Dr Chaand Nagpaul, GPC chair
I am pleased to say we have reached an agreement which we believe offers important and significant improvements to the contract.
The changes will provide some much needed stability and respite for GP practices by reducing bureaucracy and providing financial relief in key areas. Progress on ending the bureaucratic unplanned admission DES is welcome as it will enable GPs to spend more time looking after frail older patients, rather than on box ticking.
Reimbursements for CQC fees and rising costs of indemnity will protect practice resources so that they can be concentrated on frontline care for patients. Guaranteed cover for reimbursement to the sickness and maternity leave system will help practices continue to provide GP appointments when staff are unwell.
It is encouraging that NHS England were prepared to listen to GPs’ concerns in many of these areas and work with the BMA’s GP committee to deliver workable solutions.
However, we should not pretend that these changes will solve the enormous challenges confronting general practice that have left many GP practices facing closure. Stagnating budgets, staff shortages and rising patient demand are combining to overwhelm services in many areas of the country.
Claiming back funding from overseas countries for hospital services when their citizens use the NHS is nothing new and has been common practice for many years. We have ensured that the minor changes this year will allow overseas patients who hold an EHIC card or S1 form to self-declare at registration so that reception staff do not become border guards, and that practices are reimbursed for associated administration.
But claiming back funding from overseas countries for hospital services will generate relatively small amounts of extra money and will not address the incredible funding pressure on GP services.
While many of these new arrangements are a step in the right direction, what we really need is for the government to properly resource general practice to ensure that GPs can provide the time and care needed to meet the increasing needs of patients.
Jeremy Hunt, health secretary
GPs are the first port of call for most people entering the NHS and are often a gateway to other health services.
We’ve made it clear that overseas visitors are welcome to use our NHS – but only if they make a fair and proportionate contribution to it, just as the British taxpayer does.
These changes are about making sure the primary care system plays a full and proper role in ensuring any appropriate costs are identified and recovered.
A strong, dependable primary care system is the bedrock of the NHS, and people need to have confidence that they can get to see a GP at any time during the working week, if they become unwell.
We are concerned that the variation in opening hours across the country – including the three quarters of surgeries that regularly close for an afternoon every week – means that some patients cannot access the appointments they need, which can have knock-on effects on other parts of the NHS.
Around 17 million patients are already benefitting from evening and weekend GP appointments, but it stands to reason that those appointments should be offered alongside, not at the expense of, usual opening hours.
Simon Stevens, chief executive, NHS England
We’re now turning the corner on a decade of underinvestment in GP services, but with new cash clearly tied to new ways of working that both improve patient care and support family doctors. While this new national contract is just one piece of the jigsaw, it’s another concrete step towards more convenient appointments for patients and more time for GPs to look after frail older people.
Dr Arvind Madan, NHS England director of primary care
This is really positive news, especially the agreement between NHS and the BMA to put a mainstream focus on frail older patients. This will help GPs focus their time and resources on the areas that matter most to their patients.
Dr Nigel Watson, chief executive of Wessex LMC
I think there are some really good things in there. If you look at the challenges that general practice faces, which is about workload and workforce, there are some important initiatives. The getting rid of the AUA DES, covering CQC fees totally, covering sick leave, are all good. I think helping with indemnity cost is partially good but I still think we need a proper solution to the total indemnity cost. I think the bit about the retainer scheme is a good initiative as is reflecting Capita issues and covering increased superannuation costs.
But this is not going to solve everything in one go. I think this along with ensuring that the GP Forward View delivers, alongside transformation relating to new models of care, will need to be built upon next year. I think it is part of a building process.
There are lots of things I would have liked to see – funding for practice pharmacists, contributions to transformation to work at scale. I could have given them a list twice as long with twice as much resource that is needed.
But whereas before there has deliberately been very little change in the contract, this has actually delivered a bit of positive change.
Dr Chris Hewitt, chief executive of Leicester, Leicestershire and Rutland LMC
There is some very interesting stuff in the new contract but the devil is going to be in the detail. There are clearly some hard-won changes in the 2017/18 contract, but we fear that for many GPs in our area the recognition of what is happening in our practices may be too little, too late.
Many GPs and practice managers in our area say they are in the last chance saloon and they are looking for meaningful additional things. Like suspending the CQC inspection process and abandoning QOF, and realistic core funding for frail and complex patients – which this unfortunately, despite the hard work of the GPC negotiators, is not. There are a lot of our practices that are on the cusp of packing up, a lot of practices just folding.
There are some really welcome things in there – such as non-discretionary sickness reimbursement, full reimbursement for CQC fees – but unfortunately too many practices have already taken on too much water.
Dr Dean Eggitt, medical secretary of Doncaster LMC
It’s about time this contract was out. My feeling about it is that there is a sting in the tail. For years NHS Employers and the Government have been saying that there is no money in the pot to do XY and Z and then suddenly they find money to do all of these things. It’s incongruous, it doesn’t make sense.
Not that I am going to look a gift horse in the mouth and say no, but what are the strings attached to this? Like always, I think the saying is the devil is in the detail. I’ll be very keen to find out what we are tying ourselves into by accepting these positive contract changes.
I hope my colleagues are right and it’s all positive, but as always I remain sceptical.
Dr John Canning, secretary of Cleveland LMC (former GPC member and chair of the BMA professional fees committee)
As an LMC secretary I am very pleased that the hard work of our new executive team has produced a good outcome.
What we need now is sustained progress to enable general practice to deliver what it is able.
Dr Krishna Kasaraneni, medical director of Humberside LMCs and chair of the GPC education and training subcommittee
I’m presenting it to Humberside LMCs this evening, and certainly from the LMC point of view we see it as a positive change which actually supports our vision. For the first time in a long time it feels like they’ve got the message.
Indemnity reimbursement, scrapping of the AUA DES these are all really positive things.
The indemnity thing this time round, they did a survey of the indemnity increases this year. It’s still a guestimate but it’s a better guestimate than it would have been.
Dr Peter Holden, chair of the BMA’s professional fees committee and former GPC negotiator
It’s only one cheer, it’s not three cheers, but they are just beginning to realise how desperate things are.
For GPs, far more important is getting rid of the AUA DES, getting CQC paid in full. CQC has been a new expense that’s come in, even though we were always meant to have our expenses back, so this is a straight credit to the bottom line. And at least there’s a nod in the direction of the costs of indemnity.
But the real big victory is that maternity and sick leave is no lo longer discretionary, it has to be paid. IT applies to partnerships because it’s the partnership that has an obligation to keep the service running. That money is not there to pay you for sickness, it’s not there to pay you for maternity leave, it’s there to provide service continuity whilst you’re on leave.
No doubt the Daily Mail will major on the rubbish about half day opening. You can close for training, and in our neck of the woods it’s the CCG that drives that bloody train. So my argument is that of course we can have our half day, everyone accepts Marks and Spencer doesn’t open till 9.30 on a Tuesday for precisely that reason. Its NHS England looking like they’re being tough, but it’s no stick at all. The key message for GPs, the only audience I care about, is there is no change on that front at all.
Dr David Wrigley, deputy chair of the BMA and a GP in Carnforth, Lancashire
I think this announcement will be welcomed by the profession but no one should be left in any doubt that it goes anywhere near dealing with the severe crisis in general practice and the wider NHS we now face.
We are short of thousands of GPs and nurses, workload is crippling and dangerously high, cuts to NHS services makes patient care even harder and we have a government that seems ‘ostrich like’ in its viewpoint on the NHS in that they think it is doing pretty well.
The profession needs to press for more radical action to ensure patient care becomes safer and working in the NHS becomes more tolerable.
Dr Robert Morley, Birmingham LMC medical secretary
The new GPC England executive team should be congratulated on negotiating the best GMS settlement we’ve had since the introduction of the new contract in 2004.
There are a lot of very positive measures in here, not least of which are the full reimbursement of CQC fees of course, together with additional funding for indemnity cost increases, and the abolition of the AUA DES with funding transferred to global sum. There are a number of other significant gains here too and all in all the positives considerably outweigh the few concessions.
This agreement is a definite step in the right direction after years of underfunding, undermining and destructive policies have brought general practice to its knees. There is a long, long way to go however for general practice to recover its position as the secure, resilient and professionally-led bedrock of the NHS.
This settlement must be seen as the beginning, not the end of the recovery programme; the government and NHS England must be held robustly to account to ensure that is the case.
Dr Grant Ingrams, deputy chair of the GPC IT subcommittee and a GP in Leicester
It is a curate’s egg. Overall it moves in the right direction – i.e. moving funding into the global sum.
I think Chaand is being shortsighted if he does not believe that the additional data will not be used for performance management. [I] expect it to be encompassed into CQC’s reports soon!
I am particularly sure that this will include the retired QOF indicators, with commenters not recognising (or caring) that the data will obviously be worse since retirement as practices will not be polishing the coding.
I am in two minds regarding the CQC funding – personally I would have preferred the DH to have reduced and ‘capped’ CQC funding to minimise the damage they do to practices. Overall it stil means that the CQC will be consuming more and more of the health budget.
We need the fine details of the requirement to collect EHIC details etc. Again it is interesting that there is no promise to alter the regulations so that general practice is no longer a free resource to all comers.
Dr Gurmit Mahay, medical secretary of Wolverhampton LMC
I think the GPC has done very well in negotiating with NHSE in a difficult financially austere environment. There are big wins for GPs in lessening the asset stripping that has been going on recently by way of exorbitant CQC fees. Shelter from the bombardment of stressed practices from more bureaucracy in the form of a cumbersome unplanned admissions DES. Better recognition of workload in the improved fees for Learning Disability examinations.
Recompense for the catastrophe brought on by the outsourcing of records management to Capita. Better alignment and funding of cover for GP sickness. Overall, given the environment we all find ourselves in with a lack of money in the system (the care sector being an emerging interesting case study), I think our leaders have done well and deserve credit where it is due.
Professor Helen Stokes-Lampard, chair of RCGP
Today’s announcement provides us with some certainty for the year ahead, and we thank our colleagues at the General Practitioners Committee of the BMA for their efforts under very difficult circumstances.
But these changes to our annual contract must not be seen as a lever to make hard-pressed GPs compromise their own welfare and patient safety by forcing them to be open at times which might be impractical and unrealistic for their particular local circumstances.
Smaller practices might need to close temporarily to allow GPs to make home visits, for example, or for their teams to undertake mandatory training. We need to see very clear guidance about when closing practices temporarily during core hours is acceptable – as sometimes there will be no alternative.
Initiatives to encourage experienced, highly-trained GPs to remain in practice is something the College has been calling for, so that this is enshrined in the contract is good news.
Frontline GPs will also be pleased that many of the more bureaucratic elements of our work have been taken into account and that we will get full reimbursement of CQC registration costs, as well as support for GPs to meet the rising costs of indemnity.
The College has been outspoken about the role of GP teams in charging overseas patients for care – but we have also said that where appropriate the NHS should be able to claim back money from the countries of those patients who use NHS services. The plans to introduce self declaration by patients at the point of registration is a straightforward exercise that should not be a significant administrative burden for GP teams, and should not deter patients from accessing care when they need it.
All in all, the contract should be encouraging news for GPs and our patients, but the changes certainly aren’t a cure for the intense pressures currently facing our profession. We need the pledges made in NHS England’s GP Forward View – for £2.4bn extra a year for general practice and 5000 more GPs by 2020 – to be implemented in full as a matter of urgency, so that we can continue to provide the care our patients need in a way that is safe for both them, GPs and our teams.
Dr Tracey Vell, cheif executive of Manchester LMC
I found the new changes to be stabilising but not transformational. So in terms of stabilising financial position I welcome the increases to global sum by redistribution and CQC reimbursement but they are not enough to transform general practice but we see this manifest in other contractual options. I like the attention paid to sickness and other benefits which bring us out of a disrespectful position into a humane space but much more could still be done.
I think QOF in any revised form is outdated though and we should have driven that back into core.