BMA reaches agreement on GP contract in Wales

The BMA’s General Practitioners Committee for Wales has negotiated a settlement with the Welsh government on the general practitioners contract for 2013-14, after securing a key agreement on the minimum practice income guarantee.

Earlier this month the committee rejected the proposed general medical services (GMS) contract because of concerns about the effect of removing the guarantee,1 which is received by more than 60% of practices in Wales.

The committee was worried that the plan to remove this source of income over a period of seven years could “fatally destabilise” some rural practices, in particular small surgeries and practices with more than one location.

The Welsh government has agreed not to take steps to remove the guarantee from April 2014 and will instead discuss the future of the payment with the committee at a later date. Any future changes to provision would be modelled down to the level of practices, and practices would be told before changes were implemented, the government has said. The government has also made a commitment to consider an “off-formula solution” for outlier practices.

David Bailey, chairman of the Welsh General Practitioners Committee, said that coming to an agreement on the minimum practice income guarantee was the “key issue” of the contract negotiation. “[The government] had already agreed to a number of key concessions around QOF [the Quality and Outcomes Framework] that make it more workable for practices, less likely to impact on patient access, and more responsive to what patients want,” he said.

Several of the changes to QOF put forward for the GMS contract in England are not going to be introduced in Wales or in Scotland.2 These include two new indicators relating to annual exercise questionnaires for all patients with hypertension (HYP4 and HYP5), which Bailey described as “ludicrous,” and reducing the time window for indicators from 15 months to 12 months.

Although QOF thresholds will increase in Wales, as in England, the increases will be to the median Welsh achievement level rather than the upper quartile. The need to formally report an exemption where secondary care referral services are not available will not exist in Wales, and the organisational domain will continue, albeit with amendments.

The Welsh government has suggested a 1.5% contract uplift for general practices. Bailey said that all that practices could hope for with this settlement was to maintain current levels of funding. “With the extra work and the extra expenses, it’s still going to be hard to do more than stand still,” he said.

Given the current financial climate, the agreed contract is the best that Welsh GPs could have achieved, Bailey added. “There was never going to be good settlement for GPs in Wales any more than there was anywhere else, because we’re in the middle of a double dip recession,” he said. “It’s a deal that is acceptable to both sides and will mean that practices aren’t at risk of being seriously disabled, which is probably the best we can expect at the current time.”

Health Minister Lesley Griffiths said that the Welsh Government had listened carefully to the concerns expressed by GPs about workload implications of the new contract. “This agreement with GPC Wales will enhance our position for further joint working and collaboration in the coming years to continue to develop and improve services for patients across Wales,” she said.

Dean Royles, director of the NHS Employers organisation, said: “The GPC has clearly now abandoned a UK approach to negotiating changes to the GP contract.

“Whilst Scotland and Wales have settled, England intends to continue consulting on a package of proposals that seek to deliver a significant improvement in services for patients.”