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Independents' Day

Give English GPs as good a deal as in Scotland, GPC urges

Exclusive The GPC has urged the UK Government to stop ‘discriminating’ against GPs in England and give them similar arrangements to those in Scotland or risk overloading practices.

Speaking to Pulse, GPC negotiator Dr Chaand Nagpaul implored the English Government to follow in the footsteps of Scotland and retract its contract imposition, or face the responsibility of creating new health inequalities in the UK.

The GPC intervention comes as the union surveys GPs on whether the proposed contract changes could make them leave the NHS, as it prepares to draw up its response to the Government’s official consultation ahead of a possible imposition from April.

The GP contract deal in Scotland differs from England in that all retired QOF points are recycled within the QOF - rather than assigned to new DESs - certain ‘unworkable’ QOF indicators have been removed and upper thresholds will not be allowed to go over 90% (see box, below)

Dr Nagpaul said the ‘stark difference’ between the deals would mean patients suffer in England due to ‘significant additional’ GP workload.

He said: ‘We would very much hope, even at this stage, that the Government will show English GPs the same respect as Scottish GPs have been afforded.

‘We find it very hard to understand why GPs in England are being discriminated against [when] there is a deal that is acceptable north of the border, which is not an imposition.’

Urging the Government to return to negotiations, he said the GPC accepts the phase-out of MPIG in England, where there are significant funding variations – unlike GPs in Scotland and Wales – as long as it is carried out in a sensible manner.

He said: ‘Our objection is around the removing of a huge quantum of funding from the QOF and then adding a huge quantum of work to DESs which are driven by political ideology.

‘This will lead to GPs immediately having money taken away and being asked to earn it back, to significant additional workload, as well as the QOF itself having imposed upon it excessive and unrealistic indicators.

‘Scotland has agreed to take on the risk-profiling [DES] as part of the QOF, and in fact, when we were negotiating we felt this was one way to make risk-profiling workload neutral. We proposed to replace one set of QP indicators with this because in that way you would replace one set of workload for another.’

Pulse revealed last week that more than three quarters of GP partners expect to slash their drawings and nearly half expect to cut extra services offered to patients if the Government’s proposed contract changes come into force.

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Dr Nagpaul added that it was ‘inexplicable’ the UK should have such inequalities between countries in the provision of general practice.

He said: ‘There is no doubt that the English imposition will not just disadvantage GPs but also patients. GPs will be overstretched an unable to manage their workload properly, and they will also be diverted from primary care into other Government initiatives thought the DESs.

‘The Scottish Government will get greater productivity from GPs, because it is actually trying to work with the workforce and expressing sensitivity to the GP workforce’s perspective. The [UK] Government said in its own imposition letter that it still believes that there is scope for a negotiated agreement to bypass the imposition.

‘I very much implore the Government to look to the Scottish approach and sensibly retract their imposition so that English GPs can have similar arrangements to those in Scotland.’

Dr Nagpaul also asked GPs to make their voices heard through the BMA survey, He said: ‘This is a crucial time when the Government needs to hear what GPs actually feel, because it is really the profession that the Government will rely on to implement much of its healthcare aspirations and policies. This is not just another survey.’

A DH spokesperson said: ‘We are consulting on our proposed changes and remain happy to return to negotiations. So far the GPC have refused to negotiate.’

Dr Tony Grewal, medical director at Londonwide LMCs and a GP in London, said: ‘The [UK] Government is acting most unwisely, especially as GPs are the ones who are going to keep this show together.

‘I would advise that if they value us and treat us with respect they will be surprised with how much we will deliver. My advice to English GPs would be to move to Scotland.’

The Scottish GP contract deal for 2013/14

  • The organisational domain of the QOF will be scrapped in Scotland, as in England, but instead of the points going into new enhanced services the points will be reused within QOF.
  • A substantial portion of points’ achievement from the QOF organisational domain will be transferred to the core funding element of the contract.
  • A further 17 points will be transferred to a new public health domain, 33 points will remain for patient experience but no longer within the organisational domain, while 23 points will be transferred to a new medicines management domain
  • No new DESs, but new indicators on ‘anticipatory care planning activity’ will replace quality and productivity QOF indicators on A&E and emergency pathways, instead of the risk-profiling DES created in England.
  • The majority of NICE’s QOF proposals for 2013/14 will be included, but there are concessions on the proposals branded ‘unworkable’ by the UK GPC, with some of them not being introduced at all while others will see agreements for wider exception reporting. The indicators that are not being implemented frees up 11 points which will be used to introduce a new patient safety programme in general practice.
  • Scottish GPs will also avoid the full extent of QOF threshold hikes proposed in the UK consultation, where some may be raised to 100%, as no Scottish thresholds are to be set above 90%.
  • While English GPs will see the MPIG in England phased out over seven years, the Scottish GPC has agreed that the parties will look at the variablity in funding in Scotland, but not have a wholesale removal of the MPIG.

Readers' comments (11)

  • Look at the pay differential before you make your wish... There's nothing stopping English GPs taking on additional partners to deal with the extra workload - oh but then the pay would go down to that of Scottish GPs. You can't have your cake and eat it.

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  • (1) Consider the cost of living in the South East for example compared with Scotland before drawing conclusions from any pay differential.
    (2) Introducing 100% thresholds for QOF indicators is a cynical exercise to claw back any increase in funding on offer. Such thresholds are unattainable and unethical. Any attempt to mitigate losses by increasing exception reporting will result in decreased prevalence and loss in value of the points earned. I would like to be more involved in commissioning but the extra effort required to maintain income will prevent this.
    (3) Hands off the MPIG! In 2011-12 61% of practices were still in need of payments. The simple fact is that some areas will always be more expensive to cover than others and eroding the MPIG with politically driven adjustments to the contract will destabilise practices unable to divert or allocate resources to the extra work.

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  • It is well known that English GP's earn significantly more than their Welsh and Scottish counterparts. Reflect!

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  • already given up hope NI GP

    Not a good idea to fight amongst ourselves guys,you are falling into the trap of divide and conquer.

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  • Minor but important correction to a comment above - exception reporting does not reduce income.
    The prevalence factor determines the £ per point for each QOF disease area. That factor is based on the on register size, which is not affected by exception reporting.

    Practices can therefore achieve 100% by showing that any patients that did not meet the QOF indicator where appropriately exception reported.

    BUT the key word there is appropriately. That's three invites / year ignored for 'informed dissent', or a very good clinical reason such as end of life for 'patient unsuitable'. Not we didn't get round to inviting them and it's now too late, or the patient lives in a nursing home (have seen both plenty of times).

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  • Trying to achieve 100% target rate is impossible - when have you seen any government policy which stipulates 100% achievement or fail.

    It will only lead to more gaming as it is impossible to achieve and more time wasted ticking boxes rather than dealing with patient's real concerns or health. I run an hour late this morning due to one patinet with seriously difficult issue - it didn't gain any extra money for me as I ticked no box for qof but I feel better for doing what I was suppossed to be doing. I'm sure Mr Tesco/virgin/etc will be telling me I'm inefficient and costing them unneccesary expenditure if I was working for them, dwelling on things which earns no extra income......... is that what the government want from primary care in the future?

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  • Vinci Ho

    You remember Mel Gibson's film Braveheart?
    I suggest all GPC negotiators dig out the DVD and watch it again.....

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  • I was at a Scottish meeting last night. To be honest the new contract seems terrible, more work and no new money. The only thing is it isn't as bad as the English/Welsh contract

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  • The grass is always greener on the other side of the lane?

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  • Divide & conquer indeed. Things will get tougher & tougher until we all cave-in & sign up with Tescos, Virgin or whoever, thereby absolving politicians of all blame in the demise of the NHS.

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