There has been a significant injection of cash into core general practice over the past two years – a total of nearly £0.5bn to be precise. NHS England chief executive Simon Stevens has so far been as good as his word that he would increase funding each year until 2020 and that every practice would benefit.
Practices are coping with the fallout of a decade of austerity
We are a world away from the Buckman years, which ended in 2013 when the GPC rejected a deal that vastly increased workload – with major changes to the QOF alongside four new DESs – only for the Government to impose it anyway, with a retaliatory 1.32% funding uplift.
In monetary terms, this new deal is around the same as last year’s, but the tone is different. There is one nasty surprise for practices that close in routine hours and we still need precise details of how the new frailty register will be policed. But the rest looks largely sensible and will not add appreciably to workload; where it does, there is some – albeit small – reimbursement.
Mr Stevens was frustrated last year that the message that NHS England was directly reimbursing rises in practice indemnity and CQC fees was rather lost (it didn’t help that they were not even mentioned in the official press release). So this year they were listed separately, alongside some other eyecatching measures, such as better GP sick pay and scrapping the Avoiding Unplanned Admissions DES.
Yet, practices are coping with the fallout of a decade of austerity. In all but one of the past seven years, GP take-home pay has decreased in real terms, and gloomy accountants tell us the new contract deal is unlikely to reverse this overall trend.
The GPC is confident most partners will see a 1% increase in drawings, citing NHS data showing a 1.7% rise in earnings in 2014/15, despite a ‘derisory’ deal that year. But inflation is rising, the number of GPs is falling – so expect locum costs to go up – and MPIG and PMS cuts will take their toll this year.
While a £239m funding uplift is not to be sniffed at, contrast this with the £1.8bn allocated to bail out trusts last year and the priorities become clearer. Trusts are predicting a combined end-of-year deficit of £837m and CCGs are broke. NHS England is overspent by £61m; its primary care budget is underspent by £50m but don’t expect any of this to come GPs’ way. There are other holes to fill.
Add the sustainability and transformation plans’ intent to shift more care into the community and you can see a trajectory that will put even greater pressure on GP practices. The fact is there are flaws in the primary care system that this injection of cash will not fix.
The BMA’s Urgent Prescription tried to tackle these, but no one knows when its ideas might be realised (despite their being ‘urgent’). I would have liked to see something like a full QOF suspension and a move towards ‘overflow hubs’ to help practices manage patient contacts. Or even a halt to appraisals, or a pledge that ‘no practice will close’.
There is a worrying sense general practice is being given a suitcase of cash and expected to stagger on, soaking up workload from other areas of the NHS. This year’s deal may be encouraging but GPs are likely to put any celebrations on ice.
Nigel Praities is editor of Pulse