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BMA defends staff uplift calculation amid GP affordability concerns

BMA defends staff uplift calculation amid GP affordability concerns

The BMA has defended the size of the uplift it has negotiated to allow England’s GP practices to increase staff salaries.

This comes in light of criticism by GP partners, who claimed they would need to dip into their own pockets to pass on the full recommended 6% pay rise to salaried GPs and non-ARRS staff.

The BMA said that although it has been ‘clear’ that a 6% uplift is ‘ultimately not enough’, it is ‘pleased that the additional funding advised by the DDRB will not come from cuts to services’.

And it highlighted that securing the funding via the global sum meant it was secured as recurrent funding for future years.

‘This uplift is a step in the right direction and we look forward to working with the Government and NHS England in the coming months to find a long-term solution to addressing sub-inflationary resource in general practice,’ a spokesperson said.

The BMA also went some way further to explain the calculations used and said the money, which is backdated to 1 April, should land in GP practices’ accounts this month.

The global sum has been increased for 2022/23 by £2.45, from £102.28 to £104.73. This accounted for a 3.9% uplift to staffing expenses, which is on top of a 2.1% uplift earlier in the year – together this totalled a global sum increase of £233.14m. 

But, as less than half of the global sum goes towards staff expenses, the 6% uplift is applied only to this portion of GP funding.

The update said: ‘The GP contract is notionally divided into three elements: GP contractor income, other staff expenses and other expenses.

‘As part of the five-year contract investment framework, the other staff expenses element was agreed to be 44% of global sum (GS), and NHS England have agreed to apply the 6% uplift to this part of GS, as this reflects the NHS income practices receive to cover these costs.

‘NHS England has confirmed that this element of funding is calculated to contribute to both the costs of salary, and on-costs, such as employers’ national insurance contributions, employers’ superannuation payments – into their employees’ pensions – and other staff benefits.’

The GPCE has also confirmed that it was successful in achieving a 6% uplift for the trainers’ grant, even though this did not form part of the DDRB’s recommendation for a pay rise. 

The BMA’s update admitted: ‘This supplementary uplift is being paid via the global sum and is not, therefore, tailored to the individual staff expenses of each practice. These will be dependent on their own staffing structures.

‘There is no England-wide GP contractual option that allows an individualised practice uplift; however, increasing investment in global sum is a key GPCE policy, which ensures this in-year uplift is recurrent and locked-in for future years.’

But it added: ‘GPCE believes the decision to further uplift this year’s GMS global sum, providing an additional contribution towards practice staff costs, is helpful: we know investment in staff is a key priority for GP contractors. 

‘This is the last year of the agreed 2019/24 contract investment framework, and the first in which a supplementary uplift has been agreed in-year.’

However, some GPs still questioned whether the uplift goes far enough.

Dr Michael Mullineux, a GP partner in Berkshire, told Pulse he thinks the assumption that 44% of the global sum payment goes towards staff expenses is ‘incorrect’ and as such the 6% pay rise is not ‘adequately funded’.

He said: ‘Although we run quite a tight ship, according to our accountants, with quite good cost controls, the reality is it’s about a third less than the funding required to give all our staff a 6% increase. 

‘That is the bottom line. I think they’ve grossly underestimated the amount allocated.’

He added that his practice ‘will be paying the 6%, but it isn’t adequately funded’.

‘It’s an expedient that we have to follow, but as always happens it comes down to the partners funding out of their own pockets.’

Lancashire and Cumbria LMCs chief executive Dr Adam Janjua said that, having done the calculations for his own practice, it is ‘very clear that the amount coming in does not cover all practice staff getting a complete 6% pay rise’. 

In an update to local practices, circulated yesterday, he said: ‘At a time when partners are having to cut their earnings to levels (in some practices) that are dangerously close to a salaried GPs earning – I can’t in good conscience recommend that they give all staff 6% if it eats up partner income once they have used up the full incoming amount.’

LMC chief Dr Janjua has advised his local practices to pass on the 6% uplift to all salaried GPs, but said that uplifts for other staff ‘are at the discretion of the practice management’. 

‘But we’d strongly encourage practice to pass on the full amount of incoming money and try and get staff as close to the suggested percentage of increase as possible. This will involve some difficult conversations with staff, but practice viability is paramount,’ he added. 

Medical secretary at YORLMC Dr Brian McGregor told practices that the global sum uplift is ‘not perfect as we are using a capitation based payment and practices will have different levels of staffing’.

But he said the BMA’s economists ‘believe the uplift will cover the pay rise and on-cost in the vast majority of practices’. 

A DHSC spokesperson said: ‘We are hugely grateful to GPs and their teams for the work they do.

‘Working closely with the British Medical Association, we accepted the Review Body on Doctors’ and Dentists’ Remuneration’s recommendation in full to give salaried general practice staff a 6% pay rise.

‘The GP contract has now been uplifted which means salaried general practice staff, including salaried GPs, will receive their pay rise this month, backdated to April.’

GP partners are bound by the five-year contract and are excluded from the salary uplift.

Although some salaried GP contracts may not explicitly link to annual DDRB awards, the BMA has said it encourages ‘practices to pass on the uplift they receive for the purpose it is intended’. 

In Scotland, a BMA survey found that the 6% pay rise for all doctors, including GPs but excluding juniors, means Scottish GPs are ‘more likely to leave the NHS’.



Please note, only GPs are permitted to add comments to articles

neo 99 4 October, 2023 5:50 pm

This is incompetence from the BMA again. 6% of 44% of the initial global sum comes to £104.98 not £104.73. In addition it clearly does not include on-costs. I suppose the expectation is the on-costs will come for the uplift from the final year of the appalling 5 year contract circa 2.5%. Be honest at least with your membership! Or if you really believe the current calculation includes on costs then you need to get a new GPC member working your abacus.

David Church 4 October, 2023 6:16 pm

So, after much persuasion from BMA, the DOH has slowly, reluctantly, warily, taken a step in the right direction, but not realised they are stood in the middle of an estuary, with tributaries either side of their homely soft sandbar, and they are still a long way from the beach, and the tide is coming is as tides do up flat estuaries. It’s OK. they have their mobile phones (which don;t work amongst the mountains around here), and can call the Lifeboat – but the lifeboat is needed elsewhere to rescue people abandoned by the broken NHS, so will it arrive in time?
Or will DoH get wet feet and catch a cold, or worse?

Douglas Callow 4 October, 2023 6:18 pm

BMA when will you ever learn- TIP don’t make an assumption of the proportion of global sum that is used for staff expenses you have had 5 months to go and ask LMCs to gather the accurate information from practices and their accountants !!

Matthew Shaw 4 October, 2023 7:25 pm

What about all the PCN staff? This is either divisive [- the PCN staff miss out ] or we dilute the meagre pay rise even further to subsidise the PCN staff and keep things equitable. So our staff expect 6% and we can give them 2%.

Julius Parker 4 October, 2023 8:44 pm

Dear Colleagues ( who read Pulse)
DOI Deputy Chair GPC England
Several points; the 44% figure is not 44% of Global Sum, it is 44% of that proportion of the GP Contract that contributes to “staff expenses” as distinct from GP income and other expenses. GPCE did confirm in writing with NHSE this proportion of the GP contract included on-costs. No, we know it doesn’t cover all practice cost pressures and the negotiations were never about that, they were solely focused on staff expenses. Using Global Sum as a contractual vehicle embeds this into our Contract as a recurrent uplift, but as a captitated payment mechanism it isn’t going to match up with practice expenses on an individualised practice basis. On 1.4/23 GP partners had a 2.1% uplift and no more, and no prospect of receiving more based on the past four years — this is the first in-year Global Sum increase of the multiyear deal. ARRS staff have already received an Agenda for Change 5% uplift within the ARRS allocations and these negotiations were for directly employed GP practice staff, including salaried GP colleagues, only. I believe this is a start and a first step in the right direction.

Dr No 4 October, 2023 10:26 pm

We already took a 5% pay cut (Partners) to help fund 2.1% this year. The global sum up lift is NOT enough to find 6%. We cannot sustain further partner pay cuts. Ergo, services WILL be cut to fund this 6% in my practice. If we don’t meet 6% for our staff I will be explaining to them exactly why not, they deserve nothing less. GPC you have been captured by your masters. You are sheep negotiating with wolves. Another nail in the coffin…

Michael Mullineux 5 October, 2023 7:18 am

Sorry Julius that is obtuse nonsense. 6% fully funded was the promise that was made. Your BMA colleagues have contacted salaried GPs to highlight that they should receive 6% and that anything less would not be acceptable. Then you have effectively shafted partnerships throughout England expecting us to pick up the bill for the wholly inadequate increase negotiated as a ‘start’ to improved funding clearly without even taking medical accountant advice on staff costs using a percentage of 44% which is so far off the mark that one wonders whether any GPC negotiators have ever looked at a set of medical accounts

Mr Marvellous 5 October, 2023 10:41 am

@Julius thanks for the further information but I would concur with Michael Mullineux here – we’re told by our specialist medical accountants that our staff costs are at the low end compared to their other GP clients (of which they have many). The increase, for us, won’t cover the 6%.

There’s something really wrong here with the assessment, and the 44% assumptions seems quite wrong.

Julius Parker 5 October, 2023 11:18 am

Dear Colleagues
DOI Deputy Chair GPC England
Thank you for this feedback; apologies for apparently being obtuse — I thought greater transparency would be helpful. It may be nonsense to some people but at least it isn’t fake-news. The 44% proportion of the Contract Funding contributing to staff expenses was fixed at the start of the five year deal and as colleagues will be aware NHSE/DHSC will not negotiate outside that, so it was (in my opinion) constructive that they would consider any additional funding at all. GPCE could have declined to negotiate and presumably NHSE/DHSC would have imposed whatever outcome they considered most appropriate. I would reiterate that on 1/4/23 partners had only a 2.1% increase and no expectation of any further funding based on what has happened over the past four years. GPCE completely understands the pressures faced by partnerships both financially and in many other ways. This is a contribution to those costs framed within the NHSE/DHSC negotiations on this issue (that is to implement a staff expenses. element), and represents a 5% overall increase in Global Sum for 2023/24

Gregory Rose 5 October, 2023 1:07 pm

HI Julius,
Thanks for sticking your head above the parapet and conversing on here. I would like to ask you one thing, staying away from the concerns about how the uplift has been applied that cause so much antagonism.
My concern is how the BMA represent the interests of salaried GPs so strongly when it is so hard for you to do so with partners due to the link to inflexible and imposed national contracts. There is a determined message on salaried GP rights via BMA contracts and salary uplifts etc. Yet every time salaried GPs are strongly represented, partners (and practices overall) feel the consequences as we aren’t in a position to resist. So we end up between a rock and a hard place when it comes to inadequate (and imposed) national contracts led on by the GPC, and the BMA support for salaried GPs. And yet the BMA via GPC are our representatives too. It feels like one section of the BMA supporting salaried GPs is paying no account at all of the difficulties in the contracting for practices that are giving problems for partners. Is this something you are aware of and are looking into?

Douglas Callow 5 October, 2023 1:12 pm

BMA are betting that Tories and labour will push on with a wholly or near as damn it salaried GP service Gregory

Gregory Rose 5 October, 2023 1:18 pm

Yes, I know that’s the direction of travel for the politicians. I wish them luck with that. I have very good salaried GPs in a very successful practice. But without partners to lead, it will all fall apart very quickly. I’ve not seen a managed salaried GP only service yet that doesn’t just fall apart and end up with CQC issues etc. Happily by the time they’ve worked out how to move in that direction I will almost certainly be retired.

M Rain 5 October, 2023 2:10 pm

If no money is paid by the government to “Adequately” pay for the “promised” 6% pay lift, then it wont be passed on to staff, It is as simple as that. I wonder where the extra £350 million pounds per week for the NHS promised during Brexit campaign is being spent. Can we not dip in to that money to fund this pay rise? I wonder where that money is? Perhaps it never existed.

Darren Tymens 5 October, 2023 5:50 pm

The rough maths – taking us to 6% plus on-costs – would seem to me to be as follows:

44% x (6% – 2.1%) = 1.716%
(assumptions: average practice cost of staff is 44% of GMS income (obviously this is open to debate but is NHSE’s figures); 2.1% already delivered for staff costs in last year of 5 year contract)

1.716% x £99.70 = £1.71
(assumptions: the GMS funding from 2022-23 is used, prior to the 2023-24 uplift being applied)

£1.71 x 10/7 = £2.44
(assumptions: on costs consist of approximately 30% of staff costs)

The further increase to this year’s GMS in this deal is £2.45

Likely results:
Practices with non-partner staff costs > 44% of GMS income may be worse off
Practices with non-partner staff costs < 44% of GMS income may be better off

Good points:
– NHSE didn't tell us what they told hospitals ('find the money from within existing funding')
– Money into GMS, so recurrent
– First time NHSE have offered additional money to account for increased expenses in 5 years
– Trainers grant increase a helpful bonus

Bad points:
– Not everyone wins (though still better than the default of no extra funding)
– Nothing about other increased expenses (though this was never on the table)
– Nothing in it for Partners (though this was never on the table either)

Carolyn Protheroe 5 October, 2023 6:11 pm

Gregory Rose I agree, I am a 6 session partner at a heavy doctor number well run 8000 partnership but I locum in a deprived area practice run by a non profit organisation. They have been unable to retain GPs, they run on locums, the lack of continuity in a demanding and unhealthy population is detrimental to care. But salaried gp leave and lack the inclination to push change, indeed why should they put up with the workload and difficulties when there are plenty of other opportunities. The push to salaried does not recognise the investment in time and forethought and pride that is accompanied by being a part of a partnership. It is ownership and responsibility. This is poorly recognised by all political parties.

Michael Mullineux 5 October, 2023 7:01 pm

Some of the content seems to suggest we should be grateful for any increase demonstrating clearly how pathetically browbeaten we have become. We were promised a 6% increase to fund this proposal. It was a surprise, but it was promised. This has not been delivered. There will not be a single practice in England that only spend 44% of Global sum on staff costs. If there is, please let me know how you manage this. This appears to be an extrapolated figure from the NHS as a whole diluting true GP costs. Have a look at your accounts, ask your accountants. Staff costs in General Practice are at best 60% of Global sum and at worst probably exceed 75% Partners sold short again. And we should be grateful?

Vikas Kaura 5 October, 2023 9:03 pm

Let’s move on and while we have the ear of the GPC deputy chair.
The GMS contract is not fit for purpose, it has allowed the creep of vertical integration of hospitals into GP with no resistance(now almost complete)
You seem to be bound by contracts when negotiating. How about negotiating a GMS contract that can be defended. All GPs both salaried and partners will benefit.

Julius Parker 5 October, 2023 10:37 pm

Dear Colleagues
Usual DOI Deputy Chair GPC England
Dr Mullineux: it is not 44% of Global Sum — the calculation used was 44% of Contract income, Global Sum is the ( in my view) appropriate payment vehicle. Global Sum is only one part of Contract income and I agree, staff costs for practices will be greater than 44% of it, because it is only a proportion of practice income
Dr Kaura: agreed, we will be negotiating the 2024/25 contract outside the confines of the multiyear deal; and GPC England does want a contract that is good for all GPs, and as Dr Rose asks , yes, GPC England believes ( alongside LMCs) that the Independent Contractor Model offers, or rather, can offer, the most cost-efficient, professionally rewarding and patient-focused method of delivering General Practice — that is primary medical services to a registered list model. I used the word “start” because as you know GPC England is under new leadership and this is the start, as in first step, of our substantive Contract negotiations.

Andrew Schapira 10 October, 2023 1:58 pm

Isn’t the problem a hopelessly divided profession incapable of agreeing on industrial action