GP contract: £2.8bn deal gives English practices core funding boost for five years
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l521 (Published 31 January 2019) Cite this as: BMJ 2019;364:l521
General practices in England will be able to give all staff a 2% pay uplift this year, after a landmark £2.8bn (€3.2bn; $3.7bn) five year contract deal was agreed by the BMA’s General Practitioners Committee and NHS England.
The deal, described as the most significant change to the GP contract since 2004, will increase core practice funding by almost £1bn over the next five years. This will be supplemented by an extra £1.8bn over the same five years to support primary care networks, in which practices will work together to provide care to 30 000 to 50 000 patients across a wider geographic area.
The agreement will provide upfront investment of £405m this year, delivered through a combination of a 1.4% increase to core funding and a new network contract (delivered through a directed enhanced service (DES)) that will operate alongside practices’ standard contracts.
It also delivers a state backed indemnity scheme for all GPs. This means that, from April 2019, GPs (including those who work out of hours) and practice staff will no longer have to personally fund clinical negligence cover.
The General Practitioners Committee recommends, on the basis of the deal, that “practice staff, including salaried GPs, receive at least a 2% uplift in 2019-20 through a combination of increase to income and decrease to individuals’ indemnity expenses. However, each practice, salaried GP, and other staff will need to agree how the uplift is realised.”
Practices’ global sum payments will increase each year until 2023-24 in line with predicted inflation, to guarantee uplifts to core practice pay and expenses each year.
Expanded network workforce
The BMA said that the deal would kick start the “rebuilding” of general practice by tackling longstanding workforce and workload pressures and by improving services for patients in line with the NHS Long Term Plan.
In the first year (2019-20) the new network DES will fund at least one social prescribing link worker and one clinical pharmacist for each network. From 2020-21 money will be available to fund an extra 22 000 members of the primary care workforce by 2023-24.
NHS England will recurrently fund 100% of the cost of employing social prescribers and 70% of the cost for the rest of the expanded network workforce, including pharmacists, physician associates, practice based physiotherapists, and paramedics. Each network will be led by a local GP in a clinical director role, fully funded by NHS England.
Each network will also get a recurrent annual payment of £1.50 per patient to be used by the individual network practices to support their work. This is an extension of the current funding received by practices from clinical commissioning groups but is now non-discretionary. Additional funding has also been added to the global sum for practices to establish and engage with networks.
From 2020-21 the DES will fund networks to work towards aims in line with the long term plan, including medicine reviews, provision of enhanced support to care homes, supporting early cancer diagnosis and prevention, and diagnosis of cardiovascular disease.
The BMA has provided a summary and further details of the changes online.1
Other key changes include:
Retiring “low value” indicators from the Quality and Outcomes Framework. A total of 175 points will be retired (from 28 indicators); 101 of the retired points will be recycled in 15 new indicators, with the remaining 74 creating a new quality improvement domain
£20m to be invested in the global sum for practices to cover the costs of dealing with subject access requests by patients
NHS 111 will be able to book practice appointments directly on behalf of patients. This will be permitted at a rate of one appointment per 3000 patients available each day and will only happen after triage
An agreement between the BMA and NHS England to make a joint representation to the government with proposals to reduce the negative effects of the pension annual allowance on GP recruitment and retention
The General Practitioners Committee will work with NHS England to develop a standard specification for IT systems in primary care, to increase patients’ digital access. Practices will make at least 25% of appointments available for online booking by July 2019 and offer online consultations by April 2020, subject to further guidance.
Richard Vautrey, chair of the GPC, 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.
“After years of derisory pay uplifts for staff and tightening financial pressures on practices, we have been able to negotiate a five year deal guaranteeing investment that covers pay and expenses, and at least matches predicted inflation.
“This package sets us on the road to rebuilding not only general practice but also the wider primary healthcare team—delivering an expanded workforce embedded within practices and giving GPs a leadership role in bringing together the community healthcare team.”
Ian Dodge, national director for strategy and innovation at NHS England, who led negotiations with the BMA, said, “Through this comprehensive deal, the BMA and NHS England have sought to solve the big problems that general practice faces and make it possible to expand services for patients.”
Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said, “We hope that today’s announcement will mean that we can finally move towards making general practice sustainable for the future.”