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GP Contract Reforms

GP Contract Reforms

What do the GP Contract Reforms mean for workforce shortages in Primary Care?

As a busy doctor, it can be difficult to keep abreast of the changes taking place throughout primary care services. But keeping your knowledge up to date about what these changes might mean for your professional and personal life is essential in helping you to plan your future.

In this article we summarise some of the changes outlined in the NHS GP Contract Reforms (January 2019), that aim to solve workforce and workload issues, and examine what this might mean for GPs at different stages of the career spectrum.

Understanding the world you live and work in is at the centre of everything we do. So, we'd love to know how you're feeling about the introduction of the NHS GP Contract Reforms - join our online discussion using #GPContractStories

Helping to solve workforce and workload issues

Workforce and workload issues in Primary Care have been well documented over recent years, and a number of plans to tackle them were outlined in General Practice Forward View in 2016.

Solving workforce and workload issues remains one of five main objectives the GP Contract Reforms set out to address. The cause are manifold but include:

  • Fewer GPs remaining in the profession, with many early and mid-career GPs finding the partnership model undesirable (GP Partnership Review, January 2019).

Newly qualified GP? How attractive is the GP Partnership model to you in your future career?  Join our online conversation using #GPContractStories

  • An increasing number of GPs choosing to work on a part-time basis. The number of salaried GPs working less than or equal to 15 hours per week increased from 1,170 in September 2015, to 1,705 in September 2018 (+535). During the same period, the number working more than 15, but less than 37.5 hours per week, increased from 7,601 to 10,229 (+2,628) 1
  • Many experienced GPs choosing to reduce their hours or leave the profession  altogether in a bid to avoid pension annual allowance tax charges:

"The annual allowance cap creates an incentive for GPs to either cut their time commitment to the NHS, or quit the NHS pension scheme altogether, thus leaving themselves and their families without coverage for ill-health retirement or death-in-service.

"This could be resolved by creating a new 'partial pension' option. Under this, GPs could choose to halve the rate at which their pension builds up, and in return pay half rate contributions." - BMA / NHS England, January 2019.

Tackling workforce shortages

From 1 July 2019, GP practices in England that are part of a registered Primary Care Network (PCN), can start receiving some of the additional investment guaranteed under new GP Contract Reforms.
This marks the start of a five-year funding programme for Primary Care services, helping to deliver the wider NHS Long Term Plan.

As part of the Contract Reforms, The BMA and NHS England set out a number of tactics to reduce workload on existing GPs alongside plans to recruit and retain qualified doctors.

 1. Primary Care Network roll-out across England

By bringing GP practices together to serve larger populations (of no less than 30,000, and no more than 50,000 patients) the new contract sets out how surgeries should work together to share resources and deliver services most effectively for their communities.

PCNs aren't a new concept (in fact, by October 2018 almost 90% of practices in England were already leading, or part of one) but the additional funding guaranteed to each PCN is.

The 'additional role reimbursement scheme' is being introduced to support an estimated 20,000+ additional staff into PCNs by 2023/34.

The roles being supported through this funding are designed to take some of the workload demand away from GPs to other front-line providers and will cover positions for which there is "both credible supply and demand" - BMA / NHS England, January 2019.

70% of the additional costs are guaranteed for PCNs employing additional:

  • Clinical Pharmacists (from 2019)
  • Physician Associates, and First Contact Physiotherapists (from 2020)
  • First Contact Community Paramedics (from 2021)

100% of the additional costs are guaranteed for PCNs employing social prescribing link workers (from 2019).

Funding for the roles will be on a recurrent basis throughout the five-year plan.
All other staff groups will continue to be funded through the core practice contract (including GPs and nurses).

How much of a shift in demand have you seen for front line services during your career in primary care?

How much of the pressure felt by GPs is a result of demand for appointments that will now be covered by additional roles such as clinical pharmacists?

GPs: Do you think the new contract goes far enough in helping to reduce workload pressures?

Join our online conversation using #GPContractStories

2. GP retention schemes

The contract reforms emphasise the importance of retaining existing GPs within the workforce. Many are choosing to reduce their working hours, commitments, or retire from the profession altogether.

One of the reasons for experienced GPs leaving the profession, cited by the BMA and NHS England (January 2019), is due to concerns over exceeding the pensions annual allowance. There's also an overall pension Lifetime Allowance, which restricts the amount that can be sheltered from tax in pension contributions:

"Due to Mr Osborne's cut to the Lifetime Allowance, an estimated 2,000 GPs and 1,500 NHS consultants have taken early retirement during the last three years, rather than run the risk of breaking the limit. The result is a growing shortage of family doctors and consultants and an attendant rise in waiting times" Sky News, April 2019.

In a bid to address the issue, the GP Contract Reforms contain a proposal for the introduction of a partial pension - with the aim of allowing GPs to halve the rate that their pension builds up over time (and therefore pay half rate contributions).

NHS Pension Scheme Reform - Share your thoughts with us about the 50% pension proposal.  Join our online conversation using #GPContractStories

3. GP recruitment schemes

A Primary Care Fellowship Scheme (aimed at newly qualified GPs and nurses) is being created and part-funded as part of the Contract Reforms. This will offer participating GPs a secure contract of employment and a role tailored to their individual needs, as well as that of the Primary Care system.

Those who complete Fellowships may be encouraged to become full partners. Historically, many early and mid-career GPs have found the partnership model undesirable as a result of "trainees [being] told repeatedly throughout their training that general practice was not a great place to be" (GP Partnership Review, January 2019).

Early career GP? What have you been told about life on the Primary Care front line by your more experienced colleagues?  Join our online conversation using #GPContractStories

We're here to help

Whether you're at the start of your medical career, or closer to retirement, the GP Contract Reforms introduce new options and ways of working that could affect your personal and/or commercial finances.

Whatever your circumstances, Wesleyan Financial Services Consultants are trained to understand the career paths and financial needs of doctors and can advise on:

  • Entering, amending, or exiting from GP Partnership Agreements
  • Your NHS Pension Scheme benefits
  • Pensions annual and lifetime allowances
  • Continuing to work once you have accessed your pension benefits.

It's important to remember that the GP Contract Reforms will be rolled-out over the next five years and are not an immediate solution to the pressures being experienced by those on the front-line of Primary Care service delivery.

Mental health issues are one of the most common cause of claims against income protection policies among doctors - 34% of all claims made to Wesleyan by doctors on their income protection policy in 2018 resulted from mental health issues.

We can advise on a number of solutions to help protect your finances should you or one of your business partners become unable to work due to ill-health (including partnership protection, key person insurance, and locum insurance).

1Comparatively, the number of salaried GPs working full-time remained consistent at 1,356 in September 2016, and 1,441 in September 2018 (+85) - General Practice Workforce, England Bulletin Tables, September 2018.

To arrange a no-obligation review of your personal or commercial finances please email and quote reference 1001700

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