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A faulty production line

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)

  • We have a disproportionate number of elderly
    So how will this be recognised?
    If not recruitment of future gps will be a problem ?

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  • Look at it from whatever angle you want. General Practice has gone from being the crown jewels of the NHS to the sick man. Now it is moribund and with many experienced GPs leaving by 2020 we now at least know when the NHS will be put out of it's misery.
    We've been shafted and if you're under 35 your future looks grim- eternal work, constant blame, unrealistic expectations. General Practice is dead.

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  • We are sleepwalking into a situation where we have so little control over our professional lives that our personal lives are going to become intolerable. The government want to make us responsible for people who don't live anywhere near us, they want us to be available 24/7 for over 75s, they want to hold us responsible for their underfunding of Out of Hours, they want us to tell everyone anything the CQC doesn't like, they want to sell our patients records, they want to halt pay progression, they want to reduce appointment times, they want us to register with an agency that makes us 'compete' with each other, they want to jail us for working in a broken system that leaves patients 'neglected'. After a few minutes reflection, the most sane conclusion is that UK general practice is beyond ridicule but it's not funny because the annual winter crisis is already well underway. We cannot go on like this. Only by throwing off the shackles of the NHS will be be free from serfdom.

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  • I would strongly recommend my fellow GPs to unite and take control of profession like dentist model. Having worked in Australia I really feel sorry for UK GPs . Here GPs are independent and no body tell them what to do off course their are boundaries but they are not salve to any Health secretary etc UK GPs are like puppets and ready to do whatever politicians want them to do. No professional independence left what so ever.Look at dentist they have control on their personal and professional life . Wake up no BMA, RACGP,GPC etc is going to stand for you if you don't stand for your rights. Public expectation will kill most of us with stress etc . Its time to educate the public there is no free lunch and amount of tax they pay in not enough to provide 24/7 NHS service.

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  • GMS Practices are getting less money than PMS Practices.Lost MPIG gradually.We are getting more work from the hospital - asking us to rept blood tests before the next hospital appointments,prescribe medications as suggested,order investigations as suggested, and ref as recommended. We are doing house officers job for the hospitals.
    Further cuts - reduction in Seniority,More work - no free time.
    locum fee - expensive and 14% pension contribution to locums.
    Paying large amount of Tax,take home pay would be lower than the receptionist/hour of work.

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  • Please ask all the NHS England Staff and CCG staff to publish their Pay and their Qualification( Job Description)

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  • Please forward these comments to PM or J Hunt.
    Please organise an email for all the GPs to comment and send it to PM. Strike is not going to work.

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  • 10:39 16 11 13 we are right in it not walking towards it , it's like a tornado unless you are in the middle where it's all calm one does and will get uprooted

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  • Reduction of QOF does NOT mean reduction in work, a lot of the QOF requirements are already being implemented as best practice, yes some admin time is saved and pointless exercise questioning time is freed up from the nurses, but overall the reduction of QOF will not equate to less work. So same amount of work for doctors and much less pay.

    On the other hand, the named clinician part is still very vague, are we talking information sharing or actual involvement in every decision no matter when why or how, the devil will be in the detail

    obviously there is no extra funding and I suppose within this reshuffling of contracts, money will be siphoned out as always. I expect a reduction in total income again for GPs, At a time where we haven't had a paylift for 10 years and we have had had realterm painful pay cuts as well as a rise in expenses and salaries, I think this contract does nothing but politicise the contract, making it beneficial for the Government to brag about meaningless objectives while we are doing the hard work and getting nothing back !!!

    The whole government's agenda is obvious, publishing GP income is only to show the public that it is playing hardball !! This contract change is not meant to improve the circumstances for GPs or patients, it is merely a political gimmick.

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  • Anonymous 15 Nov 0.01 - have you read the BMA website? If you are already receiving seniority, you will carry on doing so for the next 6 years and all money released goes back into all practices.

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