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Gold, incentives and meh

Pulse’s verdict: Everybody needs good neighbours…

Editor’s blog

It was billed as the biggest reform in 15 years – at least in England – and it has certainly delivered.

jaimie kaffash 2 duo 3x2

jaimie kaffash 2 duo 3x2

My first thought is that the BMA – and, in fairness, NHS England – have done well here. The indemnity scheme does remove a significant headache for practices. The fact that the global sum will also be increasing goes against some of the doommongering from the Government and NHS England – though I suspect that might have been a bit of expectation management on their behalf.

The 1.4% increase to core practice funding doesn’t sound like much. But alongside this, there is the removal of indemnity costs and the new ‘network contract’ DES, which brings about a similar increase. I’ll come on to this.

As well as this, the major funding for non-GP staff is, unfortunately, necessary. There is an almost admission of defeat in terms of recruiting GPs in the agreement. It reaffirms the target of 5,000 extra GPs, but gives no timeline and states: ‘Much as we would like a bigger number, this would not be credible.’ At least it’s honest. And, in that spirit, paying for other staff to carry out work is as good a firefighting tactic as any, because let’s face it, GP workload is a fire right now.

There is another unexpected positive: GPs will ‘not have to bear any additional costs’ for the increase in employer pension contribution rates. I know this is another headache removed for many.

Some of the more worrying parts of the contract might not amount to much in practice. I can’t see how the naming of GPs on more than £150,000 of NHS earnings will work. I suspect there aren’t many – when private income is discounted – and I think that it will go the way of the similar contractual requirement to publish individual earnings (I dare not remind anyone of this in case they remember to enforce it properly).

Similarly, the direct booking from NHS 111 is a pain, but I suspect a smart practice can do this without changing much.

Practices may be thrown together like children who missed school when the class was picking teams

I think there is a bigger concern on the horizon, which comes from the push for networks. All practices will need to join a network – complete with clinical lead and governance processes – by July.

For some practices, this won’t be easy. We don’t know what a ‘network’ actually means in practice. At a briefing yesterday with GPC chair Dr Richard Vautrey and NHS England national director for strategy and innovation Ian Dodge, there was talk of networks being within CCGs. I asked about whether existing federations that weren’t on CCG lines would be allowed to continue – here, it became a little vaguer, with talk about ‘common sense’.

There will be special arrangements for exceptionally rural practices – although there is as yet little detail. And there is the issue of difficulties when working together: I’m not talking about the practices who haven’t forgotten the skirmish in the car park 20 years ago, but those who simply have a different working culture to their neighbours. These differences have been cultivated in previous years, yet now they may be thrown together like children who missed school when the class was picking teams for the special projects.

This isn’t an academic argument. Because with such huge tranches of funding being channelled through networks – and shared responsibilities in carrying out work – you really need to trust your neighbours. Take the extended hours DES – this funding is going to be given to networks. Those practices who don’t 100% trust their neighbours may think twice before including this money in their 2019/20 budget planning.

Don’t forget, there was talk of GPs taking control when CCGs were introduced, and no one can claim that was a roaring success.

But I don’t want to leave this on a negative note, because GPs need some positivity. Of course, there are always potential problems when changes of this magnitude take place.

And while it’s unlikely that workload will reduce, at least this contract is trying to put out the fire.

Because I fear, if this contract doesn’t lead to improvements in the profession, we haven’t got many more places to go.

Jaimie Kaffash is Editor of Pulse. You can follow him on Twitter @jkaffash

Readers' comments (10)

  • The end game before private Yankee hmos

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  • Thanks Jaimie, good analysis. There understandably is a lot of doom mongering comments by pulse readers over recent years but for the first time in a long time this genuinely looks like good news and for once we should try and be positive about it

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  • There may well be some positives in here, but at the end of the day it does nothing to address one of the main factors behind GP recrutiment - SALARY - I realise no-one likes to talk about this but it's the elephant in the room - a 20% pay cut over the ;ast 10yrs must have an effect. Coupled with that this new contract will do nothing to address our workload, although it might help with some of the year on year increase.
    No reduction in day to day workload, no pay rise - is it any surprise that GPs are leaving early and new recruits don't want to join in?

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  • There needs to be a bonfire of the regulations affecting GPs - limit the right of patients to make complaints to multiple bodies and give GPs the power to off-list patients when the GP feels this is appropriate (alternative health practitioners have far greater rights than us in this respect - osteopaths and practitioners of Chinese medicine can all tell patients to go elsewhere if they encounter someone exceptionally difficult, much like a London Cabbie can tell people he doesn't go south of the River). This would be worth more than extra funding.

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  • This is saying- oh they haven’t made u pay for this, that and the other that they were gonna to claw from you so be happy..... yeah feat - they haven’t stolen our dinner money?!
    The extra funding goes to federations and GPs- not us- we don’t see it! We like many in London had s small private practice with our nhs one ( separately run and only for patients out of area) - as our nhs finances dropped- this supported the practice... we never took a wage from it?!
    We can’t run the nhs without it? How can they give us 2 months to close it? Hospital doctors work privately- why target us?
    I can’t afford to continue my nhs work as a partner without that additional income stream - so am looking for employment elsewhere and suspect our nhs surgery will fail....so yaaaaay new contract- decimate general practice further!

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  • @Dr Fowler
    Running the numbers for my practice, I think they have addressed salary. They are not jumping up and down yelling a massive pay rise, that would not sit well politically, but it is on the cards. For a typical full timer (2000 patients):

    Extra 10k profit by reducing 12k indemnity to the 100s. (While losing the indemnity top-up funding.)
    Extra 2k profit from expected outcome of uplift.
    Extra 4k from 'signing up to' the network. Which is money for old rope.

    + (maybe) a couple of thousand for moving our pharmacist out to the 'network' and funding through them.
    Dont see huge value in social prescriber, but we will see.

    That is not quite a 20% reversal (I think it is more than 20% real terms pay cut by the way).
    BUT it does start moving things in the opposite direction. By quite a significant amount.

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  • Will this stop the loss of GPs though, will it change plans, is it a game changer, will it save GP land and hence the NHS.I know what I thinks onset encourage me to stay as a full time partner any longer than I was before the new contract.It will not revers the slide into the abyss.

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  • two trends worry me.
    1) the move to larger groupings. This has not worked in the past and they are enforcing it by making some pay contingent on it.
    2) The growth of 'noctors' taking the simple and quick consultations from us. This leaves us as 'GP consultants' with an indigestible load of difficult and emotionally exhausting consultations. I personally need some light relief to make the job bearable so that I can cope with full time. Many colleagues cope by being part time.
    I appreciate that any help is welcome when the chips are down but the direction of travel will I fear end in more demoralisation.

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  • Bob Hodges

    My assessment of the financial impact is similar to ObiOne's. This is welcome.

    We merged last year and are now a single practice Network with 3 sites, already doing a lot of what is specified.

    Change is never popular, especially with doctors. Opportunities will go unnoticed even when they dance naked on top of a piano singing 'opportunities are here again'.

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  • You don't mention the 30% cost of new network staff which we have to cough up out of practice funds - that will dent your additional profits will it not?

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