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Gold, incentives and meh

Landmark contract deal cuts QOF by 40% and boosts global sum - but will force GPs to publish their pay

GP practices will have their QOF work slashed by almost 40% next year as part of a sweeping new contract deal which will increase the value of the global sum, create a new emergency admissions DES and see GPs forced to publish their net pay.

Under the new deal, practices will see 341 out of 900 QOF points removed from the framework - the equivalent of £54,000 for the average practice - with the majority reinvested in core GP funding.

But in return, GPs will have to accept ‘named GP’ responsibility for all patients aged 75 years and older, publish their net income from 2015 and commit to police the care their patients receive from out-of-hours providers.

Seniority payments will be reduced by 15% each year and eventually phased out and practice boundaries will be abolished completely in October 2014, although practices will not have responsibility for home visits for patients out of their catchment area.

Some 238 points (£37,000 for the average practice) will be reinvested in the global sum, and a further 100 points (£16,000 for the average practice) from the axing of the quality and productivity domain in QOF, will be ploughed into into a new ‘inappropriate hospital admissions’ DES. Three points will be invested in the learning disabilities DES.

The new DES will mean GPs will have to case-manage vulnerable patients and allow emergency providers to contact GPs to decide whether patients should be admitted to hospital or A&E.

Practices will have to publish the ‘full net income’ of their GPs from 2015, in line with the Government’s drive on transparency on public sector pay. But the BMA said that any changes would only be made alongside other healthcare professions.

A statement said: ‘We have negotiated the establishment of a working group to ensure that the calculation and publication of earnings are on a like-for-like basis with other healthcare professionals and that the published earnings would be GP NHS net earnings relating to the contract only.’

The main thrust of the changes to the GMS contract for 2014/15 are:

  • Reducing the size of the QOF by 341 points, with 238 QOF points being put into the global sum;
  • A new DES to prevent patients being inappropriately admitted to hospital, with an overall budget of £162m. This will replace the current risk-profiling DES, with extra funding from the removal of 100 QOF points from the quality and productivity domain;
  • Practices will have to publish the full net income of their GPs from 2015;
  • Complete abolition of practice boundaries from October 2014, although NHS England local area teams will take responsibility for the home visits of patients from out-of-area patients,
  • A new contractual obligation for GPs to monitor the quality of out-of-hours services when used by their patients and report any concerns;
  • Reduction of seniority payments by 15% each year, with no new entrants from April next year;
  • ‘Named GPs’ will take on accountability for patients over the age of 75, to be the main point of call for providers outside the practice;
  • Practices will have to display the result of their CQC inspection in the waiting room;
  • The introduction of the Friends and Family test from December 2014 asking patients how likely they are to recommend a GP practice;
  • The introduction of new IT systems including the ability for patients to book appointments online and access their Summary Care Record

GPC chair Dr Chaand Nagpaul said that the new deal would deliver real benefit to patients and help ease the pressures on GPs.  

He said: ‘The BMA believes that through constructive talks we have reached an acceptable deal that will help to relieve workload pressures on GPs and is a first step towards enabling general practice to meet the challenges that it faces in the coming years.’

RCGP chair Professor Clare Gerada said: ‘This is welcome news for patients and for GPs as it will help us to get back to our real job of providing care where it is most needed, rather than more box-ticking.’

Dr Peter Swinyard, chair of the Family Doctor Association, also broadly welcomed the deal, but he warned that the ‘devil is in the detail’.

He said: ‘I think this is a good deal for GPs as it will take off many of the things we have been arguing about for the past year or two. It will reverse some of the complete daftness of the contract imposition from last spring and it will allow GPs to have a little more headroom to look after people and start planning care rather than spending their entire lives ticking boxes or going through their colleagues’ notes to check boxes were ticked.’

Dame Barbara Hakin, chief operating officer and deputy chief executive at NHS England, said: ‘As a GP myself for many years, I know the importance of being able to do what we have been trained for - to use our professional clinical judgment to provide care and treatment that meets all aspects of a patient’s needs.’

‘We know that patients who receive a proactive and coordinated health and social care service are less likely to need to be admitted to hospital. In fact a fifth of hospital admissions could be avoided if this happened every time, and we know that this is particularly important for the most vulnerable patients with complex needs where properly coordinated care makes such a difference.’

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Readers' comments (74)

  • I agree with 2.29, the BMA are becoming less and less relevant, and certainly dont stand up for GPs. Just as I approach parity they start taking away my seniority, great! I approached them for help with a practice issue, and was told 'they dont cover practice disputes'. They only seem to represent the hospital Drs, but will they have to publish their annual incomes too!
    I dont understand why we cant move to a model like the dentists and consultants have with co-payment for treatment, and some being fully private. Everyone knows there isnt enough money to make the system work, but the politiians dont want to stand up and say so. If they truely wanted to evolve the NHS this is something which needs a proper adult discussion

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  • The fact Peter Holden (who claims to be the driving engine behind the GPC negotiating team) thinks this is a contractual win sums it up. How out of touch are you to think grassroot GPs think this is a good contract? (by the way, the 2004 contract you are so proud of, got us to this state hasn't it?)

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  • very simple solution,If I am a named GP, I will not hesitate to send a patient to A&E with slightest worry. I will not decrease the A&E load but will contribute to increase it?

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  • Can Peter Holden or other negotiators shed any light on "the named GP" bit of the "new deal".
    Can this be a salaried "slave" sorry doctor employed by partners.

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  • The new contract does not (if not worsens) address the 2 main issues that I, lowly GP, think are the biggest blockers for us to provide excellent care.
    1) Demand
    2) GP numbers

    My first taste of GP land was in the 80's, own on call, lots of visits but manageable numbers in surgeries excellent care and rapport.
    Since becoming a GP myself in the 90s i had a very short taste of that then co-ops made life a whole lot different just as the demand increased, work flowed from hospitals and surgeries became unwieldy and patients increasing in numbers, complexity and contacts but we coped. 2004 heralded the QoF and for a while this seemed ok, we had guidance, a good working relationship with hospitals- locally. Then C+B and 'Dear Team' instead of 'Dear Tom' letters. Shared care 'dumping' agreements, salaried partners, more QoF, unrealistic patient demand as DH asked for 48 hour access and more, extended hours, all to punish us for a 'flawed' contract. Yearly decreasing income, more work, population increases, the press and government concocting an A+E crisis of the GP making so that they can impose further contract changes.
    So neither the government or GP 'leaders' want to stand up and spell out the truth.
    There aren't enough GPs to cover primary care to the level of demand that the patients 'want'' becasue of the governments PR department and the increasing complexity of medicine.
    And no one is about to pay for more.
    Good luck to every GP in this country, do your best for the patients knowing that you cannot give your best under political leadership.

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  • What happened to looking for the positives? Don't we already allocate a GP to be the named resource for a complex or terminally ill patient? This surely is good practice. Attaining the age of 75 doesn't mean that a patient will necessarily need a GP to be the centre of life! There are many fit and well octogenarians and older out there The rest will be shuffling off this earth at a good speed thanks to their sedentary lifestyle, alcohol, smoking and obesity. No worries ;)

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  • It seems to me that there are strong threads of disillusionment from most of the bloggers here and also it seems the younger cohort of GP's feel understandably aggrieved that, not only will they have to put up with the new contract arrangements for more of their career but to add to the injustice they know that older GPs will have a better pension, more so now that younger GP's will not receive seniority pay themselves in due course -- does this mean the older GPs have profited at their expense as some have suggested?

    I think this view of pensions is an oversimplification because what has really happened is that, broadly speaking, GPs will have their existing pension contributions honoured, but younger GPs unfortunately have been forced to switch future contributions to a less favorable scheme -- for that we should blame the government/Department of Health and not the older GPs, although older GPs have a lot to be thankful for I agree as they have already completed most of their career in the better scheme.

    It is very important however that we do not do what the government wants us to do and start bickering amongst ourselves.

    Let's come back to the 2014 contract settlement.

    Majority opinion here anyway, I presume both young and older GP's, is inclining towards the view that the GPC now seem to approach all annual contract negotiations hoping for the ' least worst' outcome - so that we should be grateful for anything that is granted to us, in this case less box ticking, howver no new money or resources. I may be cynical, but if you were a cunning negotiator in the Department of Health/government, perhaps you would put some highly unreasonable boxes in the 2013 contract so that hey presto, these can be removed in the 2014 contract thus convincing the GPC negotiators they have got a brilliant deal -after all they have only agreed to scrapping of practice boundaries, named GPs for over 75's and publishing of GP incomes, all for the same resources.

    Most grassroot GPs have a very clear concern that this contract will not lead to a 'named clinician', but a 'blamed clinician' when anything goes wrong with the care of patients over 75 years of age -- notwithstanding the many other variables required for vulnerable elderly patients to flourish in the community such as good family backup, community and social care and support, including mental health and other support services and in appropriate cases prompt access to the emergency services and good secondary care.

    By the way I seem to remember that it was going to be the 'appropriate clinician' who would be the namd doctor -- not the GP in every case, why and when did that change?

    Is this another example of GP's being singled out for special treatment?

    If you doubt that GPs are being singled out may I ask why has the primary care share of the NHS budget shrunk from 10% down to 7%,whilst GP FTE numbers remained static whereas consultant numbers increased by 40%, whilst concurrently much of the workload has been shifted from secondary to primary care over the past decade?

    What were and are our leaders thinking of?

    Regarding the disillusionment which is clearly widespread amongst grassroot GP's, and expressed on the blogs on pulse particularly, I disagree that the options are either agree, strike or exit stage.

    I would suggest that a strike has little chance of success which has already been demonstrated by the previous GPC led strike when only it seems at the last minute was the legality of the issue even considered and threats were made that doctors would face legal action if they were on strike.

    May I propose that if GP's genuinely wish to consider a viable alternative option, a like-minded body should convene to explore the option of supporting and furthering the aims of those GP's who are interested in becoming truly independent contractors, rather than GMS/PMS. In many cases one would presume resignation from partnership would be the first step.

    Some of our locum colleagues, many of whom have decided they do not wish to become partners, have already gone down this route with the formation of a cooperative model, similar to the concept of legal chambers -- perhaps that could be adopted on a larger scale, if enough GP's were interested?

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  • Anon 7:16

    That is the best, most rational analysis of the new contract that I have seen.
    More power to your elbow. .

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  • publishing income will certainly give press something else t beat us with, and could cause in practice resentment issues with salaried doctors who really haven't a clue how much extra responsibility and work partners take on

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  • Is it time now for those GPs who sat on the QOF development boards and produced the GPAQ points, erectile dysfunction points etc etc to stand up and reveal themselves to be the dimwits that they have now be proven to be?

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