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Health boards go into deficit to sustain directly-managed GP practices

Some health boards in Wales are running up large overspends as a result of running managed practices, the BMA has warned.

In 2017/18, Betsi Cadwaladr University Health Board in North Wales – a region with by far the highest number of managed practices at 13 – overspent by £1.3 million compared with a deficit the previous year when they only had seven managed practices, BMA Wales reported.

And Hywel Dda University Health Board who were responsible for three managed practices in 2017/18, had an overspend of £1.1 million.

Figures from both these health boards show they relied heavily on locum sessional GPs and salaried GPs backing the BMAs long-argued view that such practices are much more expensive to run than those with a GMS contract.

Data included in a briefing paper for Welsh Assembly Members confirm that managed practices do not provide value for money for the health board and the taxpayer, BMA Wales said.

Betsi Cadwaladr allocated £8.89 million of its total budget to managed practices in 2017-18 but ended up spending £10.19m the data shows.

The average overspend of each of the managed practices in last year was £100,355 with one practice reporting busting the budget by £599,296.

And it spent an average of £226,851 per practice on GP sessional locums.

Hywel Dda – which attributed the overspend to increased use of locums – spent which £3.2 million on its managed practices in 2017/18 compared with 2.1 million the previous year.

BMA Wales pointed out that health boards were starting to realise that the cost of directly managing a practice is not sustainable and are actively trying to return them to GMS status.

The latest ‘heat map’ shows 29 health board managed practices across Wales and 82 practices deemed ‘at risk’.

BMA Wales is currently in the process of negotiating a new GP contract with the Welsh government.

Dr Charlotte Jones, chair of the BMA’s Welsh GP committee said: ‘BMA Cymru Wales has always been clear that the most cost-effective way of providing primary care services is via the independent contractor model providing GMS services.

‘It is better for patients, providing them with the continuity of care they deserve and provides better value-for-money to Health Boards and ultimately the taxpayer.’

She added she welcomed moves to return managed practices to GMS status but it could not be overlooked that there are still practices at risk and considering handing back their contract who need more support.

‘We will continue to encourage Health Board’s to support practices, all of whom are facing challenging times across Wales.

‘This would include addressing last person standing issues through active intervention on premises by taking over or guaranteeing leases, as well as addressing additional challenges and pressures to make partnership an attractive option for GPs now and in the future.’

But Betsi Cadwaladr executive director for primary care, Chris Stockport said there were a number of factors that had not been included in the BMA report, including a reducing in prescribing costs due a quality scheme they had introduced.

He added: ‘There a number of reimbursements that the Health Board makes to GP practices such as for staff cover and costs associated with building improvements that were not included in this data for our managed practices, this data will be included in the future.’

Costs related to training and raising staff wages should also be taken into account he said.

‘We continue to look at all areas of our operation to ensure we make appropriate savings whilst also ensuring patients in North Wales receive the highest quality care.’

Jill Paterson, director of primary care, community and long-term care at Hywel Dda University Health Board said: ‘The health board is currently reviewing service provision across all managed practices, looking at skill mix in line with the primary care model for Wales to deliver safe and effective patient services. Wherever possible, we are seeking to return managed practices back to independent status with a GMS contract and the first of these is due to complete in early 2019.

‘We are currently reviewing all locum costs and have proposed a locum cap to reduce costs to support our ambition to build robust high quality multi-disciplinary teams.’