The Welsh LMC conference will vote on a motion proposing that Wales moves to a item-of-service fee GP contract similar to that used in Australia.
This year’s conference agenda highlights that Welsh GPs are concerned with sustainability of practices amid workload and financial pressures.
Motions include demands for workload limits, premises support as well as specific bailouts for struggling practices.
One motion says that ‘conference despairs at the thought of continuing to flog the dead horse that is our capitation-based GMS contract, and we rejuvenate our call for GPC Wales to negotiate an activity-based model’.
It adds that ‘conference urges GPC Wales to negotiate an IOS fee based unified GMS contract similar to that in place in Australia’.
English GP representatives voted in favour of keeping a capitation-based contract from 2024 at a closed session of the England LMC conference in November, as Pulse revealed.
Welsh GP leaders will also vote on whether to request that the Welsh Government provides ‘financial support to practices in line with rising inflation for the purpose of sustainability and stability’.
For practices at risk of closing, the conference will debate whether the Government should ‘mandate the provision of a meaningful support package from [local health boards] if a practice is found to be at high risk of collapse’.
The motion claims that the current sustainability process is ‘not fit for purpose’ and support provided by LHBs for practices at risk is ‘at best inadequate and at worst non-existent’.
Just this week, a GP practice in Ceredigion warned it will have to shut unless it is able to recruit additional GPs, likening itself to ‘a sinking ship’.
Welsh LMCs will also debate motions on whether rural and multi-site practices should receive additional funding in recognition of being more costly to run.
And they will question the ‘cluster’ model – similar to England’s primary care networks – that was brought in and mandated via the 2014/15 GP contract.
GP leaders will also propose motions to regain protected learning time and cover arrangements that were lost in the 2022/23 GP contract.
And they will discuss recruitment schemes, including a motion to retain the incentives to encourage GP registrars to choose GP vocational training schemes in Mid, West and North Wales.
Lastly, the LMC conference will debate a motion proposing that the Welsh Audit Office ‘examine the value for money obtained when managed practices are run by LHBs’.
An ageing workforce and increased patient demand since the pandemic has compounded a longer-term issue of practices being forced to hand back contracts to health boards, GPC Wales warned last month.
Choice motions in full
Sustainability
Conference believes that the current sustainability process is not fit for purpose, and that the support from Local Health Boards (LHBs) for practices at risk is at best inadequate and at worst non-existent. We call on GPCW to:
i. work with Welsh Government and LHBs to reform the process and make it both simpler and more responsive.
ii. mandate the provision of a meaningful support package from LHBs if a practice is found to be at high risk of collapse.
Rising building costs are putting practices at risk of financial collapse. Conference calls on GPC
Wales to task Welsh Government to:
i. Put sufficient short term financial support (above the current contract agreement) in place to avoid contract hand-backs.
ii. Work in the medium term to de-risk the premises element of general practice along the lines of the Scottish model.
That Conference urges Welsh Government and NHS Wales to review funding formulae for multisite and small rural practices to prevent further practice failures, in the spirit of the original Carr-Hill formula.
Conference asks Welsh Government to recognise the increased burden of resourcing and running branch surgeries by providing a monetary uplift to practices with more than one site.
Conference requests Welsh Government to provide financial support to practices in line with rising inflation for the purpose of sustainability and stability
Workforce
That Conference calls on Welsh Government to develop a short, medium and long-term workforce strategy, in conjunction with other relevant partner agencies, and to ensure that contract negotiations acknowledge the reduced capacity, accepting that ‘Business as Usual’ is no longer an option.
Workload
Most GPs in Wales are regularly consulting at levels in excess of the 35 patient contacts a day recognised as the threshold for ‘unsafe’ workload by the BMA. Conference calls on GPC Wales to ensure that practical and effective steps are taken within the contract negotiations to bring consulting rates within safe limits for the sake of patients, clinicians and the sustainability of General Practice
Access
Conference believes that improved continuity of relationship-based care should be encouraged in preference to access targets.
Urgent care
Conference demands that Welsh Government and Health Boards take action to ensure the timely provision of Ambulance services for patients, and not expect GPs to provide urgent and emergency care until the ambulance reaches the patient.
Education and training
Conference is disappointed in Welsh Government’s unilateral removal of the universal training incentive scheme and calls on them to reinstate the payment of the first Applied Knowledge Test (AKT) and Clinical Skills Assessment fee for all trainees in Wales.
Conference advises Welsh Government that the incentives to encourage GP registrars to choose GP vocational training schemes in Mid, West and North Wales have had a positive effect, and request that it is continued to build a sustainable GP workforce in
these areas.
Climate change
Conference asks NHS Wales to measure the carbon footprint of a sample of Welsh GP Practices in order to better understand the steps needed to deliver net-zero carbon Healthcare.
GMC contract
The half day and lunch time closing changes within the 2022-23 contract put a disproportionate strain on small practices. Conference asks GPC Wales to ensure that reciprocal cover arrangements are recognised in subsequent contractual agreements
Conference recognises that LHBs were guilty of a contractual breach by not providing cover to facilitate practice protected learning time in the previous contractual year. We call on GPCW to ensure that in the future full cover will be mandated from LHBs for all protected learning sessions.
Conference despairs at the thought of continuing to flog the dead horse that is our capitation-based GMS contract, and we rejuvenate our call for GPC Wales to negotiate an activity-based model.
Conference urges GPC Wales to negotiate an IOS fee based unified GMS contract similar to that in place in Australia.
Collaboratives
Conference observes that despite political desires, Clusters are not delivering improved services, Accelerated Clusters are not deemed fit for purpose and these should be scrapped, and resources transferred to core General Practice.
Health boards
Conference directs GPC Wales to instruct the Welsh Audit Office to examine the value for money obtained when managed practices are run by LHBs within Wales.
READERS' COMMENTS [3]
Please note, only GPs are permitted to add comments to articles
Quick research tells me health spending for primary care in Australia is approx 34% of the yearly budget. Most of it goes to allied health professionals rather than GPs, who have about 20% of this share (or approx. 6% of total) with the rest shared between midwifes, physios, dentists etc.
https://www1.racgp.org.au/ajgp/2021/september/general-practice-and-primary-healthcare-health-exp
You can actually see a GP in Australia, which is already an Improvement on the NHS.
“support provided by LHBs for practices at risk is ‘at best inadequate and at worst non-existent’. ”
Oh, so there has been some improvement since 2015, then, at least at the ‘at-worst’ end!