The BMA’s GP committee has reached agreement with NHS England over the changes to the annual GP contract for 2018/19 in England, which will see increased funding for pay, expenses, and indemnity cover, as well as a number of improvements related to issues with practice premises.
It is hoped this interim funding increase will help practices and provide some stability, but the BMA insists it will not solve the fundamental issues impacting general practice, which GPC says it is committed to focusing on over the coming months.
The key changes include:
• An initial 1 per cent pay uplift and inflationary uplift to expenses, which is expected to be increased further through any recommendation from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), which is due later this year1. This will be backdated to 1 April;
• £60m to cover in-year rising indemnity costs;
• Changes to Premises Cost Directions to enable further investment in GP premises, and clarification on issues related to last person standing;
• £10m to support the implementation of the e-Referral Service, together with agreement for comprehensive joint guidance, locally determined paper switch-off dates with emphasis on the need for a functional system that is fit for use, and resources for training;
• Uplifts for services fees for specific vaccinations and immunisations;
• Improvements in funding for sickness and maternity/parental/adoption leave cover;
• Strengthened violent patient regulations2.
Taken together, the changes deliver an initial £256m investment – more than has been secured in recent years.
In addition to these contractual changes, GPC and NHS England have agreed a number of areas on which they will work together, including:
• A major review of GP premises, working with NHS England and the Department of Health and Social Care, to begin as early as summer 2018;
• Local pilots to move to phase 4 of Electronic Prescription Service roll-out;
• Encouraging the development and use of social prescribing, which could both help to reduce practice workload and improve patient care.
Work also continues on a state-backed indemnity scheme to be introduced by April 2019, and on a major review of QOF.
Full details of the contract agreement can be found here.
Dr Richard Vautrey, BMA GP committee England chair, said:
“I am pleased we have reached agreement with NHS England on changes to the contract this year, which includes some important improvements in areas such as pay and expenses, indemnity and premises.
“While this agreement alone will not resolve many of the issues facing general practice today, it builds on our progress from the last two years and provides stability to practices at a time when there is little else stable for our profession.
“For too long, GP pay has been in decline, despite working harder than ever to deliver more appointments in an increasingly under pressure NHS. From the outset of these negotiations we have been resolute that we would not accept a 1 per cent uplift for pay and expenses, but made it clear that after a decade of pay cuts, it is time GPs and their staff received a proper pay increase. We have therefore provided strong evidence to the DDRB that doctors should be given an uplift of RPI + 2 per cent, to bring us in line with the wider economy and we expect the government to fund any DDRB recommendation.
“We have made significant progress on the important issues in which GPs are in a uniquely disadvantaged position within the NHS: indemnity and practice premises. GPs have to effectively pay an indemnity tax of many thousands of pounds compared with their consultant colleagues, while new GPs are too often expected to buy into the bricks and mortar of a practice if they want to become a partner. To address both of these we have this year secured £60m to cover the rising cost of indemnity fees, and a number of positive changes to Premises Cost Directions, which will go some way to ease the anxieties associated with owning or leasing practice premises. In addition, we are working closely with DHSC on a state-backed indemnity scheme for general practice, to be implemented in April 2019, and we have also secured agreement to engage in a fundamental premises review to try to find solutions to the major problems facing practices across the country.
“While these changes are a further step in the right direction, and build on the important improvements last year, what is urgently needed is for the government to continue to work with the BMA to provide general practice with the proper funding and support it needs to guarantee the future of the profession and ensure safe and high-quality care to patients.”
Notes to editors
The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
1. Each year, the BMA submits detailed evidence to the Review Body on Doctor's and Dentists' Remuneration (DDRB), on matters relating to pay, recruitment, morale and motivation for doctors across the UK. In its evidence this year, the BMA asked for a recommendation to uplift the pay of all doctors across the UK in line with the Retail Price Index (RPI), plus £800 or 2 per cent, whichever is greater. Read more here.
2. Regulations already allow practices to refuse registration where there are reasonable grounds for doing so, this will be extended to include when a patient has a “VP” flag against them. The regulations will also be amended to allow a practice which has mistakenly registered a patient with a “VP flag” to be able to deregister that patient by following the same procedures for removing patients who are violent from a practice list.