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Published: Thursday, 14 February 2019 07:41

Written by News Editor

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A new contract agreement between the BMA and NHS England has been announced. Headlines are increased funding and state-backed indemnity scheme for all GPs. Some 20,000 physios, pharmacists and paramedics are to be recruited to work with under-pressure GPs. The BDA has responded by saying that the Government now risks employing double standards in its approach to primary care.

The BDA’s Chair of General Dental Practice Henrik Overgaard-Nielsen said: “It’s good to see a joined-up approach to primary care services, with practitioners getting the investment needed and promised. Reform can take the pressure off GPs, but there’s so much that high street dentistry can do to help share that burden. 

“Government now risks employing double standards in its approach to primary care. The logic on investment, integration and improved access is irresistible, and failure to apply it consistently will leave this service facing an uncertain future. Dentistry cannot be left in a silo. A string of recent headlines have shown that patients in many parts of England now lack access to basic services. Recruitment and retention problems are mounting. Ministers must not write off these problems as ‘business as usual’.”

The BMA explains:

The contract gives practices almost £1bn across five years, while another £1.8bn will be invested to support the formation of Primary Care Networks, in which practices will work together to provide care to patients across a wider geographic area. In the first year, this funding – delivered through a directed enhanced service (DES) paid to practices – will allow networks to employ at least one social prescribing link worker and one clinical pharmacist, while subsequent years will see the workforce expanded by over 20,000 people to include physician associates, practice-based physiotherapists and paramedics. It is hoped this wider team will both improve patient experience, ensuring they are seen by the correct professional at the right time, and help GPs manage their workloads.

The contract also delivers the much-awaited meaning family doctors will be brought in line with their hospital colleagues, and no longer have to personally fund clinical negligence cover, which has become increasingly unsustainable and been a key factor impairing GP recruitment and retention.

Key changes in the package include:

• Guaranteed investment of £405m through the practice contract and network contract in the first year, meaning every practice will be able to uplift staff pay by at least 2 per cent
• Building Primary Care Networks from the ground up. Networks will typically cover 30,000-50,000 patients and be led by a local GP in a clinical director role. 
• Funding for the expanded network workforce. Networks will receive 100 per cent recurrent funding to employ social prescribers and 70 per cent for clinical pharmacists this year, and the same for physiotherapists, physician associates and paramedics as they are introduced.
• The introduction of a state-backed indemnity scheme beginning in April 2019.
• Increased digital access for patients, meaning practices will make 25 per cent of appointments bookable online, improve their online presence and give new patients access to their digital records as standard.
• An agreement between the BMA and NHS England to make joint representation to the Government with proposals to reduce the problem created by the pension annual allowance, to address the impact this is having on GP recruitment and retention.
• NHS 111 direct booking in to practice appointments at a rate of one appointment per 3,000 patients available per day. This will happen only after triage.
• Funding for practices to deal with subject access requests following the removal of the ability to cover costs under GDPR legislation. Practices will also have access to a Data Protection Officer (DPO) through their clinical commissioning group (CCG), to provide support on GDPR issues.
• QOF changes to remove unnecessary indicators and provide a focus on professionally-led quality improvement.

Further changes will be implemented from 2020 onward, including:

• Increased workforce as part of the networks, totalling 22,000 additional roles in England by 2023/24.
• Investment to increase via both the practice contract and network contract, allowing practices to uplift their staff pay at least in line with predicted inflation.
• Resources available to practices to enable online and video consultations.

Dr Richard Vautrey, BMA GP committee chair, said: “We are confident that these widespread changes – the most significant in 15 years – will deliver the best not just for GPs across England, but also for the patients they treat on a daily basis. Recent years have seen hard-working family doctors deal with an overstretched workforce doing their best to meet rising demand from patients suffering more and more complex conditions, all on the back of a decade of underinvestment in general practice.

“Therefore, we are pleased after months of discussions with NHS England, to have negotiated a package of reforms to the GP contract and beyond, that will begin addressing the unsustainable situation – whereby doctors are choosing to leave the profession while patients wait longer and longer for appointments – and laying the foundations for a general practice fit for the future.”

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