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My three tests for the new GP contract

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We believe the new GP contract for England will be published next week. This will be a watershed, revealing whether the NHS in England is serious about supporting general practice.

Having said that, let’s be realistic. The profession is not about to be washed away in a flood of additional funding that will be unleashed on 1 April. As NHS England chief executive has pointed out himself, the supposed £10bn additional funding trumpeted by the Prime Minister is not even enough to prevent the amount spend per patient in the NHS dropping.

But there is cause for optimism. NHS England has already promised at least a 4% increase in funding for general practice and I understand that within the BMA they are cautiously pleased with the result (but then they didn’t exactly set their expectations high).

Whatever emerges, I believe there are three tests that should be applied to assess whether it is a good deal. These are detailed below.

1) It must substantially increase funding for routine work

Ministers say that austerity cannot continue for GPs, although quite what that means is unclear. Last year’s deal delivered the largest funding increase for practices in years, with a 3.2% funding uplift for routine work.

This was a substantial message of intent, but NHS England needs to go further. A recent Pulse survey showed that despite this substantial funding increase take-home pay for GP partners dropped. Since the publication of the GP Forward View, 47% of GPs say their practice finances have got worse.

This cannot continue if NHS England is serious about keeping practices afloat. There must be concerted action to reimburse rising expenses. The scheme to reimburse indemnity costs is welcome, although there are doubts whether it will be enough, but rocketing CQC fees must also be covered and inflation generally is currently running at 2.5% (RPI). This must be reflected in any funding uplift.

2) It must meaningfully reduce workload

There has not been any major move to reduce GP workload, apart from a rather half-hearted attempt to persuade hospitals to stop patients bouncing back to practices. In contrast, Scotland and Wales have suspended the QOF and brokered ’stability deals’ to reduce demands on practices.

There was an agreement last year to explore the end of the QOF and the unplanned admissions DES in England; and this is an opportunity to reduce GP workload, if NHS England is brave enough to grasp it.

Scrapping the DES is a no-brainer. It is bureaucratic and has had little effect, although the funding must be used to boost core funding rather than incentivising yet another new workstream for practices.

Going ‘cold turkey’ on the QOF may not be on the agenda, but surely there could be a similar scheme to that in just implemented in Leeds, where practices are allowed to ignore most of QOF and still be paid the equivalent of their performance from previous years?

Any ideas about putting seven-day access or ‘one-stop shops’ in the contract should be binned. Previous years have also seen small, but disruptive, new requirements placed in the contract e.g. publishing CQC scores and GP income. NHS England should resist temptation to gerrymander and keep things simple – better still, heed the GPC’s call for a longer-term contract deal.

3) It must implement the Urgent Prescription

The GPC executive buried the LMCs’ call for some form of industrial action last year on the basis that NHS England had accepted their Urgent Prescription document as a ‘basis for further discussion’.

You may not have heard of this document, but it calls for limits on GPs’ daily workload, longer appointments and overflow hubs to ensure that practices can cope.

The credibility of the GPC depends on seeing some real progress on implementing this document’s aims on top of the promises already made in the GP Forward View. Not ‘pilots’ or other exploratory moves to implement them, but concrete, funded proposals to take them forward. If that is missing, then it will call into question the GPC’s whole approach and will embolden those who seek a more militant approach (à la Northern Ireland)

Of course, as always, Pulse will let you know as soon as we hear details of the deal, with detailed analysis of what we think it means for the profession.

Nigel Praities is editor of Pulse

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Readers' comments (9)

  • Excellent analysis Nigel. We are all waiting for news of this contract. In fact, we have our local GPC roadshow this evening which is going to feel a little redundant without the ability to talk openly about it because it is still in the cloak and dagger stage.

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  • My concern is that the £2.4billion promised to primary care is the same amount missing from the social care budget. Will the expectation be that Primary Care will have to fix the social care problems as well? The Five Year Forward View is almost half way and on the ground not much has changed. The Vanguard and Devolution schemes cost more to manage and the only bright hope is the Primary Care Home from the NAPC but that too needs funding to survive. All the models are pushing the profession into a fully salaried system but will kill off continuity of care and the personal doctor/patient relationship. The push for 7 day working means spreading everything thinly into shift like working. What should be commissioned is an urgent care system that meets patients expectations. Patients only know two places to access healthcare GP's or A+E. Rather than adding complexity and competition have proper triage at the front door and have the right skill mix to deal with the urgent care. Long term conditions need more time to be dealt with properly as well as the forgotten about prevention agenda. The new contract will have a sting in the tail to do more or lose funding.

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  • Pay for bronze , get bronze,mate.

    Eventually you will get the service you fund when all the good will has dried up.

    Surprisingly there are still people out there trying to make things work on a shoestring.

    Thet will soon be gone.

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  • Azeem Majeed

    Thank you Nigel.

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  • Cold turkey on QOF sounds good to me. Some bold moves are not needed.

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  • We have seen nothing yet! Wait until STP closures of beds and hospital services hit. Somehow GPs will be expected to pick up the pieces.

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  • Vinci Ho

    Quite like the ending of the most recently talkable movie La La Land ; a confrontation between a sad reality and a glamorous happy ending.
    Not holding breath for this new contract.....

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  • Is the Urgent Prescription the one for diamorphine / midazolam /nozinan/ glycopyrronium? I know its been written; someone should cash it and get a District Nurse to set up the driver to 'implement' it.

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  • At least you guys have a government to negotiate with, here in lala land(aka Northern Ireland), we are running at 5.5% NHS spending with dreadful waiting lists, overworked gps and no hope, no future and hopefully, no nhs gp services......if only the troops here could have the courage to jump NOW!

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