Real-terms cut in patient services investment

This government is keen to tell us that, when it comes to health, its mantra is that investing in patient services should be paramount.

It is unfortunate therefore that a general lack of understanding about how the GMS contract works and a great deal of hype about ‘over-paid’ GPs may be leading to a cut in that investment in real terms.

The central plank of the new GMS contract is that it divided up income into different channels, effectively separating essential, key GP services from work that might be regarded as extra. Hence the global sum covered essential, core services for which income should not have dropped below Red Book levels. In other words, the global sum maintained the status quo for delivering core primary care services. The opportunities for increasing profits really came from the enhanced service and quality streams.

By lumping all the funding streams together in their approach to GP pay, the DoH, NHS Employers and even the Review Body have in effect punished patients for the ‘over-achievement’ of GPs.

Because there has been no adjustment for inflation to the global sum yet again, the funding per patient for essential primary care services has been cut in real terms — hardly an investment in patient services.

Therefore, GPs are being asked to subsidise these key services, something that could be seen as stealth taxation. All that the current pay round reveals is an emphasis on headline figures rather than a proper attempt to address issues raised by the GMS contract.

If the DoH and the other bodies believe that GPs are earning too much from GMS, they should look at the other parts of the contract and address whatever they believe has gone wrong with the original deal through negotiation.

DoH officials should admit they underestimated GPs’ ability to hit the quality targets and their capacity to take on extra work through enhanced services, rather than push through what amounts to a cut in spending on core services.

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