency. We do not publish or have available any other fees.
Many outside bodies are having to come to terms with the fact that the fees increases are ahead of inflation because the old NHS subsidy has vanished and therefore work must be priced at true commercial rates incorporating all overheads. Unfortunately the DDRB failed to grasp this point concerning Collaborative fees and we are preparing guidance for doctors no longer prepared to accept this area of work at the paltry uneconomic rates suggested.
Locum fees
We await the OFT clearance on our guidance
Benefits agency
The fees paid to doctors for DWP work through Atos Origin are still well behind the market. Matters are complicated by the fact that the Queens Speech announced a complete review of the benefits system and I have written to Mr Blunkett seeking meaningful input into modernising the medical evidence and the systems to procure such evidence.
Medico-legal fees
We are in the midst of discussions with the Civil Justice Council and the Association of Medical Reporting Agencies AMRO on a range of fee issues concerning civil litigation. AMRO companies are trying to dominate the market. There is evidence that AMRO is trying to influence the Civil Justice Council to make recommendations adverse to the medical profession for their own commercial interests. This is being resisted by every avenue possible and I warn the industry not to diss with us but to discuss matters with us.
Jury service is posing a major problem leaving doctors not just without income for serving on a jury but for GPs a massive financial loss paying for the locums to do their work for them. We meet the DCA next week on the issue.
Records requests
We have been working with the Health records & Data Protection Review Group and their submission to ministers is due very soon. We have made it utterly clear that as a profession there is no good reason why doctors should be out of pocket for such work and delicate negotiations prevent me elaborating further but rest assured I wont take no for an answer.
Personal Medical Attendants fees
These have risen to £70 this year. Over the past 3 years we have secured a 115% rise in fees for this work.
Hot issues over the next 12 months will include additionally
- VAT on medical services not directly connected with patient treatment of illness
- Access to Health Records
- Collaborative Arrangements
- Our relationship with the funeral industry
Last night I was asked by a former council member and former member of my committee how we were obtaining double digit percentage rises in fees with some fees quadrupling.
- There is no science to it
- There is no magic to it,
- My committee does its home work
and we know how to say no!............I commend you to learn that technique so alien to us as doctors
The facts are clear.
- The market value of doctors has shifted up a gear.
- We must all be resolute in standing firm.
- We must not work at a discount
- We must not work at unrealistic marginal cost prices.
- Those with whom we contract must either understand this or else
- Accept that the work will not be done in the future.
- We will not be emotionally blackmailed on fees issues that 'your patient will suffer' This is the 4th largest economy in the world the areas in which PFC operates are all discretionary from a clinical care point of view and this sort of intellectual bankruptcy will not wash……..
- The labourer is worthy of his hire
RB the value of a doctors’ time is in our own hands
I move
