The GP contract deal arrives at a difficult time for the NHS, with the Government’s decision to impose the junior doctor contract threatening to force a generation of young doctors abroad and wider pressures, from funding to rising patient demand, buffeting an increasingly stretched health service. Will this deal make a difference to creaking GP services suffering from its own huge problems? 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.
Stop the false promises and undeliverable election pledges and deliver a proper rescue plan that saves general practice
Although the challenges facing GP services are well known, it is worth restating them from the outset. We have a service that is being overwhelmed by rising demand for appointments and other services from an increasingly complex population with divergent needs. Politicians of all parties have systematically failed to provide the funding to match this demand and to make matters worse have ignored the impact this has had on the workforce. A third of GPs told a BMA survey recently they were considered retiring in the next five years while in 2015 there were 600 trainee vacancies across England. The imposition of the junior doctor contract, which will make working in the NHS unattractive to all medical graduates, is unlikely to make this situation better. Added to this are delays with the investment in infrastructure funding, the running down of the GP occupational health service – I could go on and on.
In this environment, 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.
Dr Krishna Kasaraneni is chair of the GPC’s education, training and workforce subcommittee and a GP in Doncaster