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GPs buried under trusts' workload dump

No pay rise without new work, DH tells review body

By Steve Nowottny

GPs should expect to take on new work to justify any increase in pay – even to cover inflation – the Department of Health has told the pay review body.

The DH has called for GPs to receive an increase of just 1.6% next year, to cover the rise in practice expenses but no more.

But ministers have been accused of using ‘creative accounting' to justify a fourth successive squeeze on pay, after Pulse learned projected increases in enhanced service funding were largely illusory.

The DH evidence to the Doctors' and Dentists' Review Body justified a clampdown on pay by claiming GPs' workload was down and their earnings share up.

It quoted the BMA's own survey from last year as proof GP morale had improved since 2001, and insisted: ‘Any increase in GP earnings should be linked to additional work rather than being applied through automatic uplift in contract payments.'

But it is the claim that GPs could make up any shortfall in pay through an increase in enhanced service funding of £54m in 2008/9 – and ‘by at least the same amount' in 2009/10 – that has caused most controversy.

A Pulse investigation into LES payments across 29 PCTs reveals a patchy picture of investment, with many counting extended hours payments in order to claim they are hitting a target for a 20% increase in LES investment this financial year.

Three in four PCTs said they were on track to meet the 20% uplift demanded across SHAs in September, and in some areas trusts claimed funding was set to rocket.

Devon PCT expects to spend £4.2m in 2008/9, up from £1.5m in 2007/8.

Hull, Wolverhampton, West Sussex and Camden all predict increases of at least 35%.

But LMC leaders warned GPs on the ground were unlikely to see anything like the projected increases and cautioned against double-counting. The DH admitted its £54m projection included cash originally assigned to the extended hours DES.

One trust's spokesperson admitted: ‘The distinction between DESs and LESs is becoming blurred.'

Dr Stephen Amiel, Camden and Islington LMC chair, said: ‘There is a huge credibility gap between what's being promised and what is actually being rol-led out.

‘A lot of it is rebadging as enhanced services stuff that was in the QOF. There is some creative accounting going on.'

Pulse's investigation also raises concerns over a ‘postcode pay rise', with different PCTs forecasting vastly different uplifts in LES spending.

Two trusts – Heywood, Middleton and Rochdale PCT and Bedfordshire PCT – actually plan to cut spending on local enhanced services by 5%.

GPC leaders, in the GPC's submitted evidence, warned that average GP income had fallen cumulatively by more than 10% over the past three years, and called for a minimum 3.5% uplift next year.

DH: writing on the wall for GP pay rise DH: writing on the wall for GP pay rise

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