Northern Ireland's Department of Health, Social Services and Public Safety (DHSSPS) today published proposals for the 2013/14 GMS contract, which would axe MPIG top-ups to core funding and force a massive overhaul of QOF similar to planned reforms in England.
GPC Northern Ireland chairman Dr Tom Black told GP: ‘On first reading this is the harshest of the four country impositions with the majority of NICE indicators, 23 threshold changes and no amelioration of contractor population index (CPI) or expanding population scheme. The MPIG removal threatens to destabilise general practice in Northern Ireland.’
The DHSSPS decision to push for a deal similar to England's will come as a disappointment after GP leaders in Wales and Scotland agreed significantly improved offers that protect MPIG support for practices at this stage and lessen the impact of QOF changes. The proposals look likely to be rejected by GPC Northern Ireland.
Dr Black said several factors made the Northern Irish proposals harsher than those in England. In England, the DH has proposed increasing the value of QOF points by 16% to account for rising practice list sizes, but in Northern Ireland no such measure is on the table.
The impact of plans to cut MPIG over seven years would be softened to a degree in England by the redistribution of funding from PMS contracts, he said. But Northern Ireland has only GMS practices.
Meanwhile, he added that global sum payments were based on out-of-date information and did not recognise that the population of Northern Ireland increased by 7% from 2001 to 2011. He explained: ‘GPs are paid £55 per head of population but there is no recognition that the population has increased. This means GPs are taking on extra workload for no extra funding.’
On top of these changes, GPs in Northern Ireland face threshold increases for 23 QOF indicators, compared with 20 in England.
Dr Black said he thought changes to the 2013/14 GMS contract could increase GP workload by between 10 and 15% and cut income by around 5 to 10%.
He said plans to involve GPs in commissioning in Northern Ireland under the Transforming your care scheme would raise workload by around 20%. ‘We can’t do that and at the same time and take on 10-15% workload increase,’ Dr Black said.
Under the Northern Ireland government's proposals, most of the organisational domain will be scrapped, with points redistributed to fund new indicators recommended by NICE, with any remaining money moved into core funding.
Unlike the plans in England, three medicines management targets worth 23 QOF points (around £3,000 to an average practice) will be retained.
But as in England, GPs in Northern Ireland will face raised QOF thresholds. In England the DH plans would set thresholds for achieving maximum points at the level of the best-performing 25% of practices.
In Northern Ireland 20 percentage points will be added to the bottom thresholds and five to the top thresholds of 23 indicators in 2013/14, with thresholds rising further from 2015/16.
For six indicators, GPs would have to treat 95% of patients in a domain to gain maximum points from 2013/14.
A DHSSPS spokesman said: ‘Unfortunately, following the annual negotiating process it has not been possible to reach an agreeable settlement with the NI GPC regarding the GMS contract for GPs from 2013/14. However, the NI proposals for change to the GMS contract 2013/14, which are now out for consultation, are consistent with the changes proposed in the other three countries across the UK - England, Scotland and Wales.
‘The key elements of the proposed changes for Northern Ireland focus on increased levels of investment in general practice, addressing inequalities in funding across GP practices and amendments to the QOF such as the introduction of new NICE recommendations and the removal of a number of indicators to reflect basic standards of good organisational practice.
‘The NI proposals are now out for consultation and the department remains willing to continue dialogue with GPC NI about the proposed changes as part of its planned consultation in an effort to reach an acceptable agreement.’