To kick off 2024, our anonymous blogger and practice manager gives their thoughts on worsening financial pressures, vaccination campaigns, and the forthcoming general election.

In the aftermath of Covid, primary care has come under even more pressure than before, both financially and medically.

While most practices got back to business as normal, some had not even opened their doors to face-to-face appointments. This in my view was unacceptable and gave primary care a bad name.

Signposting the right care path

The advent of EConsult continued during 2023 and was met positively by most patients. If used properly, it benefits both patients and practices alike to signpost patients to the correct care path.

The financial pressures became worse in 2023 when there were so many delays in agreeing the funding for the GMS contract, and in turn, the pay for salaried doctors and nurses.

The final agreed figures put further pressure on practices as the income was not matching the agreed extra expenditure, especially for those practices that had high-weighted list size numbers. Those practices with more partners also gained, as it was only the salaried GPs that got the increase.

More is less?

Tough decisions had to be made and although inflation was coming down, we are being affected by both issues, and could not give our non-clinical staff the same increase. We, like others, ended up giving non-clinical staff an increase of about 3%, which in real terms was a pay reduction rather than any increase.

Finances were also hit by the uncertainty of 2023/4 flu season when the cohorts were continually changed, and this has led to a substantial number of surgeries being left with excess flu vaccines.

Why were we told that any vaccines done after December would not be reimbursed is beyond me. We always have people changing their minds and coming in January or February.

In many areas, the pharmacies got in first, and were more proactive than some surgeries, and primary care lost out once again.

The same confusion happened during the Covid booster campaign in the Autumn, with the initial terms being much lower than during Covid, and so many surgeries did not sign up for the vaccination scheme.

Once again, the terms had to be reviewed and the funding reinstated to the previous level, but it was too late for practices to be able to change their minds.

The government seems to think we are a charity, and has no idea of the costs and work involved in running such a campaign. As practices, we need to cover our costs.

Along with others (I am sure), we have looked drastically at all our costs to ensure we run leanly. However, I do predict some surgeries closing due to financial pressures.

Strikes, giveaways and cutbacks

Looking ahead, can we expect things to be easier in 2024? I very much doubt it. The junior doctors have continued their series of strikes and that has a knock-on effect for everyone.

As we are going to be in an election year, there will be giveaways by the current government in tax reductions etc, which they hope will reflect well on them. But I wonder if the public are that gullible. Can we afford tax cuts with all the debt the country has? What will suffer as a result? We all know the answer to that…

Any alternative governments are not being transparent on what they would do, and of course electioneering will promise things such as a guaranteed appointments and continuity of care with the same GP an excellent aspiration -but how likely is it that it can that be delivered?

2024 is going to be another difficult year - worse than we have ever known, as the service is starved of resources. We must look at another significant increase in the minimum wage and whether the GMS will cover it, but I doubt it.

Will the doctors who are unable to get locum work because of surgery cutbacks fill other vacancies in the NHS, or will they go overseas or leave the profession?

I hope I am being more pessimistic about 2024 than what will really happen, but I doubt it.