How will the new contract change practice funding?
Under the plans set out for the Scottish GMS contract, GP funding will change in two phases. The recent vote on the contract was on the plans for phase 1, which covers 2018/19 and 2019/20. There will be a second poll on the changes proposed from 2020/21 when plans for this second phase have been finalised (see below for more details).
From April 2018, a new funding formula – the GP Workload Formula – will be introduced. This will replace the existing Scottish Allocation Formula (SAF). This new formula re-estimates the number of consultations per patient based on age, sex and deprivation. GPC Scotland says it more accurately reflects the workload of GPs because it gives greater weight to older patients and deprivation.
The new arrangements will include MPIG and core standard payments (previously QOF payments) in a new consolidated global sum.
The out-of-hours opt-out deduction will end under the new deal. Nationally 6% will be deducted from the 2017/18 global sum prior to the new funding formula being applied. A new opt-in out-of-hours enhanced service will be developed for practices that choose to provide out-of-hours services. Seniority arrangements remain unchanged.
GPC Scotland says no practice will lose out under the deal – practices will be protected from any funding losses and the Scottish government is investing an additional £24m to cover this.
The guarantee to protect GP practice income and expenses continues ‘until there is a proposal acceptable to the profession for the introduction of phase 2’. Any future funding uplifts will apply to all GP practices’ share of the total derived from the new funding formula, including the new income guarantee. Population increases will only apply to the formula sum.
In total, the Scottish government has pledged £100m funding to support the new GMS contract in 2018/19.
What happens to enhanced services?
There will be no new enhanced services under the new contract (with the exception of the new out-of-hours enhanced service).
The Vaccination Transformation Programme will oversee transferring delivery of vaccinations from GPs to NHS boards, although some small remote and rural practices may agree to continue providing vaccinations through locally agreed contract options. When this is complete the relevant additional and enhanced services for vaccinations will no longer be included in the GMS contract. However, funding for enhanced services that are transferred to NHS boards between 2018 and 2021 will remain with practices.
There is no plan to change the enhanced services currently provided by practices, although this could be looked at in future.
Is there any concern about the changes to the funding formula?
Despite the fact that GPC Scotland has said that no practice will lose out financially under the new contract, there has been concern among some GPs about the changes.
Many rural GPs believe the new funding formula fails to recognise their practices’ needs and could strip away a significant amount of their core income. They are concerned that this could leave them reliant on the top-up funding proposed by the deal, which could potentially be eroded over time.
A poll by the Rural GP Association of Scotland (RGPAS) earlier this month suggested that almost 90% of its members had either voted against the proposed contract or planned to do so.
What does the new contract say about GP pay?
As part of the new deal a GP partner whole-time equivalent minimum earnings expectation will be introduced from April 2019. This means that from this date no GP partner should receive less that £80,430 NHS income (including pension contributions) pro-rata. The contract classes a whole-time equivalent GP as working 40 hours a week.
The extra income to cover any rise in salary will be provided through the National Services Scotland Practitioner Services Division on the basis of the income, hours and sessions information.
GPC Scotland chair Dr Alan McDevitt told the special LMCs conference that debated the new contract in December that the plans would 'bring in £20m to our lowest-paid GPs'. Currently around 20% of GP partners earn less than £75,000 in a whole-time equivalent post.
What does phase 2 propose and when will this happen?
Phase 2 is still subject to further negotiations between the Scottish government and GPC Scotland, but the agreed direction of travel is towards introducing a standard income range with pay progression for GPs (which is comparable to that of consultants) and direct re-imbursement of practice expenses, covering staff and premises costs.
The current plan is for this to be introduced from April 2020, but any changes would only come into effect if they are backed in another poll of the profession. As mentioned above, the arrangements from phase 1 will continue until phase 2, or another deal, is agreed by the profession.
The changes planned for phase 2 will remove the direct link between the new formula and practice funding. The formula will then be used to guide allocation of primary care resources across the country, but not used to allocate money directly.
There is some work to be done before the full details of phase 2 can be finalised and a formal deal put before the profession. The Scottish government and GPC Scotland say that to prepare for this next phase they need to ‘fully understand the current expenses of running a GP practice, the income of salaried GPs and the income of GP partners as well as the hours worked by individual GPs' so that they can establish the total cost of introducing a consultant comparable income scale for GPs.
All practices will be required to provide data on earnings, expenses and hours/sessions worked to NHS National Services Scotland Practitioner Services to enable this to happen.
Are there any concerns about this aspect of the plans?
Some GPs are worried that the plans for phase 2 threaten the independent contractor status of practices by effectively removing the need for practices to make a profit.
At the special Scottish LMC conference in December, Dr Lynn Duff a GP from Lanarkshire said: ‘Remove [the profit mechanism] and it’s the worst of both worlds – we still have responsibility, but no control of our own destiny. Just calling us independent contractors does not make it so. We need a driven, energised, incentivised workforce of GPs and any move towards limiting GP earnings to a certain range stifles innovation and the unintended consequences of removing this link will be huge.’
However Dr McDevitt said that phase 2 would only happen if GPC Scotland felt that it had a decent offer to make to the profession and, even then, it would only be introduced if GPs backed the plans.