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Contract changes will cut GP income

QOF changes and increased care will cost more than any small pay rise

Louise Prime

Wednesday, 24 October 2012

GPs face a further significant cut in pay as a result of the changes to the GP contract that the government is threatening to impose, the BMA has warned. It says additional costs would more than swallow up any small increase in practice income. But the government insists that it will not back away from the changes it wants to see if it can’t reach agreement with the BMA.

The government’s proposals for England, now with the BMA for consideration, include new measures that it says would help prevent unnecessary emergency admissions of people with long-term conditions. These include new quality improvement schemes for diagnosis and care of people with dementia, care for the most frail or seriously ill patients, patient access to online services and support to help people with long-term conditions better monitor their own health.

It also wants to gradually reduce variability in practice funding over the next seven years, and alter the global sum funding formula to reflect local deprivation levels.

Chair of the BMA GP committee Dr Laurence Buckman told GPs: “It is clear that this programme of changes would have huge implications for GP workload and income. I know that many of you are already under enormous strain – this is a point that we have made to the government repeatedly and we will do more to evidence what is now a very serious situation.”

The government’s proposed changes to QOF include removing all organisation QOF points. It says it is stopping ‘additional rewards’ for organisational tasks such as good record-keeping because they ‘should be part of any good health organisation’. It expects the money thus saved to become the funding for the enhanced services – which may include risk profiling, dementia and on-line access to practice services.

It also proposes:

  • increasing upper thresholds in QOF to the upper quartile of achievement
  • cutting time limits in some QOF indicators from 15 to 12 months
  • introducing a series of proposed NICE indicator changes
  • changing the financial calculation for funding of QOF.

Dr Buckman told GPs: “While the government has suggested public sector workers could expect a pay rise of 1% next year, this set of changes of itself would be likely to lead to a significant pay cut for many GPs.

“I do not believe that we will receive any resourcing by any route that will make up for the annual pay cuts that we have had over recent years as new contract income has gradually been eroded through rising expenses and barely rising or frozen gross pay.”

The government says that it will continue to invite discussion with the BMA in the hope of reaching an agreement – but if agreement isn’t achieved then it will move to formal consultation. Health secretary Jeremy Hunt said: “The GP contract needs to change so that it further improves care for patients ... We want to drive up standards for all and want the contract to reflect the most up-to-date expert guidance and excellent standards of care.”

He added: “We want the BMA to work with us on making this happen, but will not back away from making changes that will deliver better care for patients.”

The BMA remains angry at the government’s stance. Dr Buckman said: “We will be making sure that our message – that GPs are committed to the highest levels of patient care, but that these changes seem to be more about ill-conceived quick fixes rather than solid, evidence-based improvements – cuts through the government rhetoric.

“We will be examining the proposed changes in detail now and making the strongest possible case about their damaging impact, and urging the government to return to the negotiated settlement that we had so nearly concluded.”

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