The 40% of England’s GP practices on locally agreed PMS contracts could also face financial losses and a large-scale return to GMS.
The GPC has denied claims from NHS Employers, which negotiates GP pay on behalf of the government, that it has ‘clearly now abandoned a UK approach to negotiating changes to the GP contract’.
But GPC Scotland and GPC Wales have now secured deals with devolved governments to protect MPIG top-ups to practices’ core funding.
In England and Northern Ireland, MPIG will be axed over seven years from 2014/15 under current plans – sparking a redistribution of funding that will create six-figure swings in income between practices.
Significant gaps have also emerged between the countries on how QOF changes will be implemented. Indicators and target thresholds will be different in each of the four UK countries and governments have made different decisions on how to redeploy funding from ‘retired’ indicators.
NHS Alliance GMS/PMS lead Dr David Jenner told GP: ‘I believe the concept of a four-nation contract is now a distant memory. I believe the changes are so great, the divide so great, that unless there is political will to bring the nations together under one contractual framework – from GPs and governments – things will look increasingly different in the different countries.’
While Scotland and Wales may be protected from upheaval by negotiating the retention of MPIG, Dr Jenner said the split left general practice in England exposed to a ‘move to a corporatised service’.
He warned that the extent of changes across GMS and PMS in England could lead to ‘reconfiguration of practices, mergers, acquisitions, takeovers or even practices serving notice on their contracts and partners retiring’.
The problems in England will be compounded by what could be major changes to PMS deals.
Senior DH officials say there is a future for PMS contracts, but have made clear that their funding will be brought in line with the GMS average.
NHS Commissioning Board (NHSCB) head of primary care Dr David Geddes told a recent National Association of Primary Care conference in London the move was ‘an opportunity for PMS practices to decide if they want to revert to GMS’.
Although many PMS practices have already suffered significant cuts to funding under waves of contract reviews in recent years, accountants say matching their funding to GMS will still lead to major losses.
Russell Finn, of specialist medical accountants Ramsay Brown & Partners, said high-earning PMS practices could lose ‘tens of thousands’ of pounds.
PMS funding is higher on average than GMS. GP leaders in the Celtic countries have suggested the impact of removing MPIG in England could be softened by redistributing PMS money.
But Dr Geddes made clear that although the money will remain in general practice, the NHSCB will demand extra work for it: ‘We want to pay that into the system in a way that you get something valuable out.’
GPC negotiators remain adamant the UK GP contract is not at an end, however. Northern Ireland GPC chairman Dr Tom Black argued that 90% of the core GMS contract and most of QOF remain UK-wide.
A breakthrough in talks between the GPC and the government remains possible. But even if MPIG is saved, variations in QOF will remain. The gap could be about to grow.
|GP contract: BMA roadshows|
BMA roadshows to talk GPs through the implications of changes to the GMS contract have begun across the UK.
At the first event to take place in England, in Worcester on 29 January, GPC negotiator Dr Peter Holden (pictured) warned that practices must become ‘more business-minded’ to survive.
He told GPs they needed to ‘learn when to say no’ to unfunded new work. Dr Holden said there was a ‘stunned silence’ when he explained the government’s plans for the GMS contract. ‘GPs are very angry,’ he said.
Dr Holden said GPs should consider whether new QOF targets or enhanced services were economically viable, worth the effort, or clinically appropriate.
Some new QOF targets were not financially worthwhile, he said. ‘You might as well stand on a street corner ripping up £20 notes,’ he added.
GPs at the roadshow discussed ways to maintain practice income in the future, including such options as forming federations to provide services.
At a meeting in Glasgow a day earlier, GPs expressed fears about the impact on workload of contract changes.