What is the BMA's plan for saving general practice?

The BMA's Saving General Practice document details six key factors that need to be addressed to reverse the crisis facing GPs.

Funding

Both the BMA and the RCGP have said that general practice needs an 11% share of the overall NHS budget to become sustainable. In 2016/17, just 7.9% of the NHS budget came to general practice - down sharply from 9.6% in 2005/6 when the Conservative/Lib Dem coalition government took office.

Under plans set out in the GP Forward View, which pledged a £2.4bn increase in annual GP funding, general practice's share of NHS funding will rise - but nothing like enough, the BMA says.

The union says GP funding is currently £3.7bn short of the 11% target - and it estimates this will fall only slightly to £3.4bn by 2020/21 based on current government spending plans.

What does the BMA want?
The BMA has demanded 'a firm commitment' from ministers to increase total GP funding to £14.6bn by 2020/21 to hit the 11% share required - a colossal rise from the £10bn set to be invested in 2017/18.

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Workforce

The NHS lost 1,300 full-time equivalent GPs between September 2015 and September 2017, official data revealed earlier this year.

What does the BMA want?
The BMA has called for the government to build a primary care workforce strategy around 'a genuine expansion of a multi-disciplinary workforce that is recurrently funded'. This would cover recurrent funding for pharmacists in every practice and an expansion of CAMHS, IAPT and community nursing services linked to GP practices.

A retention scheme to keep partners in general practice, and better recognition of rising demand for flexible working - including better planning on how to use locums in the GP workforce is vital, the BMA says, along with post-Brexit guarantees for EEA staff currently working in the UK and an improved recruitment and support scheme for overseas-trained GPs.

Indemnity

Indemnity costs for GPs rose by more than 50% between 2010 and 2016, the BMA says. Recent changes to the discount rate applied to personal injury payouts are set to drive up the cost of clinical negligence even further.

GPonline has reported on GPs reducing the hours they work or turning down shifts to limit indemnity costs, and the BMA says the increasing gap in costs for hospital doctors and those in primary care is driving clinicians away from general practice.

Health secretary Jeremy Hunt announced plans for a state-backed GP indemnity scheme, which could kick in from 2019.

What does the BMA want?
The BMA has warned that this indemnity package must not be delayed, and that the deal must ensure parity between doctors in primary and acute care services. The BMA has also demanded a government commitment to a further winter indemnity package in 2018/19.

Workload

GP workload has hit an unsustainable level - polling by the BMA in 2016 found that eight in 10 GPs felt their workload was unmanageable.

GPonline revealed earlier this year that GP practices in England deliver around 1m appointments every week beyond what the BMA considers a safe limit, and a majority of practices said this year they would be prepared to take part in a mass closure of patient lists in protest over workload.

What does the BMA want?
The BMA plans to develop - with or without government support - a primary care equivalent of the black alert system hospitals use to warn that they are operating under extreme pressure. It also wants practices to be empowered to 'define capacity limits for safe working'.

GP leaders have demanded an end to workload dumped on practices by hospitals, and and expansion of self care - including direct access or 'self-referral' options for patients to services such as physiotherapy. The BMA is also demanding a reduction in the bureaucratic burden placed on practices by the CQC, NHS England, the GMC and other organisations.

GP contract

BMA chair Dr Chaand Nagpaul warned last year that practice closures were at record levels, and official data show that hundreds of practices have either closed or merged since NHS England became operational in April 2013.

Erosion of GP funding - with a near 25% drop in partners' income in the seven years after the QOF was introduced in 2005/6 - is the key factor that the BMA says is forcing practices to consider alternatives to the traditional practice contract. Practices are federating, merging or joining emerging accountable care systems across England.

What does the BMA want?
The BMA has called on the government to express an 'ongoing commitment to the national GMS contract and independent contractor status'.

New care models and the development of general practice at scale should be built on top of these contracts to maintain the link between practices and their registered patient list, the BMA says, rather than replacing GMS contracts. New GP practices should also be set up under GMS, not APMS deals that are open to private providers.

The BMA also wants freedom for practices to provide a wider range of non-NHS services to their own patients and a standard set of terms and conditions for GP employed in accountable care organisations.

Infrastructure

Outdated premises and IT equipment are both undermining patient care in general practice, with a lack of significant investment to renew either in recent years.

The poor quality of IT hardware and software in GP practices contributed to their vulnerability to the recent NHS cyber attack that left some practices unable to access their computer systems.

What does the BMA want?
GP leaders have demanded an 'immediate software and hardware refresh for all GP practices to address system failures arising from a decade of neglect'.

They have also demanded a fundamental review of premises arrangementsA fundamental review of premises arrangements, to 'remove "last partner standing" scenarios, reduce the risk of practices seeking alternative contractual models owing to premises problems, and remove any barriers discouraging doctors from becoming GP partners'.

The BMA has also demanded 'fully funded rental and maintenance costs for all practices' and 'increased and ongoing capital investment in GP premises and associated revenue costs'.

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