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DH suggests boosting GP practice funding will not alleviate recruitment problems



The Department of Health has said it does not think increasing GP contractual funding will help relieve recruitment and retention problems in its report to the independent pay review body.

In evidence submitted today to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), the DH argued that because GP practices are independent businesses they may not decide to use an uplift to boost recruitment and retention.

It also rowed back on previous proposals to look at how a funding uplift could be variably applied to target areas with poor recruitment.

The DH did not make a recommendation on the size of a GP uplift based on expenses, referring instead to NHS England’s submission on the subject – which said no funding uplift was necessary.

In today’s submission, the DH said that there was no guarantee practices would use an uplift to support recruitment and retention. 

It said: ‘GP practices are independent businesses and the Review Body will… want to take into account the ability of practices to decide how to apportion any uplift and that this might not support recruitment and retention.’

It added that, actually, ‘work is already under way’ to ’boost the GP workforce as part of the ten point plan’, agreed between NHS England, Health Education England, RCGP and BMA.

It said: ‘The Review Body will wish to consider any uplift within the context of the work already being undertaken.’

Health minister David Prior wrote to the DDRB in November last year asking it to consider how an average uplift of 1% ‘could be applied to improve recruitment and retention’.

However, today the DH warned that targeting funding uplifts to the areas with the greatest recruitment problems would ‘cut across’ the current review of the Carr Hill GP practice funding formula. 

It said: ’Having carefully considered the case for targeting the pay award to support recruitment and retention, following the remit from the Chief Secretary to the Treasury, we do not consider that there is a strong case for targeting in 2016/17…

’The Review Body will want to consider the impact on patient services of applying any differential uplift to GP contracts. As a considerable proportion of practice income is based on a weighted capitation formula, which takes account of patient profile, we have strong concerns that a differential uplift would cut across the operation of the formula.’

NHS England’s evidence to the DDRB, submitted in November, said GP practices may not need any funding uplift at all, prompting the GPC to say NHS England’s claims were ‘ridiculous’ and risked further damaging GP morale.

An independent study into why large numbers of GPs leave the profession before the age of 50, commissioned by NHS England and Health Education England and published last week in the British Journal of General Practice, cited ‘funding cuts’ as one of the key organisational changes to general practice that was pushing people to change career.

Is the Department of Health targeting promised 4% funding uplift towards new seven-day access contract?

Richmond House - DH - Department of Health - online

Richmond House – DH – Department of Health – online

Source: Charles Milligan

Last year, the Government applied a 1.16% funding uplift to the GMS contract, a similarly below-inflation uplift as in recent years.

Health secretary Jeremy Hunt has admitted that general practice funding has been ‘neglected’ by the Government and promised a boost to general practice funding of at least 4% every year until 2021, including a 4.2% increase in the allocation to general practice to £7.65bn in 2016/17.

However, the DH submission, the first indication since the 4.2% funding announcement, makes clear this will not come via the GMS contract – a deal which Mr Hunt has repeatedly referred to as a ‘disastrous’ agreement struck between a Labour Government and the BMA in 2003. 

But although the DH submission focuses heavily on the topic of contractual reform, it does not mention renegotiation of the GMS contract.

It instead focuses entirely on the Prime Minister’s new voluntary GP contract for practices with 30,000 patients or more – which will deliver seven-day routine appointments.

The DH submission says: ‘NHS England will now work with the medical and nursing professions to offer, by April 2017, a new contract that properly recognises the outcomes that GPs and their colleagues deliver for patients, including seven day access.

‘The key principles of the new contract will be: more money for primary care; more control for GPs over the way they work; and more time to care for patients including through services seven days a week. This will be supported by funding from within the £10 billion of extra investment already committed to the NHS on the back of a strong economy.’