The BMA’s GP committee for England backed a revised package of GP contract measures for 2020/21 - just three weeks after rejecting an initial offer from NHS England. Plans for a special LMCs conference to scrutinise the deal will go ahead - with a date set to be announced shortly.
NHS England has offered major concessions on plans for PCNs - scrapping plans to introduce five service specifications, with three now set to take effect covering structured medicines reviews, enhanced care in care homes and early cancer diagnosis. Specifications for personalised care and anticipatory care have been scrapped for this year.
GPs will no longer be expected to carry out fortnightly care home visits - a proposal in the draft specifications that sparked huge concern over the impact on practice workload. PCNs will be free to decide which staff deliver weekly reviews of care home residents, based on clinical need - with a £120 per care home bed payment introduced to reflect variations in workload between areas.
In areas where PCNs struggle to recruit clinical pharmacists, meanwhile, PCNs will not be expected to deliver structured medicine reviews to the same level.
The contract deal backed by the GPC will also see an apparently unlimited number of doctors offered £20,000 golden hello payments to take up partnership roles - although the payments are billed as part of a £94m fund to address recruitment and retention issues in general practice in 2020/21.
NHS England has also made a signifcant concession on funding for staff recruited through the PCN additional roles reimbursement scheme (ARRS). Accountants had warned that the 30% contribution GP practices were expected to make towards the cost of salaries for the bulk of staff to be hired through PCNs could strip £400m from core practice funding over the course of the five-year contract - but from April all staff salaries will be fully funded.
The deal also includes a £173m fund to allow PCNs to employ a wider range of additional staff - including pharmacy technicians in addition to the clinical pharmacists, physiotherapists and paramedics expected to be brought in through networks.
The number of places on the targeted enhanced recruitment scheme - which offers £20,000 payments to attract GP trainees to underdoctored areas will be almost doubled from 276 to 500 in 2021 and increased further to 800 in 2022.
Trainees will also spend longer in general practice - with 24 of their 36-month training to take place in general practice.
Practices will also be offered funding to provide 'a 6- 8-week postnatal health check for new mothers' and will receive funding for an 'above-inflation pay uplift' for staff.
GPC chair Dr Richard Vautrey said: 'After months of challenging and tough negotiations we’re pleased to have secured this package of changes that have the potential to make a real difference to GPs, the practices they work in and the patients they treat.
'The significant investment in and focus on recruitment and retention, including payments to incentivise doctors to take up partnership roles and work in under-doctored areas, is a vote of confidence in the partnership model and a much-needed first step if we are to reverse the worrying trend of falling GP numbers that we have seen in recent years.
'An expanded healthcare team working in GP practices as well as increasingly closely with community colleagues across groups of practices, will mean patients have access to a wider range of staff, allowing GPs to see those who need them most more quickly. These extra roles are now fully funded so will come at no extra cost to practices.
'These changes won’t fix the crisis gripping general practice overnight and we recognise there is much more work to do to address the real concerns that GPs and LMCs have expressed in recent weeks. However, they are a significant step in the right direction. Alongside NHS England and NHS Improvement, the government must now build on these foundations if it is to deliver on its promises to boost GP numbers, improve patient access and ultimately guarantee the future of general practice.'
NHS medical director for primary care Dr Nikita Kanani> said: 'This agreement means better care for patients, and will help relieve pressure in general practice. This contract is good news for practising GPs, and supports our practices in the new PCNs to bring in extra skilled staff, and recruit and retain our GPs.'