A package of contract changes agreed by the BMA's GP committee for April 2020 - but yet to be ratified by LMCs at a special conference due in the coming weeks - sets out plans to slow the rapid decline in GPs taking up partnership roles, to boost numbers of trainees, and improve retention of experienced doctors.
An 86-page document setting out changes to the GP contract for the second year of the five-year agreement that kicked in from April 2019, confirms that around £100m will be added to NHS England's revenue budget for each of the four coming financial years 'for the specific purpose of supporting a raft of additional recruitment and retention schemes aimed at GPs'.
NHS England will have an extra £94m to support recruitment and retention in 2020/21, with cash boosts of £117m, £114m and £103m agreed for the following years up to 2023/24.
From 1 April 2020, GPs taking up partnership roles for the first time will be eligible for a £3,000 training allowance - plus a £20,000 golden hello payment. The funding will be available on a pro-rata basis, with full-time GPs - calculated as 37.5 hours per week - eligible for the full payment.
The move comes after a four-year period that has seen the number of GPs in partnership roles drop by around 16% amid rising pressure on general practice.
The contract document suggests details of the arrangement are yet to be finalised, however. It makes clear that the payment is 'initially a loan' - but that 'we envisage that it will automatically convert to a permanent payment after an expected minimum number of years, for example five'.
The golden hello payments will be available to an unlimited number of doctors - and will also be available for 'other professional groups' taking on partnership roles, such as 'nurses or pharmacists', the contract agreement says. It adds: 'With on-costs, and business training costs, the relevant practice would claim reimbursement of £25,500. We would require assurance from the practice that the pro-rata payment and associated business training allowance had been paid to the partner within a maximum time period.'
Alongside golden hellos for new partners, the targeted enhanced recruitment scheme (TERS) - which offers £20,000 payments to GP trainees taking up posts in underdoctored areas - is set for a significant expansion over the coming years. In 2019 276 TERS places are on offer - a figure set to rise to 'at least' 500 by 2021 and 800 by 2022, the contract deal says.
The total number of GP training posts will also rise to 4,000 by 2021 from the current 3,500 - and from 2022 each GP trainee will spend 24 months of their three-year training programme in general practice, up from the current 18 months. NHS England predicts that a 'significant proportion' of doctors entering GP training could be international medical graduates - and these doctors will be offered 'a fixed five-year NHS contract'.
This five-year package will cover their three-year training programme and participation in a two-year 'fellowship scheme' - which will offer all newly-qualified GPs the chance to take up employment at a specific practice or primary care network (PCN). From 2021 all new GP trainees will be expected to join the fellowship scheme once they qualify.
In a range of further measures to boost the GP workforce, locums will be offered one paid session for CPD each month if they sign up to provide a minimum number of sessions of work per week within a specific cluster of PCNs. These 'locum support schemes' will aim to sign up around 500 locums in the 2020/21 financial year.
NHS England is also set to work with the BMA and RCGP to improve the existing GP retention scheme, and will roll out a childcare support payment through the induction and refresher scheme. This will offer GPs with children aged under 11 the chance to claim up to £2,000 per child toward the cost of childcare while enrolled.
The BMA’s GP committee voted on Thursday to approve the contract offer - which also brings a major overhaul of controversial plans that threatened to scupper PCNs less than a year after they became operational. However, LMCs will meet in the coming weeks at a special conference to consider the contract deal and could yet vote against the proposals.
BMA GP committee chair Dr Richard Vautrey said: ‘After months of challenging and tough negotiations we’re pleased to have secured this package of changes that have the potential to make a real difference to GPs, the practices they work in and the patients they treat.
‘The significant investment in and focus on recruitment and retention, including payments to incentivise doctors to take up partnership roles and work in under-doctored areas, is a vote of confidence in the partnership model and a much-needed first step if we are to reverse the worrying trend of falling GP numbers that we have seen in recent years.’