Impact of 2017/18 GP contract remains unclear, warns GPC member

A GPC member who chose not to vote in favour of the 2017/18 contract deal published last week has warned that its implications for general practice remain unclear because crucial details have yet to be finalised.

Dr Dean Eggitt (Photo: JH Lancy)
Dr Dean Eggitt (Photo: JH Lancy)

The GPC has said that changes to the government in the wake of the Brexit vote delayed the start of contract talks - a factor that may have contributed to the lack of detail - but a statement outlining the updated contract on 7 February said that GPC England had 'overwhelmingly voted to accept the negotiated contract changes for 2017/18'.

Doncaster LMC chair Dr Dean Eggitt was the only GPC member not to vote for the deal, choosing instead to abstain.

'I felt uncomfortable with voting on a deal that I don't understand,' he told GPonline. 'There is not enough detail. All we have seen are the headlines, and it would be wrong to accept a package on behalf of GPs based on headlines, not detail. If I don't know what I am voting on, I can't accept it.'

Details of the 2017/18 contract released so far amount to 'a menu of potentially nice things', Dr Eggitt said. He acknowledged that it was a difficult choice for GP representatives to turn down a deal that offered a 3.3% overall increase in GP contract funding.

Read more: GP contract deal

But he warned that each part of the deal announced so far had not been set out in enough detail for GPs to fully understand their implications and that negotiations were incomplete.

'I don't understand any of the topics in enough detail. I have a menu of potentially nice things, but might I potentially be signing up to something terrible - yes. Is it potentially a trap - yes. So how can you vote for it?'

In the current climate, with general practice and the NHS as a whole in crisis, the profession needed a 'wriggle-free deal', Dr Eggitt argued.

The full implications of key parts of the contract remain uncertain. A change in core opening hours requirements outlined in the package - set to take effect from October 2017 - will mean that 'practices who regularly close for half a day, on a weekly basis, will not ordinarily qualify to deliver' the extended hours DES.

Extended hours

GPonline analysis shows that as many as one in seven GP practices could be forced to open for longer to avoid losing an average of more than £8,000 in extended hours DES funding. The GPC has said it does not expect large numbers of practices to lose out, but final details of how the new clause will be enforced have yet to be confirmed. The RCGP is among those to have called for further clarification.

Among the stand-out elements of the contract deal was an agreement that the controversial avoiding unplanned admissions (AUA) DES would be scrapped from 31 March, with an attached £156.7m moving into practices' core funding. The DES will be replaced with 'a contractual requirement for practices to focus on the management of patients with severe frailty'.

Dr Eggitt argued that with requirements such as this it is difficult in the absence of cast-iron detail to assess how much workload will be involved.

A GPC letter to the profession says there will be 'no additional reports to produce or claims to make', but practices will have to 'use an appropriate tool' to identify patients aged 65 and over with moderate and severe frailty, deliver clinical reviews including an annual medication review, discuss whether patients have fallen in the past 12 months 'and provide any other clinically relevant interventions'.

Practices will also be expected to seek consent from patients to activate their 'enriched summary care record', and data will be extracted regularly on all of the above. 

Changes to sickness cover payments have also been hailed as an important win for practices in the new contract deal. Criteria for receiving the payments have been simplified, are no longer discretionary and will be made 'after two weeks of a GP being absent from the practice due to sick leave'. Funding has also been increased to £1,734.18 to match maternity payments.

Dr Eggitt told GPonline that the deal sounded clearly favourable, but he felt that GPC members should have been given fuller information before being asked to rubber stamp it.

'GPs pay locum insurance,' he said. 'So a potential win is that you could cancel your locum insurance, because two weeks in you get sickness pay. But I want to know the details - it would be catastrophic if GPs go ahead and cancel locum insurance only to find there is a clause that means they shouldn't have - the detail is very important.'

He added that if the new arrangements do mean practices can cancel locum insurance, the lack of detail available now means many will carry on paying unnecessarily for a period of time.

The Doncaster LMC chair said he also wanted complete clarity before agreeing to the deal because he was concerned about the government's motives in signing off a 3.3% overall funding uplift for practices after it seemed to blame general practice for the wider NHS crisis at the start of the year, rather than acknowledging extreme pressure on primary care itself.

Dr Eggitt added that annual renegotiation of the contract was a key factor contributing to practices being asked to sign off a deal when 'negotiations are just not finished'.

'Why do it annually? GPC and NHS Employers don't have time to negotiate in detail. If you did it every few years, you would have time,' he said.

Asked why he believed he was the sole GPC member to abstain, he said: 'I think a lot of people do feel uncomfortable with the lack of detail. But they feel unable to turn down what looks like a good deal.

'There are lots of potential positives, but the fact remains there is not enough detail for any of us to understand the impact of this on general practice.'

GPC deputy chair Dr Richard Vautrey said: 'This year contract negotiations started much later than expected due to the changes in government. Once concluded GPC overwhelmingly backed the contract deal when we presented all the details at our meeting in January.

'While we recognise the need for contract stability we also sought to resolve many of the areas of concern that GPs have repeatedly expressed and the LMC conference have mandated us to deal with. Scrapping the AUA enhanced service, getting full payment of CQC fees and funding for indemnity rises, as well as big improvements to sickness and paternity locum payments have all been widely welcomed in our recent roadshows around the country.'

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