GP workload could rise by 15% under contract changes in Northern Ireland

Changes to the general medical services (GMS) contract for GPs in Northern Ireland could increase their workload by up to 15% without providing any additional funding, the BMA’s Northern Ireland General Practitioners Committee has warned.

The Department of Health, Social Services and Public Safety in Northern Ireland has announced proposals for the GMS contract for 2013-14 that are very similar to those put forward for England.1

Tom Black, chairman of the committee, said that the proposals would increase the workload strains already felt by GPs in Northern Ireland. “It is estimated that our workload will increase by 10-15%—none of which will be patient centred care but increased box ticking,” he said. “Without any funding to support this increased workload, it is the patient who will suffer.”

Northern Ireland’s health department has proposed phasing out the minimum practice guarantee over a period of seven years and has put forward a raft of changes to the Quality and Outcomes Framework (QOF).

The proposal would also introduce most of the changes to clinical indicators recommended by the UK National Institute for Health and Clinical Excellence. These include referral to rehabilitation for people with chronic obstructive pulmonary disease or heart failure. For 22 indicators, the upper payment threshold would increase by 5% and the lower threshold by 20%. In addition, the QOF organisational domain indicators would be discontinued in 2013-14, and a new public health domain would be introduced.

GPs in Northern Ireland would be spared the change to QOF review dates from 15 months to 12 months that will go ahead in England.

The province’s health department has suggested an increase in core practice funding of 1.5%. It will make its final decision once it has received a recommendation on the contract uplift for 2013-14 from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB).

Black said that under the workload increases generated by the proposals some practices would find it difficult to maintain their current level of care, “let alone increase their capacity to meet the demands of these new proposals.”

He said, “GPs in Northern Ireland will have no choice but to protect their core activity of looking after sick patients, rather than taking a holistic approach to patient welfare.”

The health department has said that it would impose the contract changes after consultation if it was not able to reach an agreement with the General Practitioners Committee in Northern Ireland.

Black, however, has labelled this approach “unacceptable.”

“The agreement reached in Scotland over the future of changes to the GP contract demonstrates how a cooperative and consultative approach can achieve a positive outcome for patients and the NHS,” he said. “The Department of Health, Social Services and Public Safety in Northern Ireland needs to follow that example.”

The department’s consultation on its proposals will run until 22 March, and the contractual changes will come into effect from April 2013.