The goalposts have changed and rather than a pragmatic balanced look to see if a practice is safe and effective, we have moved towards a comparison with an impossible ideal standard which no practice can adhere too. There are fortunate practices getting outstanding by the cqc on any given day but scratch the surface and you will find issues which could result in them being adequate too and give current standards anyone can fall foul of the inspection regime.The solution is to reduce the daywork of seeing patients and provide a miminal actual service in order to spend time pandering to achieve the stupid standards, work within limits and not take on any work which is potentially unsafe especially non contractual work. Ifthe government realises that as a result of this we are unable to provide sufficient appointments and waiting lists rise to months with increase in Ed attendances and patients complaining of practices not offering some services, change might happen. Otherwise you could leave it to the BMA, listen to their waffle and see no change.
@matthew Davies. Actually the opposite is true. The pension accrual rate for the 2015 scheme is much higher (1/54) than either the 1995 scheme (1/80) and 2008 (1/60) main difference being the age at which you can take a full pension without actuarial reduction and how the lump sum is managed. So the taxation for both the annual allowance and the lifetime allowance comes quicker and is higher under the 2015 scheme. I think more likely, colleague who have paid large sums of tax related to breaches in annual allowance might be due a refund if annual allowance calculations are redone!
This approval and expansion is a concern for all UK gp practices with the potential to defund and destabilise primary care to its end. I echo the comments as to why a London CCG already in financial difficulties would be allowed to approve this expansion outside of its Jurisdiction. No doubt there has been discussions with NHSE around future unfair bailouts for the ccg being contingent on this approval in order to distrupt gp practices nationally. The absence of both the BMA and the RCGP whilst this is happening also stinks a d is suspicious. There is clearly a greater plan at work and watch the dominoes fall. The only way to fight back is for local practices to offer remote consulting however the tools (including the intentional non development of the NHS app for this purpose recently highlighted in the hsj) are not there. Practices don't have the ability to compete with GP at hand so watch the rush for a select selfish few practices to join the this disruptor service to safeguard their own survival. This with PCNs as a pointless distraction is going to irreversibly destroy UK general practice. But there is no concerted resistance from anywhere. V sad.
"A BMA spokesman said: ‘This is no different to practices looking for legal advice on partnership agreements, leases and other areas that require a legal input". It is COMPLETELY different and the fact the bma does not recognise nice this shows they are soooo out of touch. The GPC negotiated this farce of a contract change which provides nothing of benefit to primary care (including funding if you do the figures over 5 years and not just the indemnity sweetener for this year). They are responsible for this appalling mess and then to have the nerve to charge practices to sort the mess out? defies belief. No GP should be a BMA member.
This is all being made up on the hoof! 88% of practices are part of a network according to CCG? I am sure CCGs assumed this was part of a federation when asked rather than the new "definition" of PCNs. I know of very few practices working in small groups in my CCG. Having looked at the funding coming through (and the already shifting goal posts on what was agreed financially as well as finding the staff and the 30% to employ allied staff) and what is being expected (changes to QOF, care home services, enhanced medication reviews etc), the contract changes seem like a dud. There are also wider risks in PCNs with the loss of practice autonomy and the need to support PCN members who may be struggling or about to fold. It will make the CCGs job easier when a practice gives up its contract or there is a single hander retirement as the responsibility will be pushed to the network. Overall, this is a contractual herding exercise prior to setting up ACOs as the federation experiment has been a failure in most areas of the UK and will be the death knell for small and medium size practices. Going forward, it will also herald the end of the GP independent contractor status; what control do we or will we really have in a few years time? Very little to none so we are heading towards a controlled salaried workforce with pay restraint. General practice will cease to be a profession and will be no more than a technically skilled job. Pretty sad that the BMA has been complicit in this.
The narrow consultation period seems to suggest its a done deal with token consultation.
Impact for general practice would be devastating. Even if there are increases to GMS funding to account for this, I doubt (as with previous experience in 2008 when contributions were increased and when GP practices took on responsibility for employers contributions I think in 2005) any uplift would fully compensate for the increase; as an example, recent GP earning figures show that the 3.3% uplift given last year only translated into a 0.4% increase in GP funding no doubt eaten into by expenses so in essence a paycut. This increase probably brings the NHS Pension scheme employer contribution rates on a par with the civil service and judiciary but their employee contributions are far lower that senior NHS staff. So maybe negotiating a reduction in employee contributions would be an option?
For GP partners this is a double whammy, as we pay both employees and employers on our pensionable pay so this will amount to paying 35.6% into the scheme! I.e over 1/3 of income. That doesn't include additional tax from exceeding the tapered annual allowance which would make the cost even higher.
Being the cynical type, i would say the Government does not want an NHS pension scheme! Senior staff will probably stop contributions and as existing contributions are used for current pensions, the scheme could fall apart. I also don't think the NHS pension scheme is as "government backed " as we assume it is. BMA as usual will be impotent.
Technically not correct. The NHS pensions annual allowance is not based on the contributions made but the growth in the pension value from one year to the next as the scheme is a defined benefits scheme. So growth can be in excess of contributions made if you have a large pot and more so if cpi is high in any given year. So in effect you are paying tax now on money you may never get in the future if you happen to die!
No protection. No reflection!
This verdict and the farce leading to the appeal demonstrates that the profession has no confidence in the Gmc. It is time for change in one of 2 direction; if the Gmc wishes to continue to victimise rather support doctors and wants to be an advocate for patient safety at doctors expense, then the profession should not be funding it. If however, heads roll and the Gmc becomes a responsible profession led self regulatory body balancing public protection, patient safety and doctors support, I would be happy to continue funding the organisation. I doubt the latter will occur however and neither will the lame BMA take a firm position on this.
I really hope the GPC are not stupid enough to accept the abolishing of qof indicators with additional tougher targeted work alongside having to continue existing qof work as part of standard practice. Are diabetes and hypertension clinics going to stop? Doubt it. The money for those indicators we would be expected to continue providing services for should go to the global sum. Looks like however its going to be the like the admission avoidance DES again! And the GPC will trumpet it like a victory like then again, failing to realise the disaster till a few years later. The qof money needs to go into the global sum with no strings attached. That is the only appropriate solution.
To improve retention and decrease short term locum work,you have to make the day job better and " show them the money" atleast matching locum rates or more. However this won't happen as it is politically toxic and little value is attached to the work. In fact salaried posts and some partnerships now make little sense financially given the sacrifice that has gone into training and the risks involved. There is other work that pats better. So make these changes, otherwise nothing will change.
Cloud cuckoo land! Even suggesting this target given the current climate suggests NHSe has lost the plot and is clearly incompetent.
Significant issues absolutely. In my case, a missing year as a GP partner, 2 years of pension based on estimated rather than actual pensionable earnings on the pension certificate and a missing hospital post from 1995. Trying to prove that contributions had been made has been a nightmare being bounced back and forth between nhspa and pcs England who don't even respond to queries. All this made worse by the recent pension annual allowance changes which make calculation of tax due impossible as tax needs paying in Jan whilst the pension forms come out in February as well as Pcse capita not reconciling pensions contributions and submitting the figures to nhspa by November of the year or at all! What a farce!
The RCGP is also not a trade union or negotiating body for GPs and should not be involved in this. Prof Marshall clearly does not know what he is talking about. The qof changes in Scotland did not "leave a vacuum". The funding was put back into the global sum entirely which is the minimum we should be asking for otherwise the proposal is not an option.
This is absolutely not acceptable.The qof income needs to go into the Gms baseline in its entirety with no other caveats. Over the years, qof has been eroded to more or less the bare minimum now anyway. What is delivered via qof is now in national guidance and there will be an expectation to continue services such as mental health physical reviews, diabetes, copd and asthma checks etc.This needs resourcing. Remember the qof was always optional in gms2 and the fact this work is in the qof means it is not core work. And if this work is not funded or poorly funded, practices should have the option to decline. This work is however best done in primary care and should be funded appropriately.Any new work should have new money attached. All those asking for qof to be abandoned have clearly not thought this through and I really hope the GPC understand the implications. Furthermore, chronic disease management and multi-morbidity is a key healthcare area for now and the future of the NHS and should have more funding attached, not less.
@paul c. Interesting and that is what I thought too but the above is from the BMA guidance focus on private practice last updated 14th February 2018.
Well those practices will need to be aware of this Gms clause! They NHSe get you either way!
Does the 10% limit on private earnings within your practice premises still exist under the new contract?
Yes. If you earn more than 10% private earnings from your practice’s premises then your cost or notional rent will be abated accordingly. This is laid down in the National Health Service General Medical Services – Premises Costs (England) Directions 2004 and their equivalent in Scotland, Wales and Northern Ireland.
This has been an issue since the middle of last year when the inspections started. The issue was highlighted to the LMC by local GPS. Many perfectly adequate scales were labelled as inadequate and put into cold storage. Some practices have already spent £1000 of pounds buying new scales. It took till 2 weeks ago for the LMC via the GPC to send a letter out with a position on this by which time it was too late for many practices. Not really good enough considering the LMC levy we are paying.
Why have the BMA agreed to practices doing the work previously done by SBS without funding in the first place? This change in process was not made clear during the handover period so I suspect it was most practices that returned correspondence to capita. Was the current problem intentional or a commissioning oversight? Heads should roll if it was a commissioning failure and for the subsequent farce of a process in trying to deal with it. BMA should ensure its not bounced back to practices.
Ahmed Nana, Hockley farm medical practice, Leicester