It is a marker of how tough things are in general practice that NHS Employers and NHS England have agreed to such minimal contract changes for 2015/16. Many of the changes made this year will meet with approval – or perhaps apathy.
I expect most GPs will be delighted that changes to the QOF will be minor – no threshold shifts, no new work and no significant changes to payment other than to accommodate patient numbers.
The ‘named GP’ is just a return to 2004, when a registered list was in the name of a partner. I doubt this will add much work as we only have to tell patients who their doctor is ‘at the first appropriate interaction’. And automatic parental leave is a step in the right direction.
I also feel heartened by the widening of electronic access from next April. Patients will be given online access to coded information in their GP records, and there is a move towards making more appointments bookable online and offering email access to the practice. This can help people to work with their doctors in the management of long-term conditions; my only worry is the need to weed out record entries involving third parties, which could take a lot of GP time. More online booking adds little work for my practice, saves receptionist time, and I have not come across any misuse of the system among my patients.
While voices have been raised against the publication of GP earnings, only earnings relevant to NHS and CCG payments have to be stated, and as an aggregate amount alongside the number of GPs in the practice. Except for singlehanders, these figures will be meaningless. And they’ll backfire on the Government when people see how little we are paid.
A few things about the contract do bother me – for example, the inclusion of the patient participation and alcohol enhanced services in our baseline. Important areas have not been addressed. We need a rethink of the burden placed on GPs by financial stringency, the whims of the CQC and the barriers for returners.
Although the contract again fails to address gross underfunding, I broadly welcome the changes. Let 2015 be the year of the banishment of bureaucracy and the liberation of general practice.
Dr Peter Swinyard is a GP in Swindon and chairs the Family Doctor Association
On the face of it, the contract for 2015/16 seems an okay deal. It is a relief for GPs and practice managers to know that the unplanned admissions DES paperwork will be halved, and that the patient participation and alcohol screening DESs will be consigned to the bin. Giving patients a ‘named GP’ sounds sensible, if time-consuming to organise; so does offering to pay backfill for GPs to take parental leave. And thank goodness there are no additional QOF indicators.
But I don’t think grassroots GPs should be rejoicing. I see this contract as a much-needed chance to come up for air before being dragged under again – a moment of calm before the storm of a general election.
For example, the saga of the unplanned admissions DES is far from over. The bureaucracy appears reduced, with the reporting requirements cut by half, but now there will be a patient survey at the end. It fills me with despair that something we do anyway for patients who are vulnerable or have multiple comorbidities has been hijacked.
The service will become unnecessarily prescriptive and complicated, diverting attention from the few who need it most. The DES should, in fact, be abolished.
Other apparently positive changes are less helpful on closer inspection. Giving patients access to coded information in their records sounds sensible. But GPs will have to withhold codes that might not be in patients’ best interests or that involve a third party. Text information about consultations will not be available. Yet that would at least be useful so patients could review what was discussed.
Publishing pay off-putting
While the requirement to publish average GP earnings may leave the Daily Mail fewer things to bash us with, it will have a devastating effect on recruitment for lower-income practices. Some of us in deprived areas have below-average earnings and will struggle to attract staff when our paychecks are out for everyone to read. A further rift will open between salaried GPs and partners if individual earnings go public in 2016/17.
Politicians will tell the public we have got good deal. No doubt we will be made to feel guilty for moaning about extra work and less money for yet another year.
Dr Richard Ma is a GP in Islington, north London