Boosting practice funding will worsen salaried GP recruitment, claims NHS England
Exclusive An increase in GMS funding could exacerbate problems with recruitment for practices because it would lead to ‘inequity’ in pay between salaried GPs and partners, NHS England has claimed in its evidence to the doctors pay review body.
NHS England claimed that any increase in overall funding for the GMS contract relies on the practice to ‘pass [the funding] on’ to salaried GPs.
Its submission to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) for 2015/16 says that this has not happened in the past, citing last year’s DDRB report, which flagged up statistics which showed there had been a 1% funding increase but a 1.4% decrease in practice staff costs - a claim the DDRB discredited in the very same report.
It comes as the Department of Health evidence submission again recommended the GP contractual uplift should be just 1%.
If implemented, this 1% increase would follow an award of 0.28% last year, which accountants warned would lead to cut in take-home pay of 7%, while practices were given a 1.32% uplift the previous year after the health secretary ignored the DDRB’s recommendation of a 2.29% funding uplift.
The GPC argues that raising funding would be essential to give GPs confidence to take on more staff and attract GPs to the profession.
However, NHS England has claimed that far from helping attract more GPs, a funding increase would lead to inequity between salaried GPs and partners and would ‘impact’ on salaried GP recruitment.
NHS England’s evidence submission said: ‘Salaried GP recruitment and retention is a problem for some areas of England, and would not necessarily be influenced or resolved through a contract uplift. It should be noted that, as the DDRB recommendation affects the contract price, salaried GP pay may not be automatically uprated (depending on the contract). This would lead to inequity between GMP and salaried GPs with resulting impacts on salaried GP recruitment.’
A spokesperson said: ‘The reason that salaried recruitment would not be influenced or resolved through a contract uplift is that it’s down to the practice to pass it on. As noted in the last DDRB report, recent ONS (ASHE) published figures showed that, although there had been a contractual uplift of 1%, practice staff costs - which include salaried GPs - had fallen by 1.4%.’
NHS England also said that GP partner pay has ‘has increased in cash and real terms relative to other NHS staff groups’. On a cash basis this was 40% since 2002/03 and 11% in real terms – however this compared to a 24% increase in consultants’ pay and 19% for nurses.
It also said that the ’ average number of patients per medical practitioner in England has fallen’ since 2003 ‘partly because the number of GMPs continues to grow faster than the number of patients’.
However it earlier stated that the number of GP partners increased by only 0.1% between 2012 and 2013, compared to an average annual increase of 1.7% over the whole time period.
It also admitted that the number of partners intending to quit direct patient care in the next five years had increased in 2012 amongst GPs under 50 years old to 9% (6% in 2010). In the over 50s this figure was 54% (47% in 2010).
However, in last year’s report, the DDRB admitted that it had ‘serious reservations’ about GP uplift ‘using the existing flawed formula-based approach’.
GPC deputy chair Dr Richard Vautrey said that a funding increase was the only way to alleviate the recruitment crisis.
He said: ‘It’s well recognised that GP morale is at rock bottom and one of many reasons is that GP pay has been cut year after year and is now far less than that of consultants in hospital or what GPs could earn abroad. If we are to make general practice a popular choice for young doctors then improving the morale of the whole workforce is important and treating GPs fairly with respect to pay uplifts is an essential component.
‘Even a 1% uplift would be below in inflation and would effectively mean another relative pay cut but more importantly GPs need their rising practice expenses fully funded. This must be done to give practices the confidence to take on more staff.’
The BMA has called for the DDRB to independently recommend a GP uplift without using the existing formula for calculating GP expenses, which the DDRB itself has declared to be flawed.
The DH’s submission has acknowledged this by saying it ‘recognise and agrees’ with the ‘DDRB’s concerns’ over formula, adding that it ‘would welcome views from the DDRB on how recommendations for the uplift could be improved from the current the formula-based approach’.
But the DH evidence submission also said: ‘The Government recognises the key role General Medical Practitioners play in understanding, and planning for, the needs of their local populations. With the NHS facing unprecedented financial pressures against a backdrop of increasing demand, general practice will be central in managing those pressures.
‘However, the Government needs to continue to secure affordability across the NHS. Budget 2013 announced that public sector pay awards in 2015/16 will be up to 1%. This follows two years of public sector pay freeze. Therefore, the Government would expect the recommendation for General Medical Practitioners will be taken in this context.’
NHS England will be publishing supplementary DDRB evidence later this month taking into account the 2015/16 GP contract agreement.