Contract will not solve GP workload crisis

Senior GPs have warned the 2015/16 GP contract will do little to address soaring GP workload, despite a QOF freeze and enhanced service funding moving into core pay.

Changes set out in the deal, announced months earlier than usual as the Conservative party conference took place in Birmingham, will see all patients allocated a named GP from April 2015.

Practices will be forced to publish ‘mean net GP earnings relating to the contract’ for 2014/15 by 31 March 2016.

The avoiding unplanned admissions DES will continue, but with changes to cut ‘unnecessarily burdensome bureaucracy’. The patient participation and alcohol DESs will be scrapped, with funding moving into core GMS income.

GPC leaders said they had ‘negotiated stability in the QOF’, with an agreement that no new targets or indicator threshold changes would be introduced. GP reported last month that the QOF could halve in size as early as 2015/16 – the GPC revealed that talks on clinical changes ‘within the QOF envelope’ are continuing, suggesting reductions could still go ahead.

Maternity pay

Maternity payments to practices will no longer be discretionary – a move hailed as hugely significant by accountants, who said it could save practices ‘tens of thousands of pounds’ (see below).

Despite welcoming the early contract deal, the GPC acknowledged concerns that it would not resolve workload problems. GPC chairman Dr Chaand Nagpaul admitted in a letter to the profession that ‘these limited changes to the contract will not in themselves solve the workforce crisis or address the exceptional strain affecting general practice’.

The GPC set out a raft of ‘urgent measures to support general practice’ which the BMA is pressing the government to consider in tandem with the GMS agreement.

The GPC has called for CCGs to fund additional primary care staff, efforts to make it easier for GPs to return to work, emergency funds to support GP infrastructure, cuts in monitoring and bureaucracy, and others changes to ease the pressure on GPs.

Workload problems

Wessex LMCs chief executive Dr Nigel Watson said although changes in the deal were welcome, ‘it doesn’t address problems we are facing at the moment around workload’.

‘The current workforce and structures don’t work with the demand we are facing,’ he warned.

Family Doctor Association chairman Dr Peter Swinyard agreed, warning that he feared the shift of more work into the core contract could threaten the principle of ‘no new work without new resources’.

Practices with low Carr-Hill formula weighting could receive less through core funding than they did for work provided as an enhanced service, he said.

Dr Swinyard said plans to publish GP pay could be a wake-up call for those who criticise GP earnings.

The figure practices have to publish will include salaried GPs and partners, and exclude any non-NHS income or non-GMS NHS income.

Practices must make clear how many full- and part-time GPs their data covers.

Dr Swinyard said: ‘It could be quite a wake-up call to the politicians and even theDaily Mail when we publish only NHS income – there will be some people who will be quite surprised how small it is.

‘Some say it’s none of anyone’s business, but I think we’ll find it is below salaried GP pay.’

Dr Nagpaul said that ‘tough negotiations’ had brought a deal that ‘gives general practice much needed breathing space and greater stability for practices and patients’.

In his letter to GPs, he stressed that plans to extend GP access to seven days a week, set out by the prime minister, were ‘neither flagged nor agreed with the BMA’ and were not part of the contract. ‘We are in a period when headlines and unsubstantiated promises trump reality and will, I’m afraid, feature increasingly in the run up to the general election.’


Expert view - The specialist medical accountant

Laurence Slavin, 
Ramsay Brown & Partners

This announcement came many months earlier than usual, giving GPs time to consider the implications. There is the usual tinkering and moving of monies, but it all seems to be going in the right direction.

Patient participation enhanced service funding will be transferred to the global sum, and as with other funding transfers, will not be subject to an out-of-hours deduction. Further tinkering includes the continuation of the unplanned admissions enhanced service, but the administrative burden should be less onerous.

Of much greater significance is the change in maternity and paternity leave. Some area teams were refusing to reimburse locum costs, costing practices tens of thousands of pounds. These reimbursements will no longer be discretionary.

Also of significance is the agreement between the GPC and the NHS to explore how the retainer and returner scheme and the flexible career scheme might ease the workload crisis. There is a pool of newly retired GPs who could, if incentivised, be of considerable help.

It is welcome to see the commitment to re-examine the Carr-Hill formula to better reflect deprivation. It is the failure of the formula that has heaped financial problems on inner-city practices, by failing to fund them properly as MPIG is removed.

Full version of this article medeconomics.co.uk

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