The recent announcement of the 2017/18 GP contract revealed some useful changes. There is now clarity and simplification around the reimbursement for sickness absence. The reimbursement starts after two weeks, is not linked to patient numbers or periods of absence and existing GPs who are not full time can cover sickness and be reimbursed.
But what impact will the funding increases actually have?
The pay award is intended to be 1% – a 1% increase for GP partners and practice staff – with a 1.4% uplift for practice expenses. In reality these are relatively small sums. Our firm’s average GP partner earns £140,047 so 1% is £1,404 – or just £607 after tax and superannuation.
There are also new additions to practice workload, such as checking whether a patient is entitled to NHS healthcare. We don’t know exactly what this will cost and whether the funding in the contract will cover this work, but there will clearly be a cost in practice staff time – and the practices who are most likely to be negatively affected by this are those that are already most vulnerable.
Key issue undermining funding
The key issue undermining GP funding is the relentless decline of the MPIG (correction factor) while no alternative formula replaces it. Disappointingly, the 2017/18 contract says that the Carr-Hill formula will be negotiated and changes effective from 1 April 2018 at the earliest – shouldn’t it say at the latest?
The practices most vulnerable are those inner city practices with high deprivation. Typically these have high patient turnover giving them the greatest burden for checking the eligibility of new patients for NHS care under the 2017/18 contract.
Given that the average practice should find the adjustments to their MPIG is offset by the increase in global sum because the compensating increase is not practice-dependent, this means that those practices with a larger than average MPIG will suffer the most.
The pay increase negotiated nationally for GMS practices also applies to PMS practices. There are many PMS practices – including all those in London – whose future funding is uncertain because of PMS review, a 1% pay increase is unlikely to make much of a difference when the reviews are concluded.
There is a further point to make. While the pay award is theoretical, it is difficult for GP practices to secure. I hear complaints all the time that practices are underpaid by NHS England – only yesterday I visited a practice where one partner was not paid any seniority all year and another received no funding in one quarter.
The problem is finding someone who can fix the error. Centralised economies are notoriously inefficient, and remote centres who do not respond to emails or phone calls undermine the GPs ability to be paid for the work they do
So, does this pay award help general practice? Not really. It doesn’t hurt, but the bigger issues, core inefficiencies at NHS England and a funding formula broken for 13 years, are now more significant.
- Laurence Slavin is a partner with Ramsay Brown and Partners Chartered Accountants who specialise in the finances of GPs