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Government should review high cost of NHS-managed practices, say GPs

GP representatives will be asked to vote on whether to urge the Government to undertake a review into the costs of health board-managed practices.

The motion, scheduled for debate at the Wales LMCs annual conference on Saturday, calls for scrutiny to ensure that investment in independent general practice is not ‘detrimentally impacted’ as a consequence of spending in practices run by health boards.

It is a hot topic after figures collected by the RCGP showed an 885% rise in the number of managed practices in Wales over the past five years to now cover 5% of all patients.

A report from the BMA in October warned that some health boards were running up large overspends as a results of running managed practices.

In a briefing document prepared for Assembly Members, the BMA said the data confirmed that managed practices are more expensive to run and do not provide value for money. 

The increase in the number of managed practices is largely down to practices being forced to hand contracts back because of severe recruitment and retention problems.

Other motions to be discussed at the conference touch on these issues with one calling on GPC Wales to urgently negotiate with the Government to mitigate the impact of last-man-standing issues.

GP representatives will also be asked to vote on pushing the Welsh Government to make up its mind whether it truly wants to preserve independent contractor status and to rebuild confidence in GP partnerships.

On premises, the conference is set to hear that that premises issues are a major barrier to recruitment of new GP partners – a reality that needs to be addressed in contract negotiations.

And following from similar calls in Northern Ireland, LMC members will be asked to vote on adopting the Scottish model for ownership of GP premises. 

This comes as GP leaders in Northern Ireland recently told Pulse they want GPs to have the option of an interest-free loan to enable the NHS to take over responsibility for premises, emulating the offer which has been introduced in Scotland.

Other key motions to be debated include:

  • Giving GP clusters financial independence and control of community budgets 
  • Negotiating incentives to retain GPs close to retirement
  • Renumeration for GPs for work around GDPR compliance
  • An external audit of the NWIS GP IT procurement process

Motions in full

Agenda committee to be proposed by Dyfed Powys That conference encourages Welsh Government to make up its mind whether it truly wants to preserve the independent contractor status of General Practice; and: 

i. calls for the Welsh Government to develop measures to rebuild confidence in the partnership role in General Practice. (Gwent) 

ii. advises that urgent investment is required to allow this model to continue, otherwise GMS will collapse by default. 

iii. requests that Welsh Government and Local Health Boards acknowledge and address the situation where a well functioning practice is progressively destabilised when a neighbouring practice fails.

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Agenda Committee That conference:

i. demands that GPC Wales urgently negotiate with Welsh Government as a priority to offer assurance to GPs of mitigating last person standing risks of premises and staff redundancies. (Bro Taf)

ii. urges Welsh Government to make a definite commitment to ensure Local Health 

Boards address last person standing issues. (Dyfed Powys)

iii. requests Welsh Government acknowledges the inherent unfairness & inequity 

of struggling practices who have no option but handing back their GMS contract regarding staff redundancy costs, where large practices generally become HB managed with staff TUPE arrangements, while small practices are dispersed with considerable staff redundancy liabilities for the partners. (Dyfed Powys)

iv. demands Welsh Government address the sustainability of General Practice by an insurance policy to protect partners against the risk of bankruptcies. (Gwent)

Agenda Committee That conference believes that: 

iv. clusters should should control the community services budget in 
each area and not Local Health Boards. (Morgannwyg)

v. clusters should have statutory financial independence to avoid LHBs diverting or blocking appropriately commissioned services and calls on GPCW to initiate this discussion with Welsh Assembly Government. (North Wales)

Dyfed Powys That conference:

vi. asks that GPC provides guidance for practices on 3rd party premises issues. 

vii. asks GPC Wales to remind GP tenants/signatories in 3rd party premises developments that they are responsible for the tenancy cost until the end of the lease, even if the development ceases to attract notional rent payments, and this may impact on their personal assets. 

viii. advises Welsh Government and GPC Wales that premises issues are a major barrier to recruitment of new GP partners and asks that this is addressed as part of any contract revisions. 

ix. requests that Welsh Government adopts the Scottish model for ownership of GP premises.

Source: BMA Wales