Well, we have a negotiated GMS contract settlement for 2014 and that must be a great relief to both GPs and the government alike after last year’s imposed settlement which defied sense and consigned GPs to another year of dwindling income and pointless bureaucracy.
One has to wonder at the change in heart of politicians. Last year, ministers were adamant their imposed contract was good for patients; this year, they are happy to talk about the return to traditional family doctoring and freeing GPs from the ‘tick-box culture’ they themselves created the previous year.
This time, the BMA seems quite happy with its deal but one must note that, despite removing many of the imposed changes from last year and moving money into core funding, there is, quite simply, no uplift for fees or expenses this year.
That means another year of static income for GPs, while other parts of the NHS are receiving real growth in investment through the ‘pay as you go’ PbR tariff. GPs have the rising tide of work but no growth at all.
GPs should also remember this is the year local and national enhanced services end, morphing into ‘contracted services’ under the standard NHS contract next year. CCGs become responsible for commissioning these services with many being lost as income to practices through re-specification, termination or competitive tender.
So unless a practice has been a poor QOF achiever who will benefit from the transfer of QOF into core income, partners’ NHS profits - and therefore incomes - will fall, unless costs are reduced; a reduction in costs probably means reduction or lack of investment in staff.
Let’s look at what is good about the contract settlement. There is no doubt that the removal of the imposed changes of last year, and moving 238 QOF points into core funding will make life easier for practices and also ensure money remains in the practice baseline.
Especially important is the fact that all practices will receive this income even if they are on MPIG (minimum practice income guarantee); but, of course, this income can, in future years, be subject to Carr Hill formula changes or PMS baseline review. This helps practices plan their income and means more income is paid regularly through the year and is less ‘at risk’.
The duty of GPs to monitor out-of-hours contracts looks, at face value, to be a good opportunity for GPs to ensure CCGs commission quality out-of-hours services, and is a way short of health secretrary Jeremy Hunt’s earlier threats to return direct responsibility for out-of-hours provision to GPs.
Neither is there any increased demand for seven-day working or extended hours and, of note, is the fact that, this year, practices can pool their extended hours with other practices so these could be provided at a central location, thus reducing premises and other costs.
Changes to IT requirements for online repeat prescriptions and online access also look watered down. Online access is to the Summary Care Record rather than to the full detail of all the notes (to which the government is still committed, but which has real dangers in implementation). Thankfully, there is a commitment to follow the RCGP RoadMap for implementation, which safeguards against many of the risks.
Political ‘froth’ (and the bad elements)
I think there are several other elements of the contract which really are neither positive nor negative for GPs and, to be frank, have minimal impact on practices: named GPs for over 75s; publication of CQC inspection reports; and publication of GP income all look like political ‘froth’ to me. The latter is yet to be agreed but is likely to exclude any non-core NHS income and be an average across a practice.
What is bad about the new contract? One element that will not be popular is the removal of seniority pay from older GPs from 2020. However, as this money is being reinvested in the contract, it will be made available to all GPs, not just the long-serving ones, as long as the contract sum is not raided in future years. It is, though, likely - albeit in 2020 - to contribute to more GPs considering retirement at a time of probable workforce issues.
The ugly part
The really ugly element for me in this contract is the requirement, in the new unplanned admissions enhanced service, for GPs to create personalised care plans for 2% of the list over the age of 18 (likely to be around 1.5% of the average list).
That is an awful lot of care plans to produce and I fear that, unless the BMA can negotiate a very simple template for these plans, we will simply have shifted the bureaucracy from the QOF (where it was largely being undertaken by nurses and healthcare assistants) to care plans, which have to be done by GPs.
Providing same-day phone lines to these patients is what most practices do already, but surely it should be the community matrons writing the care plans not the GP themselves?
As the saying goes, 'the devil will be in the detail' here and we will have to hope it can be made simple so GPs can spend their valuable time doing the caring rather than filling out, and reviewing, complex forms.
- Dr David Jenner is a GP in Cullompton, Devon, and the NHS Alliance’s GMS lead.