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Secret Diary of a PM – The New GP Contract

A few weeks ago, the BMA revealed they had reached an agreement with the government and the NHS for the new GP contract from April 2020.

Apparently the first set of proposals, sent out two days before Christmas, have been watered down following wholesale condemnation and the threat that GPs could refuse to sign up. 

Since this second announcement there have still been voices from LMCs questioning whether or not to sign the agreement - however this has received a mixed response.

What’s in the Contract?

In essence, the contract agrees the following:

  • The new value of Global Sum from 1st April will be £93.46
  • The new value of a QOF point will be £194.83
  • More roles added to the Additional Roles Reimbursement Scheme
  • Between 2020/21 and 2023/24, the scheme will expand to 26,000 additional roles
  • All roles to be reimbursed at 100%, freeing up the existing £1.50/head to contribute to management support for PCNs. And not the 70% as first announced
  • Funding entitlements increase from £257m to £430m next year and, in 2023/24 from £891m to £1,412m
  • Extra investment will fund new GP training, recruitment and retention measures, with £20,000 plus training support for every new partner
  • Payment arrangements for vaccinations and immunisations to be reformed with an
  • item of service fee for childhood vaccinations, beginning with MMR in 2020/21
  • QOF to be updated
  • PCN service specifications significantly reduced and improved
  • Investment and Impact Fund introduced worth £40.5m from April 2020/21
  • Fellowship in General Practice programme

A Practice Manager’s Perspective

The extra investment in general practice is long overdue. There are definite advantages to working at scale, which should not be overlooked.

A number of the enhancements in this year’s contract negotiation are welcome and are clearly enabled by the profession’s strong rebuttal of the original contract offer by NHSE.

The GP Partnership model receives support and is likely to stay. NHS England have agreed a £20k golden ‘hello’ for GPs taking on partnership roles (calculated on a 37.5-hours-a-week basis), along with £3k for business training, an overdue development to prepare new GPs for partnership. However, this incentive will be in the form of a loan which is written off after an undecided length of time, suggested by NHS England to be five years.

New Roles for Primary Care

Six new roles have also been added to the list that PCNs can use funding to recruit from: pharmacy technicians, care coordinators, health coaches, dietitians, podiatrists and occupational therapists. A 100% reimbursement is to be provided for recruiting these additional roles, removing the need for a 30% contribution from practices out of the £1.50 per head.

This won’t solve the problem of being able to recruit people into the new roles, nor will it resolve questions around who is responsible legally for the new staff member at the funding levels available - but it does tackle the major issue of sourcing the 30%.

The Induction and Refresher Scheme will be expanded and enhanced to provide more support to GPs returning to general practice, including those with childcare or other caring responsibilities.

The Impact on Practice Finances

As I write this, I have details from a recent PCN conference that suggest HMRC are looking at PCNs with a view to claiming PAYE and NI payments and taxing monies not spent by the year end from the money-holding practice.

Whilst this was the view of one official, we spoke with an accountant who was aware of the possible interpretation by HMRC. In fact, we discussed the possibility of distributing any monies left in the account by the year end. This would put a new perspective on the running of PCNs and would mean a loss of finance and increase in administration.

I still think we need to be very careful how we move forward, as in my view the new contract and the news on PCNs are not as good once the small print is taken into account. With Coronavirus spreading, it adds a different perspective to the already heavy workload we are facing in primary care.

 

Stay tuned to the FPM Blog for the latest stories that matter most to practice managers.

 

 

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