Dr Krishna Kasaraneni: Contract offers stability and opens path to save general practice

The 2018/19 contract offers stability for GPs, says Dr Krishna Kasaraneni. But talks on premises and partnerships over the year ahead will show whether ministers are serious about saving general practice.

Dr Krishna Kasaraneni (Photo: JH Lancy)
Dr Krishna Kasaraneni (Photo: JH Lancy)

For colleagues in England who have been at the GPC roadshows and for those at the LMC conference on 9 March, you will already know that this year we have taken a different approach to the annual contract negotiations.

The profession has repeatedly told us that annual contract changes are disruptive to the services that they provide to their patients on a daily basis. We therefore focused this year’s negotiations on funding uplifts, like £60m for indemnity, with no changes to services offered in the consulting room and practice as a whole.

The profession also told us the fundamental issues that need tackling to stabilise general practice. We listened, and have been able to secure agreement on a comprehensive review of GP premises to look at the direction of travel, with a significant emphasis on finding solutions to issues like the last person standing scenarios.

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We have also secured improvements to the premises cost directions that should enable funds stuck in the Estates and Technology Transformation Fund to be spent on GP premises urgently. GPs have the unique burden of buying into bricks and mortar of the premises that they work in.

This was seen as one of the characteristics of ‘independent contractors’ in the past but is fast becoming one of the reasons why GPs are currently being pushed away from the profession. We want the premises review to look at how these disincentives can be turned into the incentives that general practice so desperately needs.

There will of course also be a review of the partnership model, which is even more important to retain GP partners at a time when they are leaving in huge proportions and to reenergize the whole workforce.

QOF review

Add to this the ongoing work on indemnity negotiations, and the QOF review and funding formula review that are currently happening, and the next few months are likely to bring significant changes in the five fundamental areas of general practice.

While we have secured an initial 1% pay and expenses uplift, we expect the recommendation from the DDRB this year to add to that as reflected in the BMA’s submission.

We have also built on the funding for sickness and parental leave that was part of the 2017/18 negotiations and strengthened violent patient regulations to offer better protection for GP staff.

Acknowledging the paper-light journey of the NHS that started years ago, we have secured £10m for the implementation of the e-Referral Service with an agreement for comprehensive guidance and resources for training focusing on supporting practices rather than punitive actions.

Offering a total £256m in investment, this year’s contract negotiations are about the stability that the profession has been calling for. While this agreement alone will not resolve many of the issues facing general practice, it builds on our progress from the last two years and more importantly, opens up a fundamental review of some of the crucial factors affecting general practice.

We will continue to work on all of these work streams in the coming weeks and hope that the DDRB makes an appropriate recommendation for a real-terms pay rise this year. More importantly, the government needs to demonstrate to the profession that they are serious about saving general practice by showing the courage to invest properly.

  • Dr Krishna Kasaraneni is an executive member of the BMA's GP committee (GPC) and its workforce lead

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