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Things can only get better? Dream on…



It hasn’t taken long for the BMA-induced euphoria over the new GP contract to fizzle out and for the medical and mainstream press to be full of doom and gloom for general practice. Not only are there not enough GPs, we have known that for a while, but the number of GPs is shrinking and will do even faster if pensions and workload issues are not rectified.

Experienced GPs are retiring early, and trainee GPs are not staying in general practice. Whether increased GP training numbers can counteract this remains to be seen. Workload issues are inextricably linked to workforce. Simple arithmetic would suggest that increasing demand being handled by a decreasing number of GPs will lead to increased workload for those not jumping on the ship to Australia, Locumsville or Retirementland.

This brings us back to the contract; because apparently it is going to make everything better. Indemnity for GPs has been fixed, in exchange for formation of primary care networks and five years of relative stability. That the Government had pledged to decrease indemnity and this concession should not have been used as a bargaining chip is perhaps now a moot point, now that the deal has been done.

History tells us that when general practice receives a financial boost, this can often be followed by a number of lean years. The rise in GP incomes after the introduction of QOF was followed by stagnation and even reductions of income for practices, leading GPs to suspect that this was done in retribution.

Increased workload for those not jumping on the ship to Australia, Locumsville or Retirementland

With the new contract, we don’t even have to worry about NHSE sneakily seeking similar financial vengeance, should the introduction of novel aspects of the contract lead to increased income. For starters, it seems likely that the contract doesn’t really equate to a significant increase in income for GP partners via the global sum. There is a minimal pay rise in the context of a workforce crisis.

And it doesn’t get better…

There is also a balancing mechanism clause in the new contract. It states, with no attempted deceitfulness, that ’It will enable global sum adjustment equally in either direction’, meaning that GPs will be protected against rises in inflation and the taxpayer will be protected by unexpected large increases in partner drawings. If practice income goes up through the Network Contract DES or the additional roles reimbursement, there will be a mechanism in place, from 2020/21, to decrease the number of extra staff funded and/or decrease the global sum.

In other words, if you do too well, through the new contract or other means, over the next couple of years the GPC and NHS England will have designed a mechanism to claw that money back.

Dr Samir Dawlatly is a GP partner in Birmingham