Analysis: Dust settles on ‘worst-ever’ GP contract deal

When GPC chair Dr Laurence Buckman told Pulse in January that the Government ‘held all the cards’ in the contract negotiations, he was remarkably prescient.

The new deal, which comes into effect this month, sees GPs in England face a painful funding squeeze and the worst hike in workload since the introduction of the 2004 contract. Weeks of formal consultation resulted in the Department of Health making only minimal changes to its original proposals and cutting the funding uplift from 1.5% to 1.32%.

In the three devolved nations, GPs face varying deals or impositions, but all agree that they will struggle to cope with the contract changes this year, and warn of serious consequences for patients and practices.

As the dust settles on this year’s talks and practices sift through the detail of the additional work they have to do, Pulse looks at what the future holds for the GP contract.

Gun-to-the-head negotiations.

Last October, weeks after being installed as health secretary, Jeremy Hunt rang the bell to start a bruising battle with the profession by announcing that UK-wide negotiations with the GPC ‘were not going anywhere’ and he would seek to impose a deal on practices.

He offered a 1.5% uplift to GPs in return for them accepting a deal that included an unprecedented increase in QOF workload, four new DESs and taking responsibility for administering locum superannuation payments.

The scope of the proposed deal was enormous, and the GPC rejected it almost immediately, leading to separate negotiations taking place in the devolved nations and a stand-off with the Department of Health that lasted until last month.

I don’t negotiate with a gun to my head, and there was a gun to my head.

Dr Laurence Buckman

Asked now if he would have done things differently, Dr Buckman is stoical.

‘No,’ he says, laughing bitterly. ‘To agree for them to hit me round the head and they will give me slightly more money? No.

‘We would never have agreed to this. I don’t negotiate with a gun to my head, and there was a gun to my head.’

Dr Buckman says the GPC was days away from a negotiated settlement with NHS Employers after five months of intense talks - although NHS Employers disputes this. But any notion of compromise was blown out of the water by the DH.

Dr Buckman says: ‘The October version was a negotiation. It certainly was nothing like what is being imposed. But there is no point crying over what might have been.’

Warnings ignored GPC negotiators in Wales and Scotland were able to secure more favourable deals with their respective governments, but practices in England and Northern Ireland will see the vast majority of the original deal pushed through this month with only minor amendments.

In England, the DH has made minor changes to the DESs - revising the remote monitoring DES to focus on preparatory work for next year and limiting the scope of the dementia case-finding DES to focus on at-risk groups for now.

It will also defer implementation of the QOF indicators for pulmonary and cardiac rehabilitation until next April because only 10% of GPs currently have access to those services.

But it roundly rejected GPC concerns that the changes were ‘unworkable’ and would damage patient care.

Mr Hunt said: ‘The GP contract needs to change to make sure the excellent care enjoyed by some patients is more consistent across the country.

‘I know GPs will rise to the challenge.’

Financial impact

To add insult to injury, Mr Hunt rejected a recommendation from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) for a 2.29% funding uplift to cover rising staff expenses, on the basis that he wanted to ensure GP practice staff were subjected to the same 1% pay uplift limit as other members of the public sector.

His final offer was a 1.32% funding uplift, which accountants predict will result in an average 4% cut to GP drawings.

Dr Buckman says that the award will lead to exhausted and demoralised GPs, with little time to be involved with CCGs in England.

He says: ‘There already is a workforce crisis but it will get worse.

‘You are not going to have 46,000 GPs walking out at once, but slowly people will say “I have had enough. I can’t do this forever and I am going”. It is really, really sad, and not good for patients.

‘It is a very difficult time. A demoralised time.’ Is it the worst time since the 2004 GP contract?

‘Yes, that is probably true,’ he says.

Where next?

Dr Buckman is bullish about the prospects of preserving a UK-wide GP contract, saying that this year’s events have made a split less - not more - likely.

He says: ‘We know that the three Celtic nations don’t want to do that.

‘Although the English contract does differ, the vast majority of the things we do are exactly the same.’

If Scotland is an independent nation we will work with it

Dr Alan McDevitt

Scottish GPs rejected a motion at their LMCs conference last month calling for separate contract negotiations north of the border. Scottish GPC chair Dr Alan McDevitt says that a separate contract will only be appropriate if Scotland votes for independence next year.

He says: ‘Obviously if Scotland is an independent nation we will work with [it]. From our point of view, it is about ensuring that practices have the resources they need to look after the patients they care for.’

But the NHS reforms in England are set to transform contract negotiations, with the DH transferring responsibility for holding the GP contract to the NHS Commissioning Board, now renamed NHS England.

The board will be responsible for bringing in major changes to GP funding from next year, including starting the process of abolishing MPIG and revising the Carr-Hill formula to take more account of deprivation.

The GPC has said the changes, which will see the average correction-factor-reliant practice lose around £1,700 per year over seven years, should be subject to a survey of GP opinion or a ‘special conference’ - but this has yet to be agreed by the DH or the board.

The board says that despite a change in oversight, the negotiations process will remain the same for now, with NHS Employers leading talks with the GPC. The board ‘anticipates’ the DDRB will be invited to resume making recommen- dations on GP funding and pay next year.

A spokesperson told Pulse: ‘The board would want to seek agreement, where possible, to any changes to the contract.

‘If agreement could not be reached, any changes to the contract would - as now - be subject to consultation.’

Will contract talks be any smoother next year? Dr Buckman holds out little hope.

‘No,’ he says, ‘Because the mandates will still be set by the Government.’