I will not pretend that this year’s contract will in one stroke address all the problems facing general practice. But this year’s deal will result in some much needed relief in a number of important areas that have for years been damaging the capacity of GPs to deliver effective services to their patients.
Crucially, we have listened closely to practices and their understandable anger at the unacceptable CQC fee rise, and have been able to successfully negotiate full reimbursement of the whole cost of practices’ annual bills. We’ve secured a further £30m to cover the average rise in indemnity fees.
These two pressures have been a clear and understandable source of irritation for GPs, as both claw away at precious resources. The clear flaws in the CQC processes, which the BMA has been vocal in drawing attention to, only added to the importance in GPC’s eyes of ensuring that overstretched practices were no longer forced to pick up the cost of the CQC.
These fee changes sit alongside a 1% pay uplift which will add additional resources into the global sum, with new funding found to cover work caused by the new bagging and labelling of patient records prior to notes transfer. We have also made significant strides on ensuring the sickness and maternity absministerence system is more effective at delivering payments to GP practices.
This will enable them to keep their surgeries staffed when members of their workforce are unavailable. Taken together an additional £240m will fund these contract changes in the coming year.
Just as importantly, we have sought to reduce that bane of a GP’s working life, excessive bureaucracy. The unpopular unplanned admissions direct enhanced service (DES) will be withdrawn and £156.7m added to the global sum instead. This DES will be replaced with a far more clinically appropriate focus on those patients living with severe frailty.
This is the right thing to do for the most vulnerable of our patients. Whilst we know it is a controversial area we have also ensured that changes to the overseas charging system will result in minimal extra work with an extra £5m added to global sum to cover administrative costs that practice staff will incur.
There is much to welcome in our agreement as we’ve been able to address many of the concerns repeatedly raised by GPs, but it would be wrong to say that these alterations alone will change the course of general practice. Not surprisingly the government has made much of the migrant charging element, but in reality this self-declared data collection will enable the NHS to reclaim funding from other European countries and is not about charging patients directly.
We should not get distracted by the wilder claims of politicians: this will not result in a windfall of extra revenue for general practice. Equally changes to the extended hours DES, which come into force in October, are not what was threatened by the Number 10 spin doctors when they scandalously tried to blame GPs for the failings of the NHS. Practices that for legitimate and sensible reasons close to spend time in training each month should not be impacted by this reform.
Fundamentally, it is the issues outside of the scope of these negotiations that remain there to be addressed. General practice does not have enough staff or resources to cope with the growing demand and needs of an ageing population with complicated conditions. The contract changes will relieve some of the pressure for the time being, but it is the foundations of general practice that need shoring up in the long-term.
That is why as this new contract is announced we have reiterated our call for ministers to implement, as they have promised, the pledges contained in the GP Forward View that committed to delivering a properly funded and supported general practice. We need no more warm words: we need action, and we need it now.
- Dr Richard Vautrey is deputy chair of the GPC and Leeds LMC assistant medical secretary.