Viewpoint: Revamped 2020 contract 'a watershed moment for general practice'

Following weeks of uncertainty over the future of primary care networks (PCNs), reworked specifications for the network DES have eased fears. Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer sets out her reaction to the 2020 contract deal.

Cambridgeshire LMCs chief executive Dr Katie Bramall-Stainer
Cambridgeshire LMCs chief executive Dr Katie Bramall-Stainer

After the uncertainty of recent weeks, GPC England agreed to a 2020/21 contract and update to the PCN DES with financial outcome projections to 2023/24.

This contract is generally helpful, and we are especially pleased to see safeguards that were specific to Cambridgeshire practices now being made contractual thanks to our persistent lobbying. Many of our concerns articulated last month to NHS England and NHS Improvement have been addressed.

The monies being invested in additional roles help quantify just how much disinvestment practices have experienced in the past decade - yet these monies are primarily going into primary and community care staff.

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Summary of changes to the GP contract 2020/21

The system needs to appreciate that this is an investment into the nascent integrated care agenda rather more than an explicit investment into core general practice.

Individual practices are still fragile, understaffed and overworked. These monies do not represent a quick fix. But they do provide cautious optimism for the longer term.

There is a welcome move to full reimbursement of additional roles and greater flexibility therein, and there is a future intention that by 2024, any retained staff will be put into the global sum or TUPE’d across to a community provider.

The expectation is that GMS will be taking on the transformation risks of recruitment, employment, retention, training, supervision and responsibility for the additional staff in the years ahead. There will be an additional workload up front, borne primarily by GP partners, before we start to see the intended changes. But there is light at the end of the tunnel.

Transforming general practice

This transformation marks a watershed moment for general practice, and we will need to understand how to respond in turn to make this new way of working support each and every practice. GPs will be exposed to greater clinical complexity and multi-morbidity on a recurrent basis, where 10-minute appointments will be neither safe nor appropriate.

Prime minister Boris Johnson’s electoral pledge of an extra 50m appointments a year will be very much predicated on the extended workforce of the PCN, rather than GPs per se - who we foresee increasingly holding more of an oversight role in senior clinical governance rather than traditional immediate access and face-to-face surgeries of the past.

We welcome the commitment to the recruitment of our future GP workforce, but the devil will be in the detail of how we can work the practical implications through in terms of the capacity in our surgery buildings, and the senior GP clinicians available, with providing support for the development of these new roles.

The new partnership loan is another helpful gesture, but needs to be seen in the context of being spread across four years, deducting tax and superannuation, and excluding former partners. However it is a positive step, and we are determined to make this work, as trust has been placed in us - not least in the service specifications, reduced to 3.5 from 15 pages and refreshingly light on bureaucratic box-ticking.

Understanding all these consequences and more, will be the focus of a special conference for the profession, drawn from delegates to the conference of England LMCs, which will be held on 11 March.

This article is an edited version of a message sent to Cambridgeshire LMC members following the announcement of a contract deal on 6 February.

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