GPs are being asked for their views on whether continuity of care should be included in the new GP contract.
The BMA’s GP committee for England is currently surveying grassroots GPs and said that this would be an opportunity for GPs to place their voices ‘at the heart of their future’.
The current five-year GP contract will come to an end in March, meaning the GPC will negotiate with the Government and NHS England for a new contract and said it would use the survey findings to inform negotiations.
One of the questions included in the survey asked whether continuity of care ‘should be included in any new contract’ and whether this should be ‘an agreed objective measure’ with direct core practice funding and additional support ‘to facilitate it’ or ‘an aspiration’.
GPs are also being questioned on their support for practice staff salaries (including on-costs) being ‘directly reimbursed from a ring-fenced pot’ in the same way as Additional Roles Reimbursement Scheme (ARRS) staff currently are.
The survey also contains questions on the future of PCNs, including what GPs think should happen at the end of the initially agreed period of PCN DES investment on 31 March.
The options proposed by the GPC in the survey include: keeping the PCN DES ‘as it is’ for another year; expand it to create ‘greater at scale working’; or retire it.
Retiring it would mean considering to either move the associated funding into the core contract funding global sum, and add new general practice contractual requirements regarding service integration, or move the funding to allow another part of the NHS system to host PCN services distinct from general practices.
The GPC is also asking whether funding towards the ARRS should be maintained at PCN level, but enabling ‘greater role recruitment flexibility, eg including GPs, practice nurses, GP assistants, receptionists/administrators, as well as offering less bureaucracy in terms of PCN incentive targets’.
GPC England deputy chair Dr David Wrigley said: ‘We are currently engaged in discussions with NHS England and the Department of Health and Social Care about our contractual changes for April 2024 and have our minds set on the bigger picture of what comes after that for the profession.
‘With a general election getting even closer we are meeting with opposition politicians to outline what we need in general practice to make our service fit for the future.
‘This is why we want to give you a voice. We have put together a profession-wide survey which will inform the work ahead of us and tell us what you need as GPs for the coming years. Your views are vital and will be used to inform our work going forwards.’
The survey also asks questions about work conditions and stress levels in general practice, when GPs plan to retire and why, and what could keep them in work for longer or encourage them to become partners.
It is open to all fully qualified GPs in England, including GP registrars at ST3 and above, as well as non-BMA members, and will close on 21 January.
In November, the Health Services Safety Investigations Body (HSSIB), an independent arm’s length body of the Department of Health and Social which investigates patient safety concerns across the NHS, said the GP contract should include an ‘essential’ continuity of care requirement.
And the Labour party wants to give GP practices financial incentives to let patients see the same doctor every time, in a bid to boost continuity of care.
Meanwhile, a petition to allow ARRS funding to be used to employ GPs and practice nurses has gathered thousands of signatures.
The survey questions
Should continuity of care be included in any new contract?
- Yes, as an agreed objective measure but with direct core practice funding and additional support to facilitate it.
- Yes, as an agreed objective measure but with new additional non-core funding attached and additional support to facilitate it.
- Yes, as an aspiration, but not an objective measure.
- I don’t think it should be included in the contract at all – it isn’t possible to agree and/or objectively measure continuity of care.
- I don’t think it should be included in any new contract; even if it is possible to agree an objective measure of continuity of care.
How supportive would you be of practice staff salaries (including on-costs) being directly reimbursed from a ring-fenced pot in the same way as ARRS staff currently are – even if this meant less flexibility in terms of pay and conditions offered, and how the practice is staffed?
As the end of the initially agreed period of PCN DES investment approaches (31.03.2024), which of the following would you prefer:
- Keep the PCN DES as it is for another year
- Expand the PCN DES to enable greater at-scale working
- Maintain funding towards the ARRS (Additional Roles Reimbursement Scheme) at PCN level, but enable greater role recruitment flexibility, eg including GPs, practice nurses, GP assistants, receptionists/administrators, as well as offering less bureaucracy in terms of PCN incentive targets
- Maintain the funding of the ARRS roles, but re-invest it at a ring-fenced practice-level, keeping additional incentive targets at PCN level, which should be focused on supporting core practice work/outcomes.
- Retire the PCN DES, move the associated funding into the core contract funding global sum, and add new general practice contractual requirements regarding service integration and at-scale working
- Retire the PCN DES and move the associated funding to allow another part of the NHS system to host PCN services distinct from general practices
Source: BMA General Practice Your Career – Your Future survey
READERS' COMMENTS [9]
Please note, only GPs are permitted to add comments to articles
GP surgeries’ relationship with patients should be like banks / retail stores / supermarkets — you are a customer of the organisation — not a customer of an individual like Mr Smith Bank Manager @ Any Bank. You are patient of the Practice — not a patient of Dr X, GP @ Any GP surgery.
Provide us with adequate funding to fully staff our surgeries, and continuity will happen naturally.
Continuity has been continually eroded by a long succession of ill-thought-out reforms (the PCN DES notably) and persistent de-funding.
Continuity is SO important, but I am suspicious of making this a contractual requirement with hoops to jump through and not necessarily the means to achieve this.
Unfortunately the survey does not allow you to contribute if your ‘main’ workplace is outside England, even if you werre doing some of your work in England or next to the border, or if your work is affected by decisions taken in England.
Perhaps BMA Wales, Scotland, etc, should do similar survey?
Or realise that all of us together are stronger than dividing us up into little bits and crushing us all, like Tories like to be able to do.
Continuity is great, and very important. The way that the GP contract works (one-way top down) I definitely wouldn’t put it in there -just give them another reason to remove funding when we don’t achieve the impossible. All the imposed initiatives to pool lists, merge and federate practices, closing single handers, have damaged continuity – chickens have come in to roost.
The hardest part of the job is doing a GP surgery yet this is what allows continuity to exist.
Doing a surgery is often the lowest paid role in General Practice with most other roles attracting a higher payment as well as being easier.
If we agreed that the most highly paid session of work a GP could do was a surgery (not management, CQC, appraisals, CD work, minor surgery etc) and there was a seniority system that only awarded payment for these sessions we would financially encourage patient facing work and solve many of our access and continuity issues.
Andrew Jackson sums up the crux of the problem. Until. Surgery consultations are adequately rewarded probably on an Item of Service basis, GPs will carry on jumping ship.
Spot on PD roll on April jump ship time.down from 9 sessions to 4.Yiphee.
Agree continuity as a valuable thing.
Many things undermine it. Here is a non-exhaustive list:
NHS 111; walk-in centres; primary care chronic disease management clinics; local “hub” services including urgent overflow clinics; the recent report (what was the name?) advocating removal of urgent care from everyday GP…
None of these things are bad, and the benefits they bring may outweigh the blows they deal to continuity. But continuity is not an “add-on” like, say, adding a sceening question about depression to every consultation. Continuity would have to be woven into the fabric of NHS structure and service design.
I do not see that happening in the forseeable future.
(How on Earth do you measure “continuity of care”?)
COC is a misty-eyed throwback to a simpler time when there were plentiful full time lifer GP Partners in multiple small practices with modest list sizes, where everyone knew “their” doctor’s name and vice versa.
Fast forward to today’s sprawling chaos of large practices serving a huge area staffed by a myriad of part-time short-contract surgery-hopping GPs with massive list sizes kept afloat by a cornucopia of ever changing ARRS staff.
Having engineered this “revolution” in Primary Care (in an attempt to break the monolithic GP Partner GMS powerhouse), governments now realise they threw the baby out with the bath water.
If they seriously wanted a boost to COC they would encourage young GPs into new GMS Partnerships and return the prospect of a “job for life” back to the highly valued prize status it once had with GPs, not the miserable bottomless work pit millstone it mutated into in the 21st Century.
But rather than do that, they lazily toss it into a New Contract as a vague ambition to yet again hoodwink the public into thinking they’re returning to ye goode olde days (Remember the “named doctor” charade? Fat lot of good that did for continuity).
And to answer my own rhetorical question, they’ll measure it by Patient Questionnaires, then use that stick to beat us for failing our contractual obligation to provide this mythical COC in a system designed to destroy it.
Plus ca change, plus c’est la meme chose.