BMA and NHS England at loggerheads over GP funding
The BMA has called for at least an inflationary uplift for GPs practices this year in its official evidence to the independent pay review body, while NHS England has argued that any uplift will have to be limited to ‘up to 1%’.
In evidence to the Doctors and Dentists Review Body (DDRB) published today the BMA argues that GPs have already delivered ‘substantial efficiency savings’ and have had their take-home pay cut, and calls for all doctors - including GPs - to have at least an rise in funding to match the current rate of inflation - which is 2.7% on the consumer price inflation and 3.3% on the retail price index.
But it its DDRB submission - also published today - NHS England argues that GP funding has risen more in real terms than for other doctors and that practice expenses could be further reduced by sharing back-office functions and delegating more GP work to practice staff.
NHS England said that it was too early to make a concrete recommendation for any funding uplift, but said that any increase will need to be within the pay remit set by ministers ‘of up to 1%’.
The submissions put the two bodies on a collision course for contract negotiations this year, and are the first indication that NHS England intends to take a hard line on any increases in practice funding.
In its submission, the BMA said that the 1.32% rise in practice funding last year was ‘insufficient’ to cover expenses and has called again for the formula by which the Doctors and Dentists Review Body (DDRB) calculates gross earnings to be changed.
The BMA pointed out the value of GPs’ contracts has fallen by 15% since 2007, as reported by the NHS Information Centre using the consumer price inflation measure of inflation to 2007 prices.
It also called for the DDRB to take into account the impact of the pension changes on GP expenses, as practice staff on NHS contracts - such as salaried and locum GPs - will also face the rises and seek compensatory pay increases to avoid a further cut in income.
The report said: ‘We have compared the actual outturn for the different elements against both a measure of general inflation and against the uplift (intended or imposed). This shows that gross and net earnings have failed to keep pace with general inflation (CPI), but that staff costs have typically exceeded inflation.’
But NHS England’s submission to the DDRB says that GP pay has increased by 41% over the period 2002/03 to 2011/12, and that this compares with ‘an increase of 25% for consultants and 18% for nurses over the same period’.
It says: ‘NHS England is not yet in a position to provide evidence on the level of gross uplift it deems appropriate for 2014/15. Such an increase will need to be within the pay remit set by Ministers, of up to 1%, which applies to both GMP contractors and all of the staff they employ.’
It adds that practice expenses can be reduced by ‘seeking greater efficiencies’, for example, through the introduction of federated approaches and sharing of back office functions and staff; appropriate increased delegation to other members of the practice team; and partnership working with local pharmacies.
Dr Mark Porter, BMA chair, said: ‘We recognise fully the economic constraints the NHS is working under but the continued erosion in the real value of contracts for doctors has now reached a critical point.
‘We are also concerned that despite the excellent work done by doctors under enormous pressures it is once again unlikely to be recognised as the Government has already made it quite clear what it expects the DDRB to recommend.
‘This ignores the reality. Despite claims pay is out of control, the vast majority of doctors have seen real term cuts in their income year on year.
‘Billions of the Government’s so-called NHS efficiency savings have come from the continuing erosion of staff income. It is unrealistic to think the NHS can cut its budget by almost a quarter simply by just chipping away at staff pay. Instead the Government should be working with doctors who are best placed to deliver real savings while protecting patient care.
‘When faced with an unprecedented funding squeeze, inadequate staffing levels and rising patient demand it is no surprise that morale amongst doctors is low and yet they continue to work as hard as ever on behalf of their patients. It is only fair that they do not face a further cut in pay.’