Exclusive GPs will again be incentivised to take up out-of-hours work through winter via a temporary indemnity cover scheme, despite NHS England pledging a long-term solution this year.
Urgent care bosses have been briefed by NHS England that a winter scheme will run again, with funding likely to be higher than last year to reflect the rising costs.
The Winter Indemnity Scheme – which saw indemnity costs covered for GPs who agreed to take on additional shifts – ran for the last two years. But NHS England had said the temporary solution would not run for a third year, having pledged a more long-term solution would come in from this April.
A letter from NHS England’s national urgent and emergency care director Pauline Philip said: ‘To help with winter planning, I wanted to give you early warning that NHS England is planning to re-run the GP Winter Indemnity Scheme this year to support out of hours and unscheduled care services to secure additional capacity during winter.’
She said this comes as last winter’s scheme, which ran from October to the Easter Bank Holiday, had helped secure and additional 80,000 sessions of GP cover in out-of-hours and unscheduled care, including NHS 111.
The letter added: ‘The scheme is planned to run from October 2017 to April 2018 and is likely to be in excess of the £5m announced last year, recognising continuing increases in indemnity premia. NHS England is finalising the details and will announce this as soon as it is ready to run the scheme.
‘CCGs were advised last year that the Winter Indemnity Scheme would not be repeated again this year so we hope that doing this will support your discussions and plans for increased winter capacity.’
The BMA’s GP Committee has been in negotiations with NHS England on the imminent hikes, led by deputy chair and indemnity lead Dr Mark Sanford-Wood.
He told Pulse: ‘NHS England understand absolutely the need for a reasonably urgent announcement to stabilise the market, to allay fears from the profession, so the provision over the winter months will not – as far as possible – be impacted by indemnity.
‘Our discussion has primarily talked about emergency and out of hours care. We recognise that is the major, mission critical area.’
But out-of-hours leaders said that whilst the support was welcome, there was disappointment that NHS England and the Government will again resort to an interim solution to pay for additional shifts over winter.
They particularly raised concern that the winter scheme had done nothing for ‘loyal’ GPs for whom out-of-hours work is a regular part of their portfolio work, as it only covered additional shifts.
Added to this, this year indemnity fees in and out of hours are expected to spike far beyond the typical annual inflation due to changes to the discount rate, the formula for calculating compensation claims, which took effect this year.
Urgent Health UK chair Dr Simon Abrams told Pulse: ‘Whilst this is undoubtedly better than no scheme, and is likely to provide some assistance, we remain concerned on a number of areas.
‘Our members were concerned that the scheme did nothing for those GPs who already work shifts. Ie it is not supporting those loyal to the service who are already flexible.’
He said in addition, the rises to costs expected in the next months related to the discount rate would ‘stop more GPs from working’.
He added: ‘What is needed is a definitive answer, not the interim one that the Winter Pressures Scheme offers.’
NHS England and the Department of Health declined to comment on the winter scheme, but a DH spokesperson said they remain in talks with GP representatives and MDOs about a wider solution to the problem of rising indemnity.
As previously reported, the DH has pledged that it will protect GPs against rising fees for in-hours work relating to the discount rate changes, with the parties in urgent talks on the matter. The GPC has said all options are on the table including a national risk pool.
GPC chair Dr Richard Vautrey has warned that working as a GP is to become ‘untenable’ for many by this autumn.
