New General Practice Contract Finalised

Peter Russell

January 31, 2019

A new general practice contract would address workforce and workload pressures in England, the British Medical Association (BMA) said.

The agreement would give practices almost £1 billion over 5 years, while another £1.8bn would be invested to support the formation of Primary Care Networks, in which practices would work together to provide care to patients across wider geographic areas.

According to NHS England, an "army" of 20,000 more staff would be recruited "to help patients live fitter, healthier lives and combat anxiety, loneliness and depression".

State-backed Indemnity Scheme

The contract would also end the expense of personal indemnity cover and replace it with a state-backed scheme from April 2019.

Announcing the agreement, Matt Hancock, Secretary of State for Health and Social Care, said on Twitter: "GPs are the bedrock of the NHS, and at the heart of our prevention agenda."

Simon Stevens, NHS England chief executive, said the contract formed the first major pillar implementing the NHS long-term plan, 3 weeks after it was published.

The BMA said the move was in response to an analysis showing that around half of GP appointments were not directly related to medical conditions.

The new recruits would include pharmacists, physiotherapists, paramedics, physician associates, and social prescribing support workers. NHS England said these recruits would help allow GPs to spend more time with patients who need them and ensure patients had access to a wide range of services at their local practice.

It said the announcement comes on top of the introduction of digital appointments and patient consultations via video and the web.

Key aims would be improving targets for cancer and heart disease as well as doing more to tackle obesity, diabetes, mental ill health, and support for older people at home and in care homes, it said.

'Big Boost to Primary Care'

"This 5-year deal unarguably represents the biggest boost to primary care in more than 15 years, giving patients more convenient services at their local GP surgery while breaking down the divide between family doctors and community health services," Mr Stevens said.

"It provides the practical foundation for the big service improvements in the NHS Long Term Plan. Patients across England - in towns, villages and cities - will all begin to see the benefits, beginning this year. And it allows us to keep all that's best about British general practice while future-proofing it for the decade ahead."

Among other measures included in the contract were:

  • Establishing primary care networks across the whole country by July 2019, backed by £1.8 billion of funding by 2023

  • A new £300 million fund by 2023 to fast-track reductions in avoidable A&E attendances, admissions, and delayed discharge

  • Solving the indemnity funding crisis through a new NHS Resolution Clinical Negligence Scheme for general practice to start from April 2019

  • Clinically-proven improvements in the management of diabetes, blood pressure control and cervical screening, through reforms to the GP Quality and Outcomes Framework from April

  • From April this year, new support for quality improvement, starting with prescribing safety and end-of-life care

  • Additional funding of IT which will allow both patients and practices to benefit from the latest digital technologies

  • Direct booking of calls from NHS 111 into GP surgeries to be introduced from April this year

  • Protecting the principle that general practice remains free on the NHS, through a new ban on advertising or hosting private GP services

Ian Dodge, national director for strategy and innovation at NHS England, who led discussions with the BMA, said: "General practice is the bedrock of the NHS, and the NHS needs general practice to survive and thrive. 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."

Shifting Resources to Community Care

The BMA said funding in the contract would mean that every GP practice in England would be able to uplift staff pay by at least 2%.

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. Last month, the Government announced its long-term plan for the health service, and our negotiations with NHS England were key to shaping this vision for general practice, as is evident in many of the details revealed today.

"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 Royal College of General Practitioners (RCGP) welcomed the state-backed indemnity scheme. "Escalating indemnity costs have become a huge burden for GPs at all stages of their careers, and some GPs have even cited this as their reason for leaving the profession," said Helen Stokes-Lampard, RCGP chair.

She added: "General practice has been at a crossroads for several years: workload in general practice has escalated both in volume and complexity recently, yet the share of the NHS budget our service receives is less than it was a decade ago, and we have fewer GPs than we did 2 years ago – as a result, GPs are working unsafe hours, and patients are waiting longer and longer for an appointment."

Commenting on the new contract, Richard Murray, chief executive of The King's Fund health think-tank, said: "The contract is a promising early sign that the Government and NHS England are making good on the commitments in the NHS long-term plan to shift resources to primary and community care. It is the biggest reform of general practice in over a decade and could bring significant benefits to patients.
"The new deal is welcome recognition of the pressures facing general practice and signals a fundamental change in the way that GP services will be delivered, with teams of professionals including pharmacists, physiotherapists and paramedics working with GPs and practice nurses to provide care to patients.
"As well as providing additional funding for new staff, the contract requires practices to work together in new networks to share staff and provide a wider range of services to patients. 

"The timetable for implementing these changes looks extremely challenging and it will be important that general practice and community services are supported to put these plans into practice."


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