The GP Contract

1

• The GP Contract
• The Road To Here And Beyond

2
Why the GMS contract had to change

• Red Book was John Wayne contract without
  boundaries
• OOH responsibility
• Erosion of pay against a pool
• Complexity of contractual arrangements
• Worsening recruitment/retention within the
  profession
• Increased use of local PMS contract

3
nGMS

• OOH opt-out of responsibility
• Defined core services
• No new work without new money
• An explicit pay rise
• to compensate for the unresourced work
  transferred to General Practice over the previous
  15 years
• to encourage recruitment and retention
• Pensionability of all NHS/government work
• The end of the GMS/PMS monopoly

4
Potential problems with nGMS

• Definition of core services
• Initial deliberate de-funding of global sum
• Excessive ratio of QOF to global sum
• Inadequate funding of global sum
• Still too much discretion for PCOs
• Governments right to alter contract unilaterally

5
2006

• No increase in global sum
• New work and funding delivered through DESs
• New areas of QOF work introduced
• Governments perception of over-performance and
  value for money addressed once and for all

6
2007

• DDRB recommends 0 pay increase
• DoH interprets this as no resource increase for
  general practice

7
2007 the press campaign

• Constant criticism of GP pay and hours
• Linked with failure of out-of-hours care across
  the country
• The extended hours debate
• Darzis Next Stage Review in England

8
2008-9 The GPC proposed compromise

• Funding for Access and CB DES plus 11m from
  Patient Survey to fund extended hours
• Similar level of funding in DAs
• Extended hours - 20 minutes per 1,000 patients
• 15 minutes appointments and 5 minutes admin
• Flexibly provided and voluntary participation
• Patient survey to determine convenient access
• Redistribution of 38.5 QOF points to
  osteoporosis, peripheral vascular disease, and
  new heart failure indicator and additional points
  for CKD
• Would deliver if reasonable new resources
  introduced into the contract via DDRB award

9
2008-9 The government offer

• In England uses funding from Access and CB DES
  for extended hours (158 million)
• Diverts money 58.5 QOF points to support access
  arrangements
• Extended hours - 30 minutes per 1,000 patients
• Either in 1.5 hour blocks at evenings / weekends
• Or 1 hour blocks on weekday early mornings
• Payment dependent in part on patient survey
• Guaranteed uplift in contract of 1.5 in event of
  DDRB award for GPs being less
• DoH claims that an additional 100 million is
  being provided - this is the 1.5

10
2008-9 The GPC response

• GPC voted not to accept government offer and to
  seek the professions views because
• The extended hours element is felt to be too
  onerous for the money on offer and would not meet
  the costs
• The diversion of funds from quality to
  non-evidence-based access imperative is
  unacceptable
• The 1.5 uplift has too many strings and will
  require even more hours to be worked
• It was not prepared to accept a deal under threat
  of imposition

11
2008-9 The imposition in England

• Loss of Access and CB DES funding
• Money from these available to PCTs to agree
  contracts for extended opening with practices
• QOF cut by 135 points
• - 75 points to reward GP practices for
  convenient access based on patient survey
• - 60 points to invest in primary medical care
• QOF thresholds increased by up to 20
• Funding from QOF cuts passed to PCOs, so
  recovering this will require further local
  negotiations
• Diverts funds from quality clinical care to
  political targets
• Treasury and Gordon Brown led

12
What happens next?

• Unilateral change requires 13 weeks
  consultation
• Negotiations continue
• Poll of GPs opinion during this time
• Imposition on 1st April 2008
• Scotland, Wales and Northern Ireland yet announce
  their plans

13
Issues to consider

• Profession should view in widest terms
• Governments method of negotiation
• Lack of value placed on quality care
• Government ignoring views of majority of patients
  to deliver own political agenda
• Move towards privatisation
• GPC could not accept deal

14
Choices to be made

• Accept the offer
• Reject the offer, in which case
• The government imposes its changes

15
Choice 1 Accept the offer

• The blow is less severe than the imposition
• It allows practices to continue to function
  broadly as they do at present
• This will represent a further pay cut after costs
  are taken into account
• There is no guarantee that GPs will get all the
  money back
• Providing extended hours could adversely impact
  on in-hours service leading to poorer patient
  satisfaction
• The imposition may become next years offer
  lets the government get away with gun-barrel
  negotiating

16
Choice 2 Reject the offer

• Imposition of the governments unilateral changes
• Serious financial problems for some
• Depends on whether you can get back 12k per GP
  from your PCO
• Your costs could exceed 12k
• Hands a large amount of funding to PCOs
  previously in the national contract
• Provides funding for PCOs to fund APMS

17
Where does this road lead?

• Government agenda in England
• APMS
• WICs
• NHS-D
• Cheaper general practice in polyclinics
• GP agenda
• Do we have to leave NHS to survive?
• GPs will be blamed for this

18
What can we do if we face imposition?

• Avoiding action which adversely affects patient
  care
• - participation in government initiatives
• - GPs must respond by being united
• The End Of The World?
• Resignation
• Do we all go APMS and merge with corporations?
• GPC considering strategy

19
Leaving the NHS

• Loss of all current NHS income streams
• Global sum
• MPIG
• QOF
• Premises funding
• Pension accrual (pension to date is frozen)
• IT
• Political impact
• - Loss of NHS prescriptions
• Loss of PCO / DoH interference

20
Is it going to happen anyway?

• Government agenda to introduce alternative
  providers in England to compete with GPs
• Even if vote for deal this year, bigger battle
  continues keep patient campaign going
• Timing
• If we are in for trouble why not in our time?
• Government in trouble now

21
What to do now

• Study the offer and the imposition
• Decide whether the offer is acceptable
• Decide if rejection is better than the offer
• Talk to partners, colleagues and the LMC
• Read messages from GPC
• Remain united
• Vote when the poll is held