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.