Posted by: Editor's Blog14 November 2013
First up, a disclaimer. Dissecting and analysing the annual round of GP contract changes is a big ask at the best of times. But to do so without having read the full detail of the agreement is a particularly thankless challenge.
For some reason, next year’s deal has been announced in instalments. As I write this the BMA and NHS England have both released press statements, the national newspapers have written it up and the powers-that-be have issued comment - and yet NHS England has yet to actually get round to publishing the detail of the deal.
So it’s impossible to state with absolutely certainty even what has been agreed, yet alone what the full implications will be for GPs (both the BMA and NHS England’s press statements omitted key elements of the agreement). And yet the early impressions from those two statements are that, somewhat against the odds, the 2014/15 GP contract may actually not be too bad a deal.
The things we knew were coming, which Jeremy Hunt has been banging on about for months, have duly arrived. GPs will have a new responsibility as ‘named clinicians’ to coordinate the care of the elderly, and will be tasked with monitoring the quality of out-of-hours care in their area. Both are measures which struck fear into many when they were trailed on the front page of the Daily Mail earlier this year – but in the cold light of day, they may not be so onerous. ‘It is just formalising what happens now,’ says GPC deputy chair Dr Richard Vautrey of the named GP plan.
In exchange, the GPC appears to have secured a bit of a funding coup. As expected, the QOF will be shrunk, and dramatically so, with more than a third cut at a stroke. But crucially much of the money which is removed will be added to core practice funding rather than tied to new incentives requiring GPs to take on additional work, as has tended to happen in recent years. That will mean a welcome uplift in the global sum, before a formal funding uplift is even discussed via the DDRB process in due course.
Few GPs will mourn the reduction in the QOF – many believe there should be a smaller framework anyway, and the indicators which have been removed include some of the least popular, such as the Quality and Productivity targets and GPPAQ. And if GPs are to be faced with a new enhanced service, then making it one which tackles emergency admissions, rolled into the existing risk-profiling DES, seems relatively sensible.
What makes the overall impact of the contract deal harder to judge though are the additional, less expected elements that could yet provide a sting in the tail.
The removal of seniority payments, though not unexpected and spread over six years, will hit some GPs where it hurts and certainly do little to stop exhausted older partners heading out the door. The removal of practice boundaries is something of an unknown quantity, but the GPC has consistently warned against it. That it has now been accepted with barely a murmur (no mention at all in the BMA’s statement) is a sign of how much give and take there has been around the negotiating table.
And that, ultimately, is probably the biggest surprise from next year’s deal. After months of posturing from NHS England and dark pronouncments from Jeremy Hunt, grassroots GPs had been led to expect a fundamental rethink of the contract and quite possibly a repeat of 2013’s dire imposition. In actual fact, the GPC under new chair Dr Chaand Nagpaul has engineered a compromise weeks before Christmas, a compromise which inevitably involves sacrifice but is by no means all bad news for GPs.
Will the 2014/15 GP contract deal mark a change in the profession’s fortunes? Only time – and a forensic analysis of the detail of the agreement – will tell. But one thing is immediately apparent. It could have been a whole lot worse.