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Ditch the independent annual review of GP expenses, says NHS England

Exclusive GP leaders have warned that practices could lose out under NHS England’s proposals to ditch an independent annual review of its expenses.

The proposal would see the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) no longer reviewing practice expenses, with NHS England and the GPC negotiating between themselves the total funding uplift that practices will receive.

However the GPC has said that the move could see NHS England taking a greater role in determining the level of funding to practices and warned that it could lead to another crisis in general practice.

GPs received just a 0.28% funding uplift this year after the Government accepted the DDRB’s recommendation, despite the DDRB itself complaining that the approach to calculating GP expenses it is expected to use was ‘flawed’ and saying it would have ‘serious reservations’ about continuing making recommendations using the same formula.

Despite agreeing with the DDRB’s complaint, the GPC has said it still wants it to make its uplift recommendation, although without using any set formula.

But under the NHS England’s proposals, included in its ‘supplementary’ evidence, the DDRB will only recommend an uplift in GPs’ take home pay, and not the total uplift it currently recommends. The recommendation on take-home pay will inform the negotiations between NHS England and the GPC, which will also decide what uplift is necessary to cover increases in practice expenses.

The NHS England document said: ‘Our view is that it seems anomalous that DDRB is a pay review body, yet it makes recommendations for independent contractors which involves considering the level of their expenses. In many ways this is not a logical position. Independent contractors, by their very nature, are able to influence the level of income and expenditure which their businesses experience.

‘[A]dditional income could also be gained from NHS and other public sector work. [E]xpenses could be reduced through seeking greater efficiencies, for example, through… the introduction of federated approaches and sharing of back office, functions and staff across practices; appropriate increased delegation to other members of the practice team; and partnership working with local pharmacies.’

It added: ‘If the BMA, and DDRB, feel it is no longer appropriate to use a formula to calculate the gross contract uplift, we would suggest a better alternative would be for NHS England and the negotiating parties to discuss and consider an appropriate uplift for expenses within future contract negotiations.’

However the GPC said that the independent body ‘has the necessary skills’ to recommend expenses, and that it should retain the responsibility to recommend a total funding uplift.

GPC deputy chair Dr Richard Vautrey said: ‘In the long term we are better having an independent pay review body and it was because direct negotiations with the government led to a crisis in general practice many years ago that led to the establishment of the DDRB in the first place. We should be careful to learn from history.

‘We believe that DDRB has the necessary skills and it is part of its core remit to make a recommendation both on a pay uplift and what is required to pay for practice expenses for GPs. We would work with NHS England on how any increase to the contract funding envelope should be apportioned as we have done previously once the recommendation has been made.’

Birmingham LMC executive secretary Dr Robert Morley, chair of the GPC’s contracts and regulations committee, said: ‘It is wrong to say that [determining GP expenses] should not form part and parcel of the duties against the DDRB because they need clearly to consider it on the whole.

‘I think clearly it needs to influence the level of funding to general practice. You can’t separate the two.’

He added: ‘It is a little bit ironic when they are actually washing their hands of GP commissioning and giving it to CCGs that they are now saying they want a greater role in determining the funding for general practice. I can’t understand that. There seems to be some inconsistencies and contradictions in their thinking. I think it just indicates that they haven’t a clue what they’re doing about anything to be honest.’

NHS England’s initial DDRB evidence submission in September suggested that increasing GMS funding could exacerbate problems with recruitment for practices because it would lead to ‘inequity’ in pay between salaried GPs and partners.

The DH meanwhile said that it ‘recognises and agrees with’ concerns over the DDRB formula, adding that it ‘would welcome views from the DDRB on how recommendations for the uplift could be improved. However it also said it expects the DDRB to make its recommendation while taking into account the Treasury’s 1% cap on public sector pay rises.

The evidence is meant to inform the DDRB recommendation for 2015/16, but NHS England’s plans are part of ongoing discussions about the long-term role of the pay review body.