General Practitioners Committee Scotland Contract

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Scotland GP contract FAQs

These FAQs focus on the content of the proposed new contract as well as the process of negotiations and the upcoming contract poll. These will be updated over the next few weeks.

If you have a question you would like featured on the FAQs please contact us on [email protected]. Please note we won’t be able to reply to individual emails but will update these FAQs to answer key issues raised.

 

  • Overview

    Will GP partners continue to have independent contractor status?

    Yes. GPs made clear their desire for the maintenance of independent contractor (IC) status in the BMA UK Survey (15,560 responses) of 2015 with 82% supporting its continuation.

    The Scottish Government, in negotiations, has also agreed to maintain independent contractor status in the new contract.

    The current GMS contract is already a “hybrid” form of independent contractor status because, amongst other things, GPs

    • are part of the NHS Pension scheme
    • have IT supplied
    • have premises financial support

    The new contract has to meet the HMRC rules for independent contractor status and SGPC and Scottish Government have agreed to ensure that is the case. The main benefit of IC status for GPs is the independence from line management and the GPs’ ability to control and adapt their working day and environment, including their teams, to meet the needs of their patients under the contract. The tax benefits of IC status have reduced over the years but are still important to practices as businesses.

    BMA SGPC and Scottish Government have agreed to ensure the contract will be remain an independent contractor contract.

     

    How does the contract address the challenges facing remote and rural practices?

    The contract package is intended to offer benefits to general practice as a whole and also to encourage more young doctors to choose general practice as a career. However, we know that GPs work differently across the country and there are specific challenges facing doctors working in different areas.

    General Practice operates differently in remote and rural areas and some of the new contract proposals do not easily fit remote & rural practice. The Earnings and Expenses Review confirmed that rural practices have higher expenses and the contract addresses this in Phase 1 with income and expenses protection. In phase two (subject to the second Poll) we intend to meet these higher expenses directly. We also intend to have secure income to the GPs in remote and rural in Phase 2.

    The contract proposals include an intention to continue to phase two negotiations which will include establishing a Short Life Working Group (SLWG) on Remote & Rural to consider what needs to be different for those practices. This will include early consideration of the role and purpose of the Scottish Rural Medicine Collaborative. The SLWG allows SGPC and Scottish Government to bring in expertise to inform the negotiating process which has worked well for both premises and data sharing.

     

    What key contract information is available?

    The key contract documents you should read are:

     

    What is the memorandum of understanding?

    A memorandum of understanding (MoU) has been developed between Scottish Government, GPC Scotland, integration authorities and NHS boards. The MoU sets out agreed principles of service redesign (including patient safety and person centred care), ring-fenced resources to enable the change to happen, new national and local oversight arrangements and agreed priorities.

    The MoU will be published if the profession accepts the contract proposals and the new contract is implemented. Within the contract documents is a letter which describes the purpose of the MoU and the signatories’ intention to commit to it. The letter includes the following paragraph:

    'This clear joint statement of intent provides reassurance that partners are committed to working collaboratively and positively in the period to March 2021 and beyond to deliver real change in local health and care systems that will reduce workload and risk for GPs and ensure effective multi-disciplinary team working for the benefit of patients.'

    The letter is signed by:

    • Alan McDevitt, GPC Scotland chair
    • David Williams, Glasgow HSCP chief officer and Health and Social Care Scotland chief officers chair, chief officers
    • Jeff Ace, Dumfries and Galloway NHS chief executive and NHS Scotland chief executives chair
    • Paul Gray, NHS Scotland chief executive

     

    What are the proposed changes for the new contract?

    Below is a list of the aims for the new contract and the key changes contained in the new contract proposals that would achieve each aim. All of these points are fully expanded on and explained in the contract documents.

    Sustainable funding

    • A new funding formula that better reflects GP workload will be introduced from 2018 with additional investment of £23 million. This does not include the annual uplift or increase for population rises which will be confirmed next year.
    • Overall, 63% of practices gain additional resources.
    • A new practice income guarantee will operate to ensure practice income stability. This means the 37% of practices who are not gaining additional resources will see their funding maintained at current levels.
    • A new minimum earnings expectation will be introduced from April 2019. This will ensure that GPs in Scotland earn at least £80,430 (whole-time equivalent – and includes employers’ superannuation).

    Manageable workload

    • GP practices will provide fewer services under the new contact to alleviate practice workload. New community services will be developed and be the responsibility of NHS boards. Funding for replaced services will remain with practices.
    • There will be a wider range of professionals available in practices and the community for patient care. New staff will be employed by NHS boards and attached to practices.
    • Priority services include pharmacotherapy support, treatment and care, and vaccinations transfer.
    • Changes will happen in a planned transition over three years when it is safe, appropriate and improves patient care. There will be national and local oversight involving SGPC and local medical committees.

    Reduced risk

    • The risks associated with certain aspects of independent contracting will be significantly reduced.
    • GP owned premises: new interest-free sustainability loans will be made available, supported by additional £10 million annual investment.
    • GP leased premises: there will be a planned programme to transfer leases from practices to NHS boards.
    • New information sharing agreement, reducing risk to GP contractors.

    Improve being a GP

    • There will be a focus on the GP as the expert medical generalist and senior clinical decision maker. In this role the GP will focus on three main areas: undifferentiated presentations; complex care in the community; and whole system quality improvement and clinical leadership.
    • GPs will lead and be part of an extended team of primary care professionals.
    • GPs will have more time to spend with the people who need them most.
    • The move toward peer-led quality, professionalism and transparency; and away from micromanagement will continue. GPs will be more involved in influencing the wider system to improve local population health in their communities. GP clusters will have a clear role in quality planning, quality improvement and quality assurance. Information on practice workforce and activity will be collected to improve quality and sustainability.
    • There is an expectation that GPs will have contractual provision for regular protected time for learning and development. Initially practices will have resources to support one session per month for professional time activities. The clear intention is that this will expand so there is regular protected time for each GP.

    Improve recruitment and retention

    • GP census will properly inform GP workforce planning.
    • We will agree an explicit increase in GP numbers. The Scottish Government’s workforce plan is due to be published in early 2018.
    • The main way to improve recruitment and retention is to improve the GP contract. We believe these changes will do that by reducing risk, securing GP income and outlining a clearer role for GPs with a manageable workload.

     

    Are there future changes to the contract planned?

    The new contract is intended to be phase one of developments. A second phase of contract changes will be negotiated and put to the profession in another poll before any further changes take place.

     

    Why are you suggesting changes are implemented in two phases?

    We considered a single transition but there are a number of reasons why it is necessary to split the transition into two phases.

    • We need time to develop the administrative capacity to enable the direct re-imbursement of expenses and payment of income.
    • We need time to collect data to allow us to calculate the impact on individual partners if the funding model is replaced.
    • We therefore cannot calculate the total cost and provide ministers, parliament and the profession with the necessary assurance of the affordability of the preferred model.

    In order to prepare for phase two we need full information on: current practice expenses, the income of partner GPs and salaried GP partners, as well as the hours worked by individual GPs.

    If the profession accepts the proposed new contract they are agreeing that phase one proposals can be implemented from April 2018, and that SGPC and Scottish Government can begin to negotiate phase two. Any proposed phase two changes will be presented to the profession once negotiated, and subject to a second contract poll.

     

    How do these proposals relate to the money announced by the Scottish Government for investment in general practice?

    In 2016 the Scottish Government announced increased investment in primary care and general practice which would build to £500 million recurrent by 2021. It was agreed that half of this amount, £250 million, would be negotiated with SGPC to directly support general practice.

    In 2017/18 £71.6 million was invested through the Primary Care Fund to directly support general practice. Further investment will see this increase over the three financial years from 1 April 2018 to £250 million in 2021-22. It will pay for the costs of formula transition, new staffing, premises arrangements etc.

     

     

  • Funding

    Why is the Scottish Allocation Formula (SAF) being replaced with the Scottish Workload Formula?

    The new formula was developed as part of a 2016 review of the SAF and is a methodological improvement to the previous SAF. It is based on the best available evidence and as such it more accurately reflects the workload of GPs.

    The main improvements recommended by the research were:

    • the inclusion of patients who had not visited a GP (zero consultation patients) in the calculation of relative need;
    • the estimation of age-sex and morbidity effects together, rather than calculating the age-sex effect independently; and,
    • the updating of the data and use of new indicators for the morbidity and life circumstances adjustment.

    Compared to the workload-related weightings of the original SAF, the new formula gives greater weight to older patients and deprivation.

    The new formula is being introduced alongside a £23 million investment to fund the practices that receive a greater allocation under the new formula; and a practice protection which means that the GP practices not exceeding their previous allocation will be protected from any potential funding losses. This change results in a reduction in the number of practices dependent on payment protection.

    We will monitor the impact of the funding formula during implementation.

     

    Are there proposed changes to seniority payments?

    No – seniority arrangements remain unchanged.

     

    Why are you introducing a minimum earnings expectation?

    In early 2017 the Scottish Government and SGPC commissioned a review of GP earnings and expenses in Scotland. The review found significant differentials in income and expenditure in the sample of 109 practices, with around 20% of GP partners earning less than £70,000 (excluding any private work and excluding employer superannuation) in a whole-time equivalent post (40 hours).

    From April 2019 an income floor will be introduced so that no GP partner will receive less than £80,430 (including employer pension contributions) NHS income pro-rata for a whole-time equivalent post (up to 40 hours). This extra income will be provided through NHS: National Services Scotland Practitioner Services Division (PSD) on the basis of the income, hours and session information.

    The main aim of this is to provide an immediate benefit to the estimated one in five GP partners currently earning less than this amount. This is one of the steps being taken to provide much more predictable and stable income long-term, with reduced risks to income.

     

    What will happen to local enhanced services and other local funding?

    Local funding is not part of the national agreement, however it is the intention of the contract that practices are not destabilised and that has been a feature of conversations between SGPC and the Scottish Government, and also with the integrated joint boards and the health boards.

    The contract framework is clear that the expectation is for funding to remain with practices.

    'The continuation of locally determined enhanced services is for NHS boards and local practices to agree. The expectation nationally is that enhanced services funding is not removed from practices as services are transitioned to NHS boards over 2018-2021, as doing so could be destabilising to the system.'

    On a related note, the contract framework also says: 'Practices can expect that support services they are provided with locally will continue.'

     

    What might the funding changes be in phase two?

    Phase two has not yet been negotiated and any changes proposed for phase two will be subject to a second poll of the profession. However, some broad intentions for phase two have been agreed.

    Phase two of the contract, if implemented, envisages a move to a contract that further reduces the risks of partnership, by introducing guaranteed GP incomes and direct reimbursement of practice expenses. This will see a similar income scale to consultants introduced for GPs, with pay progression to recognise seniority.

     

    Why does the contract framework talk about whole time equivalent (WTE) GPs working a 40 hour week?

    We know that GPs work in a huge variety of ways across Scotland, working different numbers of sessions and different numbers of hours per session. There is no standard measure of how many hours a full time GP works in a week.

    The Earnings and Expenses Review, which was jointly commissioned by SGPC and Scottish Government, analysed information from 109 practices. In order to compare information between practices it used a 40 hour week as a WTE GP. This is also useful as we can make comparisons with colleagues working in other specialties in this way too.

    The data in that report shows that, based on a 40 hour week, an estimated 20% of GP partners are paid less than £70k per annum (excluding private work and excluding any employer superannuation). This is why the minimum earnings expectation outlined in the contract framework is based on a 40 hour week.

    For GP partners working less than a 40 hour week this minimum earning expectation would still apply and would be calculated on a pro-rata basis.

    This does not mean we think that full time GPs only work 40 hours a week (we know that many work in excess of 50 hours per week), or that we expect all GPs to move to working a 40 hour week – it’s a tool to allow us to compare GPs across the country.

  • Services/practice team

    How will my practice staff be affected?

    We know that there are some concerns over how the proposals might impact staff.

    Our core principle is that practice staff and their terms and conditions of service must be respected. No part of the proposed new contract, in either phase one or phase two, would forcibly change the way that practices employ their current staff. Practices will continue to employ their practice managers, receptionists, practices nurses and health care assistants. For practices who have employed a wider range of staff there will be no changes in phase one.

    It is possible in future that some practice staff may wish to join the teams of practice-attached staff provided by the integration authorities/NHS boards under TUPE rules. Again, this will not be forced on staff under the contract and will be a practice decision. Guidance will be developed to support this process as the contract develops towards phase two.

     

    My practice nurse provides many of the services that would be provided by new attached staff. What does this mean for my practice?

    The new contract would provide additional primary care staff to work alongside and support GPs and practice staff. The expectation is that the new attached staff will reduce GP and existing GP staff workload and improve patient care. As the workload of existing staff is reduced, we expect that practices will focus their existing staff on activities that can more directly support GPs as Expert Medical Generalists. We accept that this transition will take time, but we see revised roles for existing practice staff as a key way to support GPs and reduce their workload.

     

    My practice has already employed a pharmacist (or other additional staff). How will I benefit under the new contract?

    Practice staffing is variable and the contract is sensitive to these differences.

    Under the proposed contract funding would be stabilised and protected indefinitely. Practices can be reassured that they will have the funding to support any additional staff they have employed. This will extend into phase 2 where staff expenses will be directly reimbursed.

    Practices will have the option of accepting additional practice attached staff and refocussing the work of their existing staff to best address the needs of the practice. Practices through their cluster can influence the plans supporting the delivery of new attached staff. Where a practice has already employed a member of staff they could indicate a preference to receive additional staff covering another area of work as a priority.

     

    What guarantees are there that the services will be delivered as outlined in the contract framework?

    To help ensure the service redesign is delivered as planned, the following have been put in place.

    • As outlined above, all parties involved in the service redesign are agreeing a memorandum of understanding (MoU) which outlines the parties’ commitment to implementing the contract framework, and specifically to the service redesign.
    • The funding provided by the Scottish Government for these services can only be used for the reasons specified in the contract document and the MoU.
    • An improvement plan will be produced in each of the 31 HSCP areas by 1 July 2018, in collaboration with the GP Sub and NHS HBs, and progress reports will be produced on a six monthly basis.
    • LMCs will be involved in monitoring the implementation of these new services as part of the local implementation group. Escalation to the national implementation group will happen where local progress is inadequate.

     

    How will the multi-disciplinary team work?

    The GP will operate as a senior clinical decision-maker leading the team to improve outcomes for patients. Non practice-employed staff will be line managed by the integration authorities to directly act as a member of the practice multidisciplinary team. Cross cover arrangements for holiday, maternity sickness etc will be covered by the integration authority to ensure service continuity for the practice.

    As senior clinical decision-maker the GP will largely direct the day-to-day working of the staff within the team. However, it is expected that many of the staff will work in an autonomous way, meeting patients’ needs, on most occasions, without recourse to the GP.

    We want these team members to be embedded as part of the practice team. Already you will have experience of staff that you direct clinically but don’t employ.

    It will be the health board’s responsibility to ensure the service is maintained.

     

    What’s the difference between chronic disease management and chronic disease monitoring?

    The contract framework mentions both chronic disease monitoring, which in the future will be delivered by the treatment and care service, and chronic disease management, which will be delivered by GPs and other relevant staff.

    Chronic disease monitoring includes tasks and processes such as height, weight, blood pressure monitoring, urinalysis, routine blood checks, questionnaires etc, which are intended to gather data to inform the management of chronic disease.

    This data will be available to GPs and other relevant staff who will then undertake management of the chronic diseases to improve patient outcomes.

     

    When do you expect a workforce plan?

    We are contributing to the Government's workforce plan which we expect to be published in early 2018. We would expect this to include plans for increased production of the staff with expected delivery times.

  • New role/new relationships

    Will training be provided to help GPs perform the new GP role?

    GPs are already expert medical generalists, these proposals simply build on this. However, we anticipate that both current trainees and existing GPs are likely to require additional training opportunities to perform this new role.

    We have an express intention to achieve regular protected time in the working week to enable all GPs to undertake training, quality work and leadership. This may take some time to achieve as it requires a significant increase in the total GP workforce to make it possible.

    We have made commitments with one session per month for every practice as a first step in this direction.

  • Workload

    Why does the contract framework state that GPs will provide workforce and workload data as part of the proposed arrangements?

    The lack of data on workload and workforce makes it very difficult to ensure that general practice is sustainable.

    This lack of data has made it difficult to provide evidence to support the calls for greater resourcing of general practice. Gathering this data will allow for greater sustainability of practices and for a more appropriate match of resources to workload.

    This data is to support GPs and other services, and not for micromanagement.

  • Premises

    What are the key changes to the premises arrangements that are being proposed?

    The Scottish Government and the SGPC have agreed a national code of practice for GP Premises ('the code') which sets out how the Scottish Government will support a shift, over 25 years, to a new model in which GPs will no longer be expected to provide their own premises.

    The contract offer proposes that from 1 April 2018, the code will be introduced and revised premises directions will take effect. The code sets out how the Scottish Government will achieve a significant transfer away from GPs of the risks of providing premises.

    The key changes proposed are:

    • All GP contractors who own their premises will have the option of taking out an interest free sustainability loan, up to the value of 20% of the existing-use value of the property. These loans will be funded by the Scottish Government’s GP Premises Sustainability Fund which is worth £10 million per year from April 2018 (£30 million by April 2021).
    • For GPs who lease their premises, there will be a planned transition to the health boards leasing these premises. NHS boards will gradually take on the responsibility from GP contractors for negotiating and entering into leases with private landlords and the subsequent obligations for maintaining the premises.

     

    Where can I find more information on the proposed premises arrangements?

    The premises proposals are described in chapter 5 of the contract framework and are explained fully in the premises code of practice. There are also a detailed list of premises FAQs hosted on the Scottish Government website.

  • Negotiation process and contract poll

    When will information on the content of the proposed new contract be available?

    Some general information on the contract has already been published. 

    The Scottish Government and SGPC published two documents outlining the direction of travel, these were published in November 2016 and May 2017 and included:

    Roadshows

    Roadshows are being held across Scotland in November 2017 to provide an opportunity for GPs to hear about the detail of the contract and to ask any questions.

    All GPs and GP trainees working in Scotland are welcome to attend these events which are being coordinated by the LMCs.

    Find the roadshow nearest you

    GPs who want to attend these events should ensure they register using the Book Now links next to the roadshow listings.

     

    Will the profession get to have a say on whether the contract is accepted?

    Yes. A contract poll will be held from 7 December 2017 to 4 January 2018 and will ask GPs to indicate whether they think the proposed new contract should be accepted and implemented.

    The poll will be administered by Electoral Reform Services and will be open to all GPs and GP trainees working in Scotland.

    The full Scottish GP Committee will meet on 18 January 2018 to discuss the results of the poll and decide whether the contract should be accepted on behalf of the profession.

     

    What is the Scottish GP Committee (SGPC)?

    SGPC is the committee within the BMA that is recognised as the body which negotiates the GP contract in Scotland with the Scottish Government.

    The committee is made up of 40 GP representatives from across Scotland (elected by LMCs), plus representatives from other BMA committees and organisations such as the BDA and RCGP.

    SGPC elects a chair (every three years), deputy chair (annually) and co-negotiator (annually) to lead these negotiations on behalf of the profession.

    The committee is kept up to date as negotiations progress and it gives the negotiating team a mandate to pursue specific negotiating aims. The committee’s actions are also guided by the policy created at the annual SLMC conference. 

    Once the contract has been negotiated it is SGPC that agrees that it can be presented to the profession, and, after the profession has had its say, it is SGPC that decides whether the contract should be accepted.

     

    How can I take part in the contract poll?

    The contract poll will be administered by Electoral Reform Services and will take place between 7 December 2017 and 4 January 2018. Any GP working in Scotland will be able to take part.

    Information on the poll will be sent out by email to all GPs and by post to all GP practices so it is vital we have up to date contact details for you. If you are a BMA member please check and update your details online. If you are not a BMA member please contact us at [email protected] to ensure we have the correct details for you.

    You can also find relevant information in our contract negotiations section.

    You will be able to take part in the contract poll electronically or via post, whichever is more convenient. Postal ballots will need to have been received by the closing date of 4 January 2018 in order to be counted.

     

    How do I know you have the correct contact details for me?

    You can confirm your details by calling us on 0300 123 1233, by logging into your web account or by emailing [email protected]

     

    When would the new contract be implemented?

    If SGPC decides on 18 January 2018 that the contract has been accepted by the profession and should be implemented, then this would happen in a phased way from 1 April 2018.

     

    What are the key dates to be aware of?

    • Early November - contract information published
    • 13 – 29 November - roadshows taking place
    • 1 December - SLMC special conference
    • 7 December - contract poll opens
    • 4 January - contract poll closes

     

    Can I contact SGPC with a query about the contract?

    Yes, you can get in touch via [email protected].