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GP practices to receive 0.28% funding uplift from April

GP practices will receive a 0.28% increase in net funding from April, after the Government accepted advice from the pay review body that falling staff costs should be taken into account when giving GPs a 1% rise in income.

Government accepted the Review Body on Doctors’ and Dentists’ Remuneration’s recommendation of a 1% overall increase in GP income.

But the DDRB also said that a 1.4% drop in staff costs meant that only a 0.28% uplift in practice funding, administed via the global sum, was needed to achieve this increase in GP pay.

Health secretary Jeremy Hunt said: ‘We thank the Review Body on Doctors’ and Dentists’ Remuneration for its 42nd report, note its recommendations and observations, and - in respect of General Medical Practitioners (GMPs), we accept its recommendation for an increase of 1% to general medical practitioners’ income after allowing for movement in their expenses, equating to an uplift of 0.28% to the overall value of general medical services contract payments for 2014-15.’

He added: ‘The DDRB’s recommendations for a 1% consolidated rise for all staff, on top of automatic increments, are unaffordable and would risk the quality of patient care. Without a pay rise, incremental pay increases already commit nearly £1billion every year for all NHS employees and add 2% each year to the NHS pay bill for employed doctors and dentists. The DDRB proposals suggest a pay rise that would risk reductions in front line staff that could lead to unsafe patient care. It is not possible to maintain appropriate numbers of front line staff, give a general pay rise of 1% and pay for incremental progression.’

How the 1% funding rise was calculated

Income: +1% rise (contribution to uplift: +0.43%)

Staff costs: -1.4% (contribution to uplift: -0.58%)

Other costs: +2.7% (contribution to uplift: 0.43%)

TOTAL UPLIFT: 0.28%

Source: DDRB

‘The Government is therefore adopting an approach by which all staff will receive at least an additional 1% of their basic pay next year. All staff who are not eligible to receive incremental pay will be given a 1% non-consolidated payment in 2014/15. Other staff will receive an increase of at least 1% through incremental progression.’

‘It is our intention that in 2015/16 the same approach will apply and staff who are not eligible to receive incremental pay will receive a non-consolidated payment of 2% of pay, whilst other staff receive incremental progression. As this will be a two year pay award, the DDRB will not be asked to make recommendations on a pay award for employed doctors and dentists in the 2015 pay round.’

However the GPC argued that the calculation was flawed.

GPC negotiator Dr Peter Holden said: ‘This is yet again GPs subsidising the NHS out of their own pocket. That is not right – that is emotional blackmail. It is completely unacceptable. Nobody disputes the economic circumstances but if we are to have a 1% increase, unless that is manifested in a 1% increase in our pockets, and in our taxable pay, then that is not a 1% increase.’

‘I don’t understand where they get the overall staff costs falling from. My concern is that there are a large number of overheads that we are now meeting that we have never met before, or that were completely reimbursed before, and that is going to impact on things. I think we are about to see a major problem over premises reimbursement and over waste reimbursement and those items alone will take thousands off a GP’s profit line.’

GPC chair Dr Chaand Nagpaul said: ‘Today’s announcement from the Government on doctors’ pay is a kick in the teeth for GPs at a time when there is overwhelming evidence that GP workload is escalating to an unsustainable level while resources are continuing to fall in real terms.’

‘It beggars belief to suggest that an 0.28% uplift in the GP contract will translate into a 1% increase in GP pay at a time when expenses are projected to continue to accelerate. This decision fails to recognise the expanding role and workload in general practice that shows no signs of abating.’

The GPC view was supported, in part, by the DDRB itself, whose report included an attack on the formula-based approach to GP pay recommendations, which it said was ‘flawed’ and did not effectively reflect staffing costs, expenses and reimbursements, hours worked or variations in correction factor or the QOF.

The report said: ‘[W]e have serious reservations about continuing to make recommendations using the existing flawed formula-based approach. If the parties wish us to continue with making recommendations using a formula-based approach, then we believe that they should: …agree appropriate coefficients to represent staff costs;… provide a comprehensive list of all expenses and reimbursements;… consider how we should take account of variations in correction factor payments and scores against QOF; [and] provide data on the distribution of the number of hours worked, including the mean and median.’

A Department of Health spokesperson said: ‘We are committed to investing in primary care and as part of our ambitious changes to the GP contract there will be a reduction of more than a third of the QOF, allowing money GPs currently earn from these targets to be pumped in to overall primary care budgets and a new enhanced service.’

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Readers' comments (68)

  • I agree with 8:25 as well. In the build up to the 2004 contract I joined the Independent GP Association which looked at true independence from the NHS. We had about twenty members ! The GP that started it left to work in Vancouver Island after the stupidist contract ever was agreed to by stupid GPs.

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  • So GPs are in a market and are small businesses then Mr Hunt?

    Statement from Anytown GP practice issued to the stock market at 0800 today
    Times are tight and we need to satisfy our shareholders by delivering value.
    To that end the board has decided to restructure its business offering taking a leaf out of Morrisons plc.
    We have analysed our market position thoroughly and concluded and to achieve these aims we need to increase profitability in order to prevent terminal decline. Our strategy has two goals.
    1. Increase turnover whilst at the same time 2. Reducing overheads

    To achieve these goals
    a) we are increasing our prices with effect from 1 April 2014 by 15% having managed to hold our prices since 2004
    b) We are delisting 63 elderly clients who are a total financial loss to the practice and seriously affect the level of service we can offer to our other clients
    c) We are reducing overheads by cutting our hours of opening from 52.5 hours per week to 40 hours per week and services outside these time will continue to be available but only by cash on the nail at the point of delivery
    d) We will be closing several of our branches in order to concentrate services on our main operational site which will reduce overheads further as some of our customers will not be able to access our main site without their own transport
    e) We will progressively reduce our operating floor space in line with reduced premises funding which in turn will increase our customer turnaround time
    f) We will cease prescribing hypodermic needles and syringes to our patients as we no longer have any identified revenue stream to cover trade waste

    The board believes these measure will put our business into a much stronger Financial position by April 2015

    Dr F. Rankenstien and Partners

    Working in slavery with the NHS

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  • I cannot be accused of being obsessed with my self image

    BMA/GPC is only as strong as its members. You cannot subcontract the obligation and task of saying NO , meaning it and YOU acting on it

    Peter Holden GPC negotiator

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  • It's about time we stoppped killing ourselves.
    There are always evangelists- look at the appraisal do gooders who believe its a good thing to get GPs to spend hours preparing and then taking them away from patients to go goo-goo of some naval gazing relfective bull. Then there's the idiots chasing the 50m challenge fund that's being announced as an injection to provide better care- horse.
    Then there's the CCG devoties who are morphing into PCT managers rather than clinicians and micromanaging us and treat us like something wiped off their shoe -dog!
    Then there's us who singulaly failed in the day of action and fail to support the GPC and BMA by doing all of the above and more, like QoF, LES, DES, care.data, Not sure I have another poo analogy to descibe us/me- it's my fault too.
    We must stop blaming the red tops and government and grow up and look at ourselves. We're selling our futures and the future of patient care to try and keep primary care afloat out of our own pockets and our broken spirit and backs. Other professionals who make life changing decision aren't allowed to work the way we do- lorry drivers, pilots etc... We aren't honest to our patients. I/we can provide a much better experience and care, but not in 10minutes with 40+ a day and on no increased investment.
    Good luck to all if ISQ, well done if you leave or change the system.

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  • Una Coales

    Portfolio GP is the way to be. Why do you think so many young GPs are choosing to work as hourly or day rate locums instead of concierge GP partners whose lives are constantly meddled with by their employer, the government and why some GP partners are selling up and working as locums to avoid the headache, stress, burnout and an early grave. Think entrepreneur. Work part time as a locum GP and part time looking at real estate, commodities, app development, private practice, etc or take a year off and travel the world as a cruise ship doctor, tax free. You only have one life to live and the NHS will only exploit your goodwill, not offer you gratitude.

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  • @11.35
    Peter. All GPs in our practice did take industrial action that day but I was very disappointed with the reaction of many other colleagues that day. I hope that the (often older) lot has retired by now and the younger who didn't take action have been stuffed enough to show more guts if the chance should ever come again.
    I did however attend a meeting with the BMA/ GPC and from what I recall there was not a lot of enthusiasm or leadership but it felt as if they eventually they had to give something to their disgruntled fee payers but there was much discussion about what 'public opinion would support or not'. Stuff public opinion - the Public would not support us if we went home with 40k for a 60 hour week. We deliver an essential service in the truest sense and this is the strength in our argument. That's what the tube drivers have grasped and the banks it seems but we haven't.
    If you are one of the more radical GPC negotiators then good on you for that. I've fond 15 years of GP and 8 can't take another 15 the way it is now and Una's post has certainly given me something to think about.

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  • I agree with all of the above posts. We are such a divided profession that we will never stand together or support any meaningful BMA action. A significant number of salaried GPs believe that partners have creamed off everything for themselves and have no sympathy for their current plight. They see little difference in working for partners or companies as long as the terms are reasonable. Partners feel that they have worked unreasonably hard and carry all the financial legal and management risk and that salaried doctors lack commitment.
    Sadly Una is right, the only thing to do is to consider your own personal position and make individual choices based in your own needs and preferences while trying to protect yourself from personal financial meltdown if possible. Portfolio it may well be.
    What I really do not understand is why the BMA is making no attempt whatsoever to find out what plans individual GPs have made so that the disaster about to hit can be mitigated. Why? Could it be that a significant number of BMA top dogs have contingency plans involving private companies/ not for profit organisations and have already planned their own personal exit strategies???? I don't know.........

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  • Una Coales

    Thanks Robert and @3:53. The answer is not to vote Labour (who forced huge multimillion pound PFI loans on unwitting NHS trusts to rebuild, expand, modernise) so that when they become insolvent (unable to repay the capital and interest no matter how many individual tariffs for 140,000 A&E visits in a 90,000 capacity hospital A&E department, hospital procedures, endless revolving door follow up appointments in OPC, in patient stays) they billed their CCG, these plush new premises may be handed to private companies (American, European, etc.) and income earned on private care (legislation now allows NHS hospitals to derive just under 50% of their income from private practice. Eventually the private side will expand and legislation will allow no limit on the private practice of hospital care.

    NHS dentists were also given a lifeline, the ability to charge NHS patients 3 tiers, perform private procedures in NHS dentistry premises, charge £20 for DNAs, bill private charges for appointments after 5 pm, etc.

    Only NHS GPs are given NO lifeline. The NHS contract for GPs does NOT allow NHS GPs to earn private income in a NHS surgery, charge for DNAs, limit the limitless appointments pts have for £80/year, so how can GPs survive the constant and relentless topslicing of income from the Big Boss Government who hold all the purse strings on public sector businesses, police, army, schools, GP surgeries etc.? Clearly government wish to replace all GP partnerships. Make a contingency plan B.

    I had hoped the BMA would help NHS GPs transition back into private practice pre 1948. The BMA has a private practitioners subcommittee and many hospital consultants already know how to manage both their NHS and private practice. There were private GPs who stubbornly refused to join the NHS and continued as independent practitioners all their lives with either a private pension which cashed out at 50 or savings in the bank and relying on real estate. Their gripe is that insurance companies are trying to cut out the private GP and have patients call the insurance company helpline to talk to a nurse advisor who will decide on the referral to see a choice of 3 cheapest consultants in the area.

    To be forewarned, is to be forearmed. The onslaught on GP partners will not stop. As Rt Hon Stephen Dorrell told me face to face, if I were a 50 year old GP, I would retire now.

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  • Una obviously has a problem with voting Labour despite them being the only party willing to fight for the NHS. She seems to have forgotten the state of the NHS & condition of hospitals the last time this shower were in power - that's why so much was needed to be spent on the NHS after they left buildings to rot. I remember very clearly buckets being stood in corridors to catch the rain because the tories refused to repair buildings.

    I have news for you Una - Hunt & co continue to use PFI ! They just don't tell us about it !

    If you want to carry on voting in the incompetent shower that is cutting your salary & inflicting the gradual privatisation of the NHS before our eyes, carry on but I won't be following your 'advice'.

    I refuse to believe everything Paul Dacre & the Barclay Bros put on their front pages - if they all paid taxes in the UK it would help.

    Only idiots believe the nonsense printed in the Daily Mail.

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  • @ Una

    If not to vote Labour - (who are denying a vote on Europe also, and under Blair started the slide and move to sell off the NHS), who to vote for?

    Letting Mr Hunt back in to complete the sell off to his new Private Healthcare masters for another term is certainly not the answer.

    The Lib Dem's are equally liable for the disaster and privatisation agenda as they could have blocked the healthcare bill disaster but stood and watched.

    Almost makes you consider UKIP as a viable alternative - but then common sense kicks in!

    General Practice is split with salaried colleagues seeing no reason why working for a partnership is any better than working for Virgin. This is the exact long term intent from the 2004 contract where a small clause hidden in the depths allowed third party ownership of GP Practices.

    Industrial action is not the answer, and was not supported. Instead lets provide the best care for our patients and refer all the people who need it, rather than wait for their leg to fall off. Lets prescribe the best branded drugs, rather than the cheap and less effective choices for a month.

    No BMA official could get up with a plan that puts the public first and the 'image' of General practice a s caring remains unaltered.

    If only the profession weren't a bunch of Turkeys waiting for Christmas, agreeing to any crap sent from the DOH. We could have just all Opted Out all our patients from care.data and what could the DOH do to all of us?

    United we stand, Divided we will fall.

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