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Only 9p per patient of global sum uplift is new funding

GPs in England will receive just 9p of new funding per patient this year to cover the costs of inflation and the new work involved in the GMS contract, with the bulk of the global sum uplift coming from money recycled elsewhere.

Although the global sum rose 92p per patient for 2019/20, almost 90% of that was from a transfer of funds from schemes the NHS is phasing out – seniority payments and the Minimum Practice Income Guarantee (MPIG).

The remainder – 9p – is to cover the costs of inflation and the extra work involved in the core contract, such as providing appointment slots for NHS 111, funding to fulfil the requirements around subject access requests and the work caused by problems with Capita’s primary care support services.

The 9p per patient also incorporates the funding to widen the extended hours DES access levels from the current 70% of the population to 100%. 

NHS England has committed to increasing funding in general practice by £109m this year. However, much of this has gone towards the costs of the new NHS indemnity scheme, which was introduced to ease spiralling costs for GPs, the requirement to join networks and a ringfenced chunk of funding is for employing non-GP staff members.

The Implementing the 2019/20 contract document reveals that 39p of the global sum uplift is recycled money from the phasing out of MPIG, and 44p is for the phasing out of seniority payments.

The NHS has been phasing out MPIG since 2014/15, reinvesting it into the GMS global sum, but that process will finish in 2020/21. The phasing out of seniority payments will similarly end in March 2020.

A 9p increase in new funding in England pales in comparison to previous years. In 2018/19, GPs received £1.75 in new investment within a total uplift of £2.57 per patient.

A BMA spokesperson said: ’As in previous years, additional funding will flow in to the GP contract through a number of routes. This year alongside the global sum increase all practices that engage in their PCN will receive a guaranteed £1.76 per patient to use to cover routine practice expenses, leading to an overall increase of £2.68 per patient. This is in addition to the significant reduction in expenses with the removal of indemnity costs for each and every GP.’

However, Dr Dean Eggitt, medical secretary of Doncaster LMC, said: ’It is a waste of money to give that to general practice. It will do absolutely nothing to improve patient care.

’The Department of Health may as well have kept that cash and spent that elsewhere or put it in the bank and saved up for another rainy day.

‘They either have to decide to fund care properly, work out how much it’s going to cost and pay for it, or, hand on heart, say to the general public “We cannot continue to deliver these services because we cannot afford it. It will not be delivered and these are the services that are going to stop”.

’There is a constant gaming with NHS England and the Government of promising newer services, promising better services, but not funding it. It’s insulting.’

On new funding going to indemnity, he said: ‘In part I think it was a wise decision in the sense that we know that some GPs cannot afford to work simply because indemnity has priced them out of the market. It allows to get some of the workforce back in. Some of that money that can be saved from spending on indemnity can be put back into practices.

’But in terms of improving patient care, getting more bums on seats, getting more patients seen, that’s not going to help. But that’s what’s been promised. We need to stop promising things we can’t deliver.’

In Wales, a similar indemnity scheme led to a £2.88 – or 3.2% – cut in the global sum per patient, drawing the ire of GPs in the region.

GPs in North Wales warned that the decision would be the ‘final nail in the coffin’ for many practices who were already struggling with severe recruitment problems.