Dr Chaand Nagpaul, GPC chair
The BMA’s GP committee (GPC) was clear from the outset that these annual variations to the contract could not resuscitate general practice from the brink of collapse following years of underfunding, rising patient demand, staff shortages and unresourced work being moved from hospitals into the community.
These limited changes provide some immediate financial support which for the first time in years recognises the expenses being incurred by practices and resources needed to deliver a pay uplift rather than a pay cut. There is no new clinical workload requirement or any change to QOF, and the deeply unpopular and imposed dementia DES will be removed with resources moving into core funding. The immunisation and vaccination item of service payment will increase by 28% from £7.64 to £9.80. There is also agreement to looking at ending QOF in its entirety and the Avoiding Unplanned Admissions enhanced service in April 2017.
However, these changes do not detract from GPC’s ultimatum to government demanding a clear rescue plan to sustain general practice in the immediate and longer term. We now need to focus on the real battle to revive general practice and which will require far broader solutions than tweaking the annual contract.
Stephen Golledge, lead negotiator for NHS Employers
We are pleased that after months of constructive negotiations we have been able to achieve an agreed contract. The changes will deliver considerable improvements in the quality of care provided to patients alongside a significant increase in the level of investment in primary care. It will also help to alleviate some of the pressures GPs have experienced in recent years. We recognise that more progress is needed to respond to GP concerns about workload and we remain committed to work with the BMA GPC.
Jeremy Hunt, health secretary
GPs are the bedrock of the NHS and I am determined to provide the support they need so they can spend more time with patients. Today’s deal is just the start of significant new investment for general practice which will help GPs to provide a truly modern, efficient service every day of the week.
Simon Stevens, NHS England chief executive
Today’s welcome agreement between NHS England and the BMA provides GPs with some stability and support, and shows what can be achieved through sensible and constructive negotiation. However this contract is only one small element of a far wider package we’re jointly developing to help practices with workload, workforce and care redesign.
That will require radical new options, including further support for GP recruitment and return to practice, funding for additional primary care staff, new options for practice premises, a reduction in paper-based red tape, alternative approaches to indemnity cover, and redesigned out of hours, 111 and extended hours arrangements, to name just a few – all underpinned by much greater team working across individual practices.
Jeremy Hughes, Chief Executive of Alzheimer’s Society
While it’s good news that GPs are more routinely identifying people with dementia, the job is clearly not done. Although the 66% diagnosis rate ambition set out in the Prime Minister’s Challenge on Dementia has been reached, it only reflects a national average and still leaves more than a third of people undiagnosed. This is higher still in some areas of the country that are failing to the meet this target.
The removal of the DES, which has been proven effective in starting to tackle unacceptably low diagnosis rates, could be seen very much as taking the foot off the gas on diagnosis.
With more people living with dementia, it’s right that there should be a real push to improve access to high quality post-diagnosis support, care and treatment, but a timely diagnosis is absolutely crucial. This low level of diagnosis is not tolerated for other health conditions and we question why dementia is being singled out as the only enhanced service to be removed.
For too long, people with dementia have been the poor relation within the NHS, with those with other diseases receiving far more support. Many people are living with dementia without a diagnosis at all, leaving them lost and confused while others still face unacceptable delays in getting a diagnosis. The £42m from the DES should now be invested in much needed post diagnostic support, treatment and care.
Dr Krishna Kasaraneni, chair of the GPC’s education, training and workforce subcommittee
Sadly, while there are positive elements within this agreement secured by GPC in a difficult climate, we still need a much bigger, bolder rescue package for general practice that addresses the multitude of pressures that are pushing the profession to breaking point.
There are points in the new deal that will provide some positive news for GPs. There will be no extra workload related to the QOF which will at least means the pile of paperwork in front of GPs won’t grow any bigger – well, at least from the QOF – this year. We also have an agreement to explore the end of the QOF in its totality and the unpopular avoiding unplanned admissions enhanced service will also be reviewed. Both of these are positive developments as is a decision to end the dementia enhanced service, with all its resource going into core funding, and the agreement to increase by 28% the vaccination and immunisation item of service fee. Most strikingly, the GPC has agreed an uplift in GP practice expense funding to £220 million to cover rising CQC fees and rising expenses. I will spare readers a rant at the fact that the CQC fees shouldn’t be even in the air given the failing and calamitous nature of the current inspection regime, but at least this uplift will lessen the financial load on practices.
However, while these changes are ones that will help general practice, the Government should not be fooled into thinking it lets them off the hook. We still need a bigger plan on workforce, funding and managing patient demand if we are to not just to hold back the tide facing general practice, but crucially begin to turn the corner back towards the kind of innovative GP services all want to see.
My message to the Government therefore is clear. Stop the false promises and undeliverable election pledges and get down to the business of delivering a proper rescue plan that saves general practice from the calamitous situation it currently faces.