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GPC chair urges GP practices to ignore NHS England on locum 'maximum rate'

Exclusive GPC chair Dr Chaand Nagpaul has urged GP practices and locums to continue setting their own rates without regard for the maximum rate that is to be set by NHS England.

Speaking about the 2016/17 GP contract at the Pulse Live conference in London today, Dr Nagpaul said there was no contractual duty on GPs to change their behaviour in light of the rate, on which there was ‘no detail’ as yet.

He said NHS England does have the power to change the e-declaration form to force practices to report when they pay more than the indicative rate, but said it was not a contractual ‘cap’.

He told delegates: ’I think we just need to be sometimes strong enough just to carry on as we are. I am going to carry on paying my locums what I negotiate with them and they will carry on charging. And if I pay more than an indicative rate I will expose that as a fact that we are under-resourced to be paying for the expenses that we need to run our practices.

’That is the stance I think we need to take, to just challenge it head-on, and not be affected by anything that is not contractual.’

He urged GPs ‘together, as practices and as locums’ to ‘carry on doing what we know to be right’ and also not to ’give it credence by calling it a cap, because it isn’t’.

Dr Nagpaul was also defiant against plans for GPs to provide routine seven-day appointments to all patients.

He said it was ’ridiculous’ of the Government to expect to be able to pay ‘less than the rest of the developed world’ for healthcare and ‘offer something that no other part of the world offers’.

He said: ‘Not only is it ludicrous, it is immoral, because if we don’t have enough money to run our health service what we must do is use it for people who most need it… Paying GPs to not be there for the most needy and instead be there superfluously is just wrong and that is why we must challenge it. This is something we all should challenge collectively.’

He further warned GPs from being tempted by the new ‘voluntary’ GP contract being developed for practices with 30,000 patients or more that deliver on the Government’s seven-day commitment in a multispecialty community partnership (MCP) model, urging them instead to stick with the ’safety’ of the national GMS contract.

De Nagpaul said the GPC was watching the developments very carefully because ’what we must do is make sure practices don’t unwittingly get themselves into difficulties through short-term attractions’.

The GPC chair added: ’We also believe that the national [GMS] contract is entirely compatible with these MCP arrangements.’

What is the locum maximum rate?

After a cap on spending on locum agency doctors and nurses was rolled out to hospitals in England earlier this year, GP practices will be given an ‘indicative maximum rate’ for locums, which will see them reporting any breaches to NHS England once a national rate is determined.

The scheme – which is to be introduced by NHS England against the wishes of GP leaders – will mean that GP practices will have to report their locum spend for the first time to the NHS. It is unclear what this information will be used for and when it will be introduced, and there is no indication as to what the indicative rate will be.

Although the measure is part of the 2016/17 GP contract deal, the GPC did not agreee to it and NHS England has not detailed what will happen to practices breaching this maximum rate.

Readers' comments (15)

  • I would think it is obvious what the rate will be use for. The government wants a 7 day a week routine service for healthcare without wanting to pay for it. Terms and conditions will become increasingly intolerable for doctors employed in the NHS or contracted to the NHS. Consequently, doctors will be looking for "routes of escape" - one of which would be locum work. So if the government can distort the market and make the locum option less unattractive, there will be less of an incentive for doctors to jump the NHS ship.

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  • Oops, typo! Should read "make the locum option more unattractive".

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  • 'He further warned GPs from being tempted by the new ‘voluntary’ GP contract being developed for practices with 30,000 patients or more.......'

    Dear Chaand, Say that to your LMC Heads who have formed most of these Federations and Alliances chew the cud over this how these hollow giants were formed in the first instance.

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  • lets hope we can have a united stance against the short term financial incentives. History tells us that we will not. Guess the superpractices will eat this up as the small patient friendly practices die off.

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  • Vinci Ho

    The only thing I would say Chaand is:
    The way it goes , you and GPC have to be ready for a 'mud wrestling' with this government ......

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  • "urging them instead to stick with the ’safety’ of the national GMS contract."

    Safety? Chaand, what planet are you on?

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  • Dr Nagpaul was also 'defiant' - love it !

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  • Thanks Chaand for grasping the grass root concerns. I was in the meeting and it was reassuring to see that GPC correctly identified most of the problems we are facing. Last year, you have given us guidance to complain about workload to the local trust and CCG. As you said we were too busy to do this, In my experience some of the CCG ignored to make any changes or may be too weak to raise an issue with the local trust!

    On a separate note - i see the danger of over enthusiastic GPs who say 'yes' to any initiative when they see some money attached to it for the short term gain and i see this more and more mainly who are about to retire or hardly do any clinical sessions. GPC needs to be absolutely clear to their members of the danger of oiling ministers 24/7.

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  • Is he trying to finish GP Practices off?
    Many can't find locums as pay is £50 an hour. A plumber and electrician earn at least £100 per hour. Ex GP partner now Locum .

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  • Am I the only one who was under the impression we would be at risk of accusations of breaching anti competition laws, and of forming a cartel if GP locum rates were set (& likely suppressed) externally in this way??
    I recall, not so long ago,the BMA suggested GP locum rates listed in the practice management pages of Pulse,& other GP magazines, alongside the Whitley Council pay scales for Nurses etc.These were withdrawn as being 'illegal' with the advice that locum GPs must be free to negotiate their own rates with individual practices depending upon the duties and responsibilities of the sessions they would be engaged for & the level of experience of the GP themselves.
    The withdrawal of these 'national' suggested GP locum rates led to a subsequent significant rise in locum fees and the variable rates of GP locum rates across the country that we see today.
    This is no doubt why NHS England are now attempting to reinstate a fee cap ,which will effectively suppress and standardise rates once again. As others have commented, they may also hope to stem the flight of GPs from NHS practice & make the locum GP role less attractive to demoralised NHS salaried and principal GP colleagues who seek escape from the current NHS GP environment.
    It seems likely from past events that NHS Englands current advice & action is therefore against the anti competition laws previously cited as the reason neither a specific fee nor a cap could be applied...or were we all misled?
    Perhaps the BMA and Dr Nagpaul can use their legal advisors and past experience to challenge this NHS England locum fee information gathering exercise and,perhaps more importantly,the attempt to cap GP locum fees under the anti competition legislation?

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