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Northern Irish GPs ‘face worst contract deal’ in UK

The GPC has warned that practices in Northern Ireland face the worst contract changes of all UK countries, after the Northern Ireland Executive said it would impose an even greater QOF workload than that proposed for GPs in England.

The Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS) today launched a consultation on the contract changes that will see GPs working to stricter QOF targets than in England and also includes plans to phase out the MPIG over seven years.

The consultation proposes a full overhaul of the QOF by implementing the majority of NICE-recommended changes and any uplift to core funding depending on the recommendations from the DDRB.

It also proposes raising QOF thresholds to the upper quartile of achievement for 23 QOF indicators, as opposed to 20 indicators in England, and snubs a request from the GPC to take into account a 7% population rise in Northern Ireland over the last 10 years.

The imposition has one slight concession, compared to the plans in England, with plans to scrap the entire organisational domain moderated, with some medicines management indicators being retained.

The deal is much stricter than in Wales and Scotland, where the GPC has come to a negotiated deal that sees watered down QOF requirements and the withdrawl of MPIG being delayed.

GPC Northern Ireland chair Dr Tom Black said: ‘The first impression is that this is the worst imposition of all four countries.

‘We will be taking a big hit resource wise on QOF, also we asked for the expanding population to be looked at. That needs to be taken into account as part of the uplift to the global sum uplift, and again they haven’t done that.

‘Also, and probably most worrying, is that we have this MPIG clause - they describe this as equitable funding over seven years - but that’s essentially a removal of MPIG, which in Northern Ireland will destabilise practices.

‘So we have virtually all indicators imposed, we have even more threshold increases than England, which is extraordinary, and we have had no amelioration with respect to the contract population index, the expanding population scheme or MPIG. So in my reckoning this would be the harshest of the four countries’ impositions and we will not accept this.’

Dr Black also said the contract changes will dump an extra 10% workload on GPs, alongside plans from the Northern Ireland Executive for GPs to take on an extra 20% of work from secondary care from April via the Transforming Your Care (TYC) commissioning system.

Dr Black said: ‘I see no way that this can be done now. I think they will either ameliorate this or we will have to convert a shift left into a shift right [GPs referring more patients to secondary care]. If the Government chooses to put the resources in secondary care, the patients obviously should follow the resources.’

Dr Black said the Northern Ireland GPC will meet with the Government to try a last-minute attempt to explain the downsides of pushing through with plans from 1 April.

Northern Ireland director of primary care Eugene Rooney wrote to Dr Black: ‘The Department is hopeful that an acceptable agreement can be reached with GPC in relation to these proposed changes.

‘In the absence of such an agreement, however, and subject to the outcome of the consultation process, the Department would propose to introduce the changes detailed in this letter. The Department will be guided by the principle of allowing contractual arrangements for GPs to evolve in ways that: reflect best, evidence-based practice; improve health outcomes; reduce inequalities; empower patients; and promote local clinical leadership and innovation.’

The move comes as NHS Employers released a statement from its director Dean Royles, which said the GPC has ‘abandoned’ the UK approach to the GP contract, after separate deals were negotiated in Scotland and Wales.

He said: ‘The GPC has clearly now abandoned a UK approach to negotiating changes to the GP contract. Whilst Scotland and Wales have settled, England intends to continue consulting on a package of proposals that seek to deliver a significant improvement in services for patients.’