Funding for primary medical and community care is set to increase as a share of the NHS budget for the first time in the health service’s 70-year history, with an extra £4.5bn invested by 2023, under a new five-year contract agreed between the British Medical Association’s (BMA) GP committee and NHS England that will also bring in a state-backed indemnity scheme and over 20,000 additional primary care-based healthcare staff across England.
NHS England said this morning that under “the biggest reform to GP services in 15 years” a new workforce in general practice will allow GPs to focus on the sickest patients and will in time allow them to provide longer appointments to people who need one. Doctors’ leaders have welcomed the changes but some pointed out that a “workforce plan is still desperately needed” to improve recruitment and retention in the profession.
The agreed changes include:
- Guaranteed investment of £405m through the practice contract and network contract in the first year, so every practice will be able to uplift staff pay by at least 2%.
- Building primary care networks from the ground up, typically covering 30,000-50,000 patients and led by a local GP as clinical director.
- Networks will receive 100% recurrent funding to employ social prescribers and 70% for clinical pharmacists this year, and the same for physiotherapists, physician associates and paramedics as they are introduced.
- A state-backed indemnity scheme introduced in April 2019.
- Increased digital access for patients: practices will make 25% of appointments bookable online, improve their online presence and give new patients access to their digital records as standard. And, from 2020 onwards, resources to enable practices to offer online and video consultations
- An agreement between the BMA and NHS England to make joint representation to the government with proposals to reduce the problem created by the pension annual allowance, to address the impact this is having on GP recruitment and retention.
- NHS 111 direct booking in to practice appointments at a rate of one appointment per 3,000 patients available per day – but only after triage.
- Funding for practices to deal with subject access requests following the removal of the ability to cover costs under GDPR legislation, and access to a data protection officer through their clinical commissioning group.
- Removal of unnecessary indicators from the Quality Outcomes Framework (QOF) and a focus on professionally-led quality improvement.
- And, to be implemented from 2020 onward, increased workforce as part of the networks, with 22,000 additional roles in total in England by 2023-24.
Dr Richard Vautrey, BMA GP committee chair, 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.
“Recent years have seen hard-working family doctors deal with an overstretched workforce doing their best to meet rising demand from patients suffering more and more complex conditions, all on the back of a decade of underinvestment in general practice. Therefore, we are pleased after months of discussions with NHS England, to have negotiated a package of reforms to the GP contract and beyond, that will begin addressing the unsustainable situation – whereby doctors are choosing to leave the profession while patients wait longer and longer for appointments – and laying the foundations for a general practice fit for the future.”
The BMA was especially pleased to have met one of its key aims, that of state-backed indemnity, from April. Dr Vautrey said: “This will mean that all GPs and practice staff, both in and out-of-hours, will be covered and represents a major change, freeing GPs from the significant risk of rapidly rising indemnity costs.
“This package sets us on the road to rebuilding not only general practice but also the wider primary health care team; delivering an expanded workforce embedded within practices and giving GPs a leadership role in bringing together the community healthcare team.”
The Royal College of GPs praised the BMA’s “excellent” negotiations, and said the additional investment would make general practice a profession that “future doctors are eager to join, and where existing GPs want to remain” – and that it is an investment “in the entire health service”. It particularly welcomed the introduction of a state-backed indemnity scheme because escalating indemnity costs have become such a huge burden for GPs.
College chair Professor Helen Stokes-Lampard said this morning: “We hope that today’s announcement of the new contract will mean that we can finally turn a corner towards making general practice sustainable for the future.
“Now we need the forthcoming NHS England workforce strategy to deliver viable measures to continue recruitment efforts into general practice, and initiatives to keep more GPs working in it.”