Five-year GP contract worth £2.8bn paves way to 'rebuild general practice'

By Nick Bostock on the 31 January 2019

GP funding in England will rise by £405m in 2019/20 as part of a groundbreaking £2.8bn five-year contract deal hailed as 'the biggest boost to primary care in 15 years'.

BMA leaders confirmed the deal will increase practice funding by almost £1bn over five years, with a further £1.8bn to support the formation of primary care networks, which all GP practices will be expected to join this year.

The five-year contract will deliver a state-backed indemnity scheme for GPs, funding for 'an army' of non-medical staff to work alongside general practice, funding to allow practices to provide online and video consultations, online booking of some GP appointments and direct bookings by NHS111.

The BMA and DHSC have also agreed to make a joint appeal to the government to address pension limits that have forced GPs to cut back clinical work or retire early.

Network contract

In 2019/20, GP funding will rise by £405m in total through increases to core pay and funding delivered through a new 'network contract' that will operate in parallel to the standard practice contract. The funding is intended to allow a 2% pay rise for all practice staff in the coming financial year.

In the first year, network funding will be delivered as a directed enhanced service (DES) that will fund each group to recruit 'at least one social prescribing link worker and a clinical pharmacist'. In future years network funding will allow groups of practices to employ 'an army of 20,000 more staff' - including physios, paramedics, pharmacists, physician associates and others, according to NHS England.

Each network will cover around 30,000 to 50,000 patients, with a 'local GP' expected to take on a clinical director role in each area.

The contract deal will deliver a state-backed indemnity deal to bring NHS GPs 'in line with their hospital colleagues' by removing the need to personally fund clinical negligence cover. Detail of how the scheme will work have yet to emerge, however.

In changes to improve digital access to general practice, GPs will be expected to make 25% of appointments available for online booking, new patients registering with practices will be offered online access to their patient record ‘as standard‘ and one appointment per 3,000 patients will be bookable direct through NHS111.

Rising demand

GPC chair Dr Richard Vautrey said: 'Recent years have seen hard-working family doctors deal with an overstretched workforce doing their best to meet rising demand from patients suffering more and more complex conditions, all on the back of a decade of underinvestment in general practice.

'After years of derisory pay uplifts for staff and tightening financial pressures on practices, we have been able to negotiate a five-year deal guaranteeing investment that covers pay and expenses, and at least matches predicted inflation.

'Crucially, this investment has enabled us to fulfil one of our key aims by once and for all banishing the personal expense of indemnity cover, with a state-backed scheme set to begin, as promised, in April. This will mean that all GPs and practice staff, both in and out of hours, will be covered and represents a major change, freeing GPs from the significant risk of rapidly rising indemnity costs.

'This package sets us on the road to rebuilding not only general practice but also the wider primary health care team; delivering an expanded workforce embedded within practices and giving GPs a leadership role in bringing together the community healthcare team.

Community-based service

'These changes present a real opportunity to demonstrate that GPs will lead the development of a more resilient community-based health service for the benefit of our patients for years to come.'

NHS England chief executive Simon Stevens said: 'This five-year deal unarguably represents the biggest boost to primary care in more than 15 years, giving patients more convenient services at their local GP surgery while breaking down the divide between family doctors and community health services.'

RCGP chair Professor Helen Stokes-Lampard said: 'Investing in general practice is investing in the entire health service – and this new contract promises to do just that, in the best interests of our profession, the sustainability of the NHS, and the care we deliver to more than 1m patients a day across the country. If implemented correctly, this contract could cultivate a profession that future doctors are eager to join, and where existing GPs want to remain – and can enjoy - working.'