This site is intended for health professionals only

GPs to cut services and reduce pay due to contract changes

Exclusive: More than three quarters of GP partners expect to slash their drawings and nearly half expect to cut extra services offered to patients if the Government’s proposed contract changes come into force, a Pulse survey has found.

The survey of 229 GPs also found 10% expected to make salaried GPs redundant and a further 36% expect to let go of clinical staff such as practice nurses, or administrative staff due to the biggest practice funding shake-up in the history of the new contract.

The figures come as GPs face tougher QOF targets, a raft of new QOF work and four new directed enhanced services to maintain their income in 2013/14.

Accountants have already warned that partners should reduce their drawings by 10% to cope with the changes that the GPC predict will cost the average practice £31,000.

Some 77% of GPs who responded to the survey said they expected to cut their pay to cope with the contract changes and a fifth (20%) said they would cut the number of routine appointments offered. Nearly half (47%) said they would cut extra services offered to patients.

The GPC has recommended that practices consider carefully whether QOF work is financially viable, and 54% of those surveyed said they would evaluate which QOF work they would carry out.


GPC chair Dr Laurence Buckman has also said that practices would struggle to carry out all the new DESs the Government is proposing to finance through retiring organisational QOF points.

Nearly a third (29%) of GPs who responded to Pulse’s survey said they would not take on any of the new DESs that involve developing online access to GPs, dementia case-finding, case management of those at risk of hospital admission and introducing telehealth.

Only 24% of GPs said they planned to take part in the telehealth DES that involves the introduction of remote monitoring of patients and 47% said they intended to opt for the DES that incentivises practices to case-manage patients at risk of hospital admission.

Dr Mary Louise Irvine, a GP in Lewisham and a member of BMA Council, said the contract changes would harm GPs ability to improve patient services.

She said: ‘I advise GPs to accept lower wages, instead of shedding staff in other areas of the practice.

‘The main impact to patient care will be the funding reductions that the changes introduce, which will restrict the scope for developing and improving practice services.’

Dr John Grenville, secretary of Derbyshire LMC, said that he thinks the Government was deliberately trying to reduce partners’ pay.

He said: ‘It’s been quite clearly Government policy since 2006 to reduce the pay of GP partners. Its being spun as us being overpaid- but the Government of the day entered into the contract voluntarily. It’s unreasonable of the current Government to use their position as a monopoly employer to force through these changes.’

Dr Ben Burville, a GP in Amble, Northumberland, said: We do a lot of dementia case finding anyway, but as for the other DESs, we just don’t have the infrastructure or the time without sacrificing other services. Our priority has to be the patients we’ve got. We’d love to hire more GPs and nurses and expand our services, but we simply don’t have the funding.’

Ms Ann Tudor, principal at Tudor Healthcare Accountants LLP and vice chairman of ICAEW Healthcare Group said members were advising all GPs to reduce their pay-cut, after one practice was caught short and had to manage with no drawings for four months.

She said: ‘GPs are looking at cuts in drawings. Those who have not reached this point yet need to project their cash flow forward to avoid nasty surprises in a few months’ time.’

‘Our worst case has been a practice that hadn’t forward planned and had to manage with no drawings for fiour months to stabilise the practice.’

A DH spokesperson said: ‘The proposals do not involve removing any money from the contract - in fact they include new investment in new vaccinations. Income is generated through GP practices retaining patients. The challenge is for practices to provide the best services for local patients.’

Click here to read our investigation into GPs at breaking point.

Will you be opting to take part in the following new DESs?

Dementia: 53%

Developing online services and access: 52%

Remote monitoring of patients/telehealth: 24%

Risk-profiling and case-managing patients at risk of hospital admission: 47%