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At the heart of general practice since 1960

A promising deal, but one key detail is missing

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It is a relief to report a positive development, and the deal agreed by NHS England and the BMA looks like good news.

The bureaucratic monster that was the Avoiding Unplanned Admissions DES is slayed, replaced by a less onerous contractual requirement to conduct regular reviews in the frail elderly and the money reinvested in core work.

There are some moves to cover some major practice expenses, with funding released to cover all CQC fees (worth around £5k for the average practice) and £30m payment towards rising GP indemnity fees.

A surprise is the guarantee that all practices will get the entitlement to have cover reimbursed when a GP is off sick; a welcome move to support practices at what can be a very difficult time.

It will be a relief to practices that any new work is kept to a minimum, with the new frailty checks detailed above and a requirement to take part in audits of retired QOF indicators and the National Diabetes Audit. The introduction of checks on entitlement for free NHS care - for all patients at registration - is funded with a £5m boost, and NHS England will invest another £2m for the increases in workload caused by Capita’s new ‘bag and barcode’ GP record collection service.

I apologise for the cliché, but this is overdue recognition that new work should attract new money. Long may it continue.

The only visible sting in the tail is a loss of funding for practices that close in core hours and are under the extended hours DES. Aside from this, the small print of the deal looks sensible, and that – in usual times – would be a cause for celebration.

But one major detail is missing. The GPC says it has secured enough of a uplift in core funding to guarantee a pay rise for GPs of 1%, but we are yet to learn precisely how this will be achieved. Last year saw an overall uplift in funding of 3.2%, but GP partners still report to us that they have seen a 4% decrease in drawings. Inflation is rising, and it remains to be seen if that will be reflected in a commensurate increase in core funding. This will be the big test of the whole deal.

And I set three tests for this deal last week and it fails on the third. Despite NHS England promising to consider the GPC’s proposed limits on GP workload and longer appointments, neither make an appearance here. We understand these are still under negotiation.

My verdict thus far? A sensible deal, with much to commend, but not a game-changer.

Nigel Praities is editor of Pulse

Update: The final uplift was announced on 09/02/17. It will see a 3.3% overall uplift, with 2.3% allocated for expenses. So, a significant investment into general practice, but only a 0.1 percentage point rise on the uplift announced last year. 

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Readers' comments (8)

  • Just bin Qof altogether as we have done up north, rsi from box ticking slowly resolving........

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  • Can I understand the guarantee of 1% pay rise? Is that for all GP's including partners who have rising costs before increased drawings can be taken. Are we moving towards a fully salaried service? As you said Nigel it has failed your test and the increasing demand remains unchecked.

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  • Vinci Ho

    A sensible contract
    A sensible analysis
    The reality is: this will only matter if it represents a cycle of 'positive changes' over the next 2-3 years to repair the damages inflicted on us , bearing in mind the root is still rise in demands(necessary and unnecessary ones) ,hence workload,together with workload dumped onto general practice due to unsustainability in other sectors of health and social care services .
    In fact , my concern is the lack of new money meaning draining blood from other sectors to feed us. End of the day , the shadow of privatisation remains.

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  • Dr David Barrett

    Some very welcome aspects, but unfortunately not far enough to get me to return to mainstream general practice.

    Demand and workload is still at unsustainable levels and I don't see the new contract would have a palpable effect. Incrementally maybe but we're still attempting to "turn a supertanker around in choppy waters".

    The left shift of work from hospitals will continue without the massive funding increase needed to support this and crucially where will all the GPs come from?

    That said it's great that sickness is finally reimbursed and now there will be full payment of CQC fees.

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  • There is still a disconnection between workload and reimbursement. A 1% uplift in funding assumes a steady state. However this figure does not come close to matching the rising number of consultations per year (and associated administrative tasks). There has been a 50% increase in such workload over the last 10 years, which has been completely unremunerated.

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  • My concern is that - as noted many times above - this is preparing for a salaried service. but I am afraid that all this DIRECT reimbursement (rather than putting it in the global sum) will draw HMRC's attention and they start dealing with us (partners) as salaried with a loss of flexibility in claims and expenses. That would push even more to jump to full salaried for the extra protection of hours and workload.

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  • with STPs all saying they will be saved by GPs doing all hospital work through MCPs is it time we had a big debate on the future of GP as an independent vs salaried service/
    LMC conference debated this, most of us want to stay independent, so how do we fight off the STP CCG NHSE?
    (sorry for all the acronyms)

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  • However it is dressed up it is another pay cut because of inflation . Uplift 1% RPI 2.5% = -1.5% . Simple math . Go figure.

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