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‘Today is a red letter day in the history of English general practice’

15 dr mark sanford wood


General practice is constantly evolving, the story of our profession drawing a narrative arc that rises and falls smoothly, rarely given to sudden step changes. Yet this week marks a quantum leap for our profession as we finally see the launch of the long-awaited state-backed indemnity scheme. Rarely do we witness such wholesale shifts in the structure of our professional bedrock, shifts whose reverberations will be felt down the years and promise to play their part in the reinvigoration of our speciality in England.

For over a decade now, the rising cost of medical indemnity has threatened clinical services to the point where Government recognised the need to step in to stabilise delivery. The winter indemnity scheme was the first temporary fix, followed closely by annual subsidies to the profession to help offset inflationary forces that were running into double figures annually. The system was creaking at the seams. Then in 2017 came the hammer blow of the Discount Rate reduction. The economic forces that drove that move are beyond the scope of this piece, but its effect was to raise the spectre of a complete collapse of the indemnity system, and with it general practice. The challenge at that time was stark and daunting.

Many people in different parts of the system rose to that challenge and spring 2017 marked the beginning of a two-year process of discussion and negotiation between the profession and the government that has finally culminated in the launch this week of the Clinical Negligence Scheme for General Practice (CNSGP). There were many possible responses to the crisis of 2017, most of which would have simply kicked the can of an under-funded system down the street and would have failed the profession, failed our patients and failed the public. To that extent those options could hardly have been called solutions and I am proud to have been a part of a wider team that ultimately delivered the only sustainable solution for the profession and for the lasting benefit of patients.

Monday April 1st 2019 will be a date that will be remembered, rightly, as a red letter day in the history of the recovery of the proud discipline of general practice

That team has seen clear leadership from the BMA in the form of our executive team of myself, Dr Richard Vautrey, Dr Farah Jameel and Dr Krishna Kasareneni, but also from key staff to whom we all owe a great debt of thanks. So I would publicly like to thank Dan Hodgson, Daniel McAlonan, Nick Duckworth, Greg Lewis, Amy Bolton and Nikki McIntosh for their key roles in signing off this landmark deal for English GPs. But change of this proportion requires leadership across organisations and huge thanks are also owed to Helen Stokes-Lampard and her colleagues at the Royal College who have worked closely with us every step of the way and whose support has been invaluable in achieving this agreement.

Neither should we forget that negotiation is a two-way process. Discussions have at times been challenging, as is only proper where hundreds of millions of pounds a year of public money is involved, and yet ultimately we found the common ground of compromise with our interlocutors in NHSE and the Department of Health and Social Care (DHSC). To that effect I would like to thank William Vineall, Ed Scully, Ed Waller, Ian Dodge and Jonathan Marron, of NHSE and DHSC who played their part in reaching the deal, and who could so easily go unrecognised.

Importantly we were also able to secure the support of two successive Secretaries of State for Health and Social Care who both listened to our concerns and committed to work with us to resolve them.

Momentous change of the sort that has been ushered in this week does not run universally smoothly and there have been many anxieties, queries and requests for clarification over recent days and weeks. Many of these are addressed in my recent blog, and no doubt more questions will come to light as events unfold. NHS Resolution (NHSR) has a website via which details of CNSGP can be accessed and queries logged, and GPs should digest the information presented.

The other side of the CNSGP equation has been the role of the Medical Defence Organisations (MDOs) whose business model has undergone a revolution through this process, and I pay tribute to their professionalism and attention to detail. The BMA has been in close contact with all MDOs throughout and their input into the process has been exemplary. Their new offers to the profession are now in the public domain and while there are differences it is clear that the average GP now has options around a residual indemnity requirement of under £1,000 per year. One thing we have made clear from the outset is that GPs will continue to require MDO membership and anyone who has not arranged this should do so immediately. The MDOs have also been through their own negotiations with government to sign over the risk which has been so inflated by the Discount Rate change and it is understood they are close to conclusion, with one MDO already reaching terms with DHSC.

The situation across the UK is more of a patchwork, with Scotland actively monitoring developments and Northern Ireland in a potentially dangerous limbo created by the lack of political leadership in Stormont. The Welsh government is launching a scheme similar to England although grave concerns have been expressed by GPC Wales about inequitable and divisive funding issues, the inception of a locum register (and what terms/conditions may be attached to that in future) and a number of key implementation issues.

In England, however, the culmination of two years of work is now an indemnity offer to GPs that for the first time in almost three decades matches that enjoyed by hospital doctors. At last the differential expenses gap that can only have deterred juniors from contemplating a career as a specialist generalist has been addressed. This can only help in the quest to grow our workforce and thereby benefit the patients we serve. As we head into the future we expect to see great changes from the 2019 landmark digital offer and the historic deal on Primary Care Networks (PCNs) both of which were other major elements of the 2019 contract agreement. But Monday April 1st 2019 will be a date that will be remembered, rightly, as a red letter day in the history of the recovery of the proud discipline of general practice.

Dr Mark Sanford-Wood is BMA GP Committee deputy chair