The proposed contract, which aims to reduce workload and ‘re-establish general practice as an attractive career choice’, offers a guaranteed minimum income of £80,000 for partners, increased use of multidisciplinary teams, and plans to free GPs from responsibility for premises.
It also proposes a new funding formula, which aims to reflect practice workload better through increased weighting for older patients and deprivation.
But rural GPs say the formula fails to recognise rural practices’ needs and will strip away up to two thirds of their core income. Although the BMA and Scottish government have given assurances that no practice will lose out under the new contract, many rural GPs are unwilling to accept moving to a funding formula that does not work properly for them, fearing they would be left to rely on top-ups that could be eroded over time.
Dr David Hogg, chair of the Rural GP Association of Scotland (RGPAS), told GPonline that a new contract that did not adequately recognise the inequalities or workload faced in rural areas where 20% of the Scottish population live was unacceptable.
The RGPAS says that over a third of its members report that the new formula would leave them facing losses of 40-69% of their core funding, with 90% of practices in the north of Scotland likely to see their allocations through the contract reduced by up to two thirds.
Despite guarantees of funding protection with the new contract, RGPAS warns that ‘the detail of this has not been provided, and this uncertainty looks set to destabilise rural healthcare across Scotland’.
He told GPonline that rural GPs had a ‘fundamental disappointment’ in the proposed new deal. Academics and others were warning that the proposed funding formula simply failed to address inequalities or workload in rural Scotland, he said. ‘This is not about GP pay and GP income, this is about resource allocation and the needs of rural Scotland.
‘It’s like building a house with lots of holes and using plaster to fill in the holes before any one moves in - it creates instability. Rural practices are already fragile, and making that greater is what we are concerned about.’
Dr Hogg added: ‘The workload allocation formula grossly under-values the workload and fails to acknowledge inequalities in rural Scotland. For a country where a fifth of the population lives rurally, it is extremely disappointing that our health leaders are proposing a system that has not been adequately rural-proofed.
‘While the proposal includes measures to protect practice income in the shortterm, it is uncertain how long this will last. Furthermore, the cuts for health boards will mean that other primary care services for rural patients, such as district nursing, will lose funding. It is unclear why a formula has been selected that short-changes rural communities where there is so much dependence on the local GP team to deliver necessary healthcare services.’
Scottish GPC chair Dr Alan McDevitt said: ‘It is completely untrue to suggest that any practice in Scotland will see a reduction in funding and extremely disappointing that this misinformation is being circulated. It is also entirely wrong to suggest that there would be any cut to any health board’s funding as a result of the proposed contract.
‘The proposed GP contract ensures that every GP practice will have increased or protected funding and if phase two is agreed, the higher expenses of rural practices will be directly reimbursed. There is no time limit on the protection of practice funding and it will be uprated along with wider practice funding.
‘The proposed contract will also mean that golden hellos in rural areas will be expanded and financial assistance for relocation costs will be put in place, helping rural GP recruitment.’
A Scottish government spokeswoman said: 'As the BMA has confirmed, under the proposed new GP contract no GP practice in Scotland will lose any funding, with 63% of practices receiving additional funding. To ensure the stability of GP practices some practices will have their income protected. This protection, which is a feature of the existing GP contract, is not "short-term" but will be in place as long as it is needed to ensure GP services in all our communities are maintained.’