The newly-announced GP contract is a big deal, with high expectations in tow. With the BMA having worked hard for it, there are positive thoughts around whether we’ll see a renewed focus on primary care, the ‘bed-rock of the NHS.’
In particular, we note positive changes around indemnity. An increasing burden on the workforce, it is welcome news that significant reduction in our indemnity bills is expected.
Additionally, there is talk about more resources to follow the areas with higher health inequalities, although it’s unlikely that the Carr-Hill Formula will be revised in the near future. There is also recognition that LMCs should be involved in this implementation.
It was encouraging to see more provision for support staff, such as physiotherapists, pharmacists, social prescribers and physician associates. There is also support to practices through a letter of comfort, when they decline to provide medication otherwise available over-the-counter, and some encouraging changes with a trimmed-down version of the dreaded QoF. But most of all, we’ll see a rise in funding and ability to award pay-rises to hardworking staff.
Unfortunately, there are many reasons why this new deal won’t stop the exodus of those leaving the profession, or attract additional GPs.
And new funding is attached to new work, hence failing to recognise the decade of underfunding.
One can only hope that inflation stays below 2%, especially as the DDRB won’t be making recommendations around pay lifts for partners for the near future.
Is the new layer of bureaucracy really needed?
A five-year deal gives certainty of expenditure on primary care to NHS England, CCGs and practices. However, it shifts the onus on the practices to absorb rises in demand, leaving them at the goodwill of the CCGs and NHS England in the case of any unexpected or significant workload fluctuations, and at risk of closures, burn-out and financial difficulties.
It must be ensured that the CCGs who have already invested in some of the areas now funded through the GP contract direct that funding into primary care.
New organisations called Primary Care Networks (PCNs), of 30-50,000 patients, will be created, shining light on the need for care-systems to collaborate. In some areas, there are existing hubs or primary care homes that can transform into PCNs, but procedures will be much more complex elsewhere. For instance, the contract casts doubt on the abilities of PCNs to secure strong primary and community care, with huge vacuum between PCNs and integrated care systems – again detracting urgent focus from clinical care. We also have the danger of PCNs becoming a burden on the practices, due to additional demands on practices.
Worryingly, continuity of care is ignored. This cost-effective intervention has high patient satisfaction rates, reduces emergency admissions and increases job satisfaction. In fact, to the contrary, the extended hours access DES is being transferred to the PCNs. This service is valued by patients, so merging it will disadvantage continuity.
There is another proposal to create a national matrix with an investment fund, requiring us to collect more numbers and fill templates, but risks deprioritising personalised care. We need to trust the professionals to concentrate on outcomes, rather than ticking boxes.
For the first time, the contract allows 111 to book patients into appointment books. Although the practice requirements are not particularly onerous and allow practices to re-triage, it opens precious appointments to a service with debatable outcomes. This trend can only go in one direction…
The additional staffing promised via PCNs require financial commitments. This has the potential to increase more capacity in practices, yet it’s a challenge to find and train staff. Furthermore, the funding risks being lost in the system.
The implementation of this contract requires significant commitment from practices, and may push already-struggling practices over the edge as they prioritise patient demand. Most of the new incentives allow little scope for practices to consolidate after a decade of cuts. We needed more focus on encouraging GP recruitment, and this deal is a step towards that, but still falls short. Let’s hope the push for primary care does not stop, and this contact does not become another lost opportunity. We don’t need attractive headlines, but an attractive and rewarding work environment. Is the new layer of bureaucracy really needed?
Dr Kamal Sidhu is a partner at Blackhall and Peterlee Practice and New Seaham Medical Group; vice-chair at South Durham Health Community Interest Company; and vice-chair at County Durham and Darlington LMC. He writes in a personal capacity.