This year’s new GP contract has been released.
GPs have their say on the changes:
Dr Paul Evans, chair of Gateshead and South Tyneside LMC – ‘Essentially, it’s not as bad as I’d feared – is it possible that NHS England has realised they need PCNs if ICSs are to work and are keen to minimise withdrawals?
‘The vaccine changes make sense – the scope for in-year changes makes me very nervous, and I suspect that NHSE will make said changes only when the withdrawal window is closed.’
Dr Katie Bramall-Stainer, chief executive of Cambridgeshire LMC – ‘What is perhaps unclear in the letter from NHSE, but which needs to be understood, is that any additional PCN services phasing will be subject to GPC England’s scrutiny, and given that 2021 will be dominated by vaccination programmes, understanding and addressing non-Covid harms, and prioritising urgent need, I foresee no basis upon which practices will have any headspace to engage with additional planning.
‘Any future enhanced services around obesity need to be very carefully planned around not blaming the patient or the GP for societal obesogenicity, and a strong evidence base. The best evidence base for addressing significant obesity comes from bariatric intervention, which as every GP knows, is extremely challenging to access for their patient, despite being incredibly effective. Perhaps we should invest more in those services, and remove the lifetime of multimorbid need from both those individuals and the NHS?’
Dr Simon Hodes, GP partner and LMC rep in Watford – ‘Delighted to see a range of support measures – and equally importantly, no new changes to QOF or incentive schemes.
‘A respite from the annual added work of extra box ticking and hoop jumping can allow us to focus on patient care, Covid-related work and the Covid vaccination programme. Huge thanks to the BMA GPC for negotiating this package.’
Dr Dave Triska, GP partner in Surrey – ‘I’d be delighted if we had more than a single option – no representation vs BMA representation is hardly a choice. I hope they can do better than the PCN DES.’
Dr Rob Barnett, medical director of Liverpool LMC – ‘I think that on the whole, it’s not bad – nothing is ever perfect. I think it would have been “pie in the sky” to think that there would have been no change, so minimal change is better than lots of change.
‘I think that on the face of it, the changes to the vaccination programme are things that have been talked about previously, and I think that generally most people will find that the new process suits them better than what we’ve currently got, which was a cliff edge sort of approach if you fail to reach a certain target.
‘I think the QI/QOF changes have been rolled over – that’s important – it means that the work that might have been done hasn’t been lost. I think that some of the changes to QOF in relation to learning disability – it’s difficult to argue against that, and therefore I think that’s fine.
‘What’s difficult is to fully understand what’s likely to happen next year, with regards to recovery. I haven’t got a clear view as to how the current QOF indicators are going to be reintroduced. Everything’s protected at the moment, but at some point someone’s going to make a decision that it shouldn’t be. And I’m worried in as much as we’re obviously in the midst of a problem at the moment, with the pandemic, and as we come out of that, we’re ramping up the vaccination programme and it actually is impossible for people to do both.
‘So, I think that, assuming common sense prevails on both sides, we’ll be ok. And so I hope that will be the case. We’ve always expected there to be an increase in the ARRS funding. I’m still not clear, though, as to what happens with underspend and how that is likely to be treated. I don’t want the money to be lost, ad it’s all very well saying that they want us to employ more people – one, we’ve got have the people to employ, and two, what we don’t want to do is “rob Peter to pay Paul”.
‘So if the workforce isn’t unlimited which it isn’t, then at the moment if networks take on paramedics, they’re going to take them from the ambulance service – that’s probably not good for the ambulance service.’
Dr Kamal Sidhu, partner in County Durham; chair at South Durham Health Community Interest Company; and vice-chair at County Durham and Darlington LMC (writing in a personal capacity) – ‘General practice is inundated with patient demand and pressures of Covid vaccination like never before and hence the headline of minimal changes is welcome. It is also helpful to see more flexibility in the ARRS roles as well as the focus on mental health including SMI reviews.
‘However, we cannot be ignorant of the massive transfer of work from secondary care and many other services running at a reduced level. This has the potential to push us over the edge. This does not find any mention in the contract letter.
‘At the same time, it would have been timely and useful to have focus on dealing the backlog of long term condition reviews, which may well take couple of years to catch up.’
Dr Uzma Ahmad, medical secretary at Walsall and West Midlands LMCs and regional rep (Black Country) at the BMA GP Committee – ‘Overall, we welcome that we had some news about the next year’s contract much earlier despite the pandemic, and the fact that there aren’t many changes to the domains, which is a sensible approach.
‘The burden of illness, both physical and mental, is going to be even more challenging due to the pandemic, and targets difficult to achieve, as target thresholds not lowered might have an impact on QOF achievement income.
‘Mental health domain, in particular with some additional funding attached for SMI checks, is a good step, but locally we have an incentive scheme to fund this, which has to be protected, and we should not lose that funding support for our SMI patients.
‘Minor changes to PCN specs (SMRs and cancer) add ambiguity to what it would look like. Not making any changes to it would have been more reassuring. SMRs remain a challenge, due to poor recruitment of pharmacists in many areas under ARRS.
‘Increased ARRS funding is again a positive step, but doesn’t address the challenges PCNs face to recruit those roles.
‘Regarding the mental health worker plan, it’s really important to establish current level of mental health workers as a baseline to establish current funding investment from mental health trusts, and ensuring that PCN funds aren’t used to fill the gap of recruitment from the others’ side, so we see a real increase in the number of mental health care workers to support the population with mental health need.
‘The restoration of services post-pandemic isn’t going up be an easy job, for primary or secondary care, and we need to be realistic around the challenges ahead of us.’
GP partner who wishes to remain anonymous – ‘I think it’s a missed opportunity by NHSE and the BMA. If this pandemic has demonstrated anything to healthcare staff, it’s how unnecessary red tape and regulations hinder effective and safe care.
‘If you remove all the unnecessary administration GPs undertake and free us to care for our patients, our output would double. Unfortunately, NHSE and BMA think that freezing admin duties to last year’s levels is doing primary care and our patients a favour.
‘This just proves they have not listened to grassroot GPs and have not taken the opportunity to improve things for GPs and patients.
‘As a GP partner approaching 50 years of age, I’m planning to leave full-time practice and to work abroad or stay as a casual locum. Many GPs in my age-range are burning out, and will wait to outlast this pandemic, and then then I suspect the GP crisis will be devastating. Now is the time to address it.’
Dr John Allingham, medical director of Kent LMC – ‘It’s good that there are no significant changes. We need time to recover from the pandemic.
‘The obesity service needs to be careful thought out and be part of complete and fully commissioned pathways.’