We believe the new GP contract for England will be published next week. This will be a watershed, revealing whether the NHS in England is serious about supporting general practice.
Having said that, let’s be realistic. The profession is not about to be washed away in a flood of additional funding that will be unleashed on 1 April. As NHS England chief executive has pointed out himself, the supposed £10bn additional funding trumpeted by the Prime Minister is not even enough to prevent the amount spend per patient in the NHS dropping.
But there is cause for optimism. NHS England has already promised at least a 4% increase in funding for general practice and I understand that within the BMA they are cautiously pleased with the result (but then they didn’t exactly set their expectations high).
Whatever emerges, I believe there are three tests that should be applied to assess whether it is a good deal. These are detailed below.
1) It must substantially increase funding for routine work
Ministers say that austerity cannot continue for GPs, although quite what that means is unclear. Last year’s deal delivered the largest funding increase for practices in years, with a 3.2% funding uplift for routine work.
This was a substantial message of intent, but NHS England needs to go further. A recent Pulse survey showed that despite this substantial funding increase take-home pay for GP partners dropped. Since the publication of the GP Forward View, 47% of GPs say their practice finances have got worse.
This cannot continue if NHS England is serious about keeping practices afloat. There must be concerted action to reimburse rising expenses. The scheme to reimburse indemnity costs is welcome, although there are doubts whether it will be enough, but rocketing CQC fees must also be covered and inflation generally is currently running at 2.5% (RPI). This must be reflected in any funding uplift.
2) It must meaningfully reduce workload
There has not been any major move to reduce GP workload, apart from a rather half-hearted attempt to persuade hospitals to stop patients bouncing back to practices. In contrast, Scotland and Wales have suspended the QOF and brokered ’stability deals’ to reduce demands on practices.
There was an agreement last year to explore the end of the QOF and the unplanned admissions DES in England; and this is an opportunity to reduce GP workload, if NHS England is brave enough to grasp it.
Scrapping the DES is a no-brainer. It is bureaucratic and has had little effect, although the funding must be used to boost core funding rather than incentivising yet another new workstream for practices.
Going ‘cold turkey’ on the QOF may not be on the agenda, but surely there could be a similar scheme to that in just implemented in Leeds, where practices are allowed to ignore most of QOF and still be paid the equivalent of their performance from previous years?
Any ideas about putting seven-day access or ‘one-stop shops’ in the contract should be binned. Previous years have also seen small, but disruptive, new requirements placed in the contract e.g. publishing CQC scores and GP income. NHS England should resist temptation to gerrymander and keep things simple – better still, heed the GPC’s call for a longer-term contract deal.
3) It must implement the Urgent Prescription
The GPC executive buried the LMCs’ call for some form of industrial action last year on the basis that NHS England had accepted their Urgent Prescription document as a ‘basis for further discussion’.
You may not have heard of this document, but it calls for limits on GPs’ daily workload, longer appointments and overflow hubs to ensure that practices can cope.
The credibility of the GPC depends on seeing some real progress on implementing this document’s aims on top of the promises already made in the GP Forward View. Not ‘pilots’ or other exploratory moves to implement them, but concrete, funded proposals to take them forward. If that is missing, then it will call into question the GPC’s whole approach and will embolden those who seek a more militant approach (à la Northern Ireland)
Of course, as always, Pulse will let you know as soon as we hear details of the deal, with detailed analysis of what we think it means for the profession.
Nigel Praities is editor of Pulse