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GPs should be ‘better off’ under new contract, say medical accountants

Medical accountants have cautiously welcomed the new five-year GP contract, which they say is largely ‘positive’ and could leave GPs ‘better off’.

However, they told Pulse reassurance is needed that the new primary care networks – which practices will be mandated to join – will have a good legal structure and will not incur any hidden tax bills.

The new deal – which involves a 1.4% funding uplift for general practice and a state-backed indemnity deal covering all practice staff – mandates all practices to join a primary care network, led by a local GP in a clinical director role and covering 30,000 to 50,000 patients.

Speaking to Pulse, Association of Independent Specialist Medical Accountants chair Bob Senior said: ‘Some bits are very positive, the five-year structure gives the profession some reassurance of certainty.

‘I completely understand the focus on primary care networks, it’s not a surprise, that has been the direction of travel for some time. What will be interesting is to see how that physically translates into action.’

He said more details are needed before he can say for certain how this will affect GP practices finacially.

‘If you talk to any accountant or lawyer they will say, fine the arrangement is interesting but what is the legal structure. Who has liability, how will it work? Is it a state body, is it a limited company, is it an unlimited partnership, there are a lot of possibilities, but we need to understand what is being together here, so we can then interpret how this work for tedious issues like pension regulations,’ Mr Senior explained.

He said there will also ‘need to be some very fast action around pension legislation, to avoid people not being able to pension income’, especially considering the short deadline for setting up the networks.

All practices will need to have joined a network by the end of June.

‘Understanding the structure of how it will work is very important from the perspective of risk and more boringly tax. You don’t want to find that there is a 20% tax in the woodwork that no one saw coming.

‘I would hope that someone at the department has done a lot of work in the background, and they just have not been able to give the detail at this stage,’ he said.

But added: ‘I think practices will have the opportunity to earn more, but there is still a question mark on whether they have the workforce to do that. I think the plans to use other staff such as physiotherapists and pharmacists is laudable, but there is not an army of these people out there ready to start. There are staffing issues in these professions too.’

Meanwhile, AISMA  board member and Hall Liddy director Andrew Pow said the contract ‘should leave GPs better off’, although the push for networks will make it harder for small practices to work independently and could lead to more mergers. 

He said:The uplift and having the majority of their indemnity paid should leave GPs better off. At least the indemnity issue gone for the future, the professional has been after that for years. This covers the whole of the practice.

‘The network side is where all the new money is going to go, but some networks are already quite established. Smaller practices can’t work in isolation, they will have to work in groups. Will this lead to more mergers of practices? It probably will do in the long run.’

Mr Pow also warned that while the indemnity deal could bring down most costs for GP partners, the cost of covering locum indemnity out of the global sum could hit practice finances, unless locums decided to reduce their fees to take that into account.

Until the figures of the global sum are released, however, it is difficult to say exactly how this new contract will affect practice finances, Mr Pow added.

The BMA has said there will be a ‘guaranteed’ increase in the global sum in the 2019/20 financial year, on top of the other funding settlements announced as part of the contract.

The global sum for 2019/20 has not yet been decided, but it will be an increase on the £88 per patient that practices currently receive, Pulse has learned.

Responding to the contract, AISMA vice chairman and MHA Moore and Smalley partner Deborah Wood added: ‘There are a number of positive messages in the new contract, but overall the devil will be in the details.’

Find all the headlines from the 2019/20 GP contract here…