The New GMS Contract

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PO Box 125
Stockport
SK6 6WL
Telephone: 07790 939650

13 November 2007

 GPC "Focus on" Guidance Papers

Over the past few months the GPC have produced a number of easy to read guidance papers known as their "Focus on" series. For ease of reference a direct link to the relevant papers is provided below:

A Reluctant Profession Accepts the New Contract

Reluctantly (should there have been a tick box on the ballot paper to indicate reluctance!?) it appears the profession has accepted the new contract, meaning we collectively in Stockport must ensure that promises made are kept.

We look forward to a hands off, high trust implementation of the contract in its entirety. We must see:

• IT systems rapidly and comprehensively updated. Practices will be unable to achieve the quality demanded by the contract without this.

• A hands off facilitation of practice staff development, especially management and nursing, not the PCT controlling or directing practice employed staff.

• Enhanced services funding actually made available to practices to deliver those services they know their patients need, many of which they are already providing

• GPs enabled to develop premises in the PCT's proposals, using new contract funding and regulation flexibilities, if they wish to, rather than profit motivated, third parties tying GPs into long term, onerous leases.

Your LMC will be helping ensure that the PCT fully implements the new GMS contract, and that PMS practices really receive equivalent benefits.

The GPC will apparently not be producing detailed guidance until the winter, as so many details are yet to negotiated. Your LMC will therefore be producing guidance on what practices need to do to "hit the ground running" in the next few months.

Latest Amendments do Little to Encourage Stockport Practices

GPs have recently received outline detail of late amendments to the contract as well as ballot papers to vote on he contract before 20th June 2003. Your LMC has attempted to provide an assessment of the impact of these amendments to Stockport GPs to assist the decision making process.

• Registered Populations - The move to registered populations will decrease the global sum per capita from £53 to £50 per patient. GPC have advised that practices’ list were adjusted for the actual list inflation prevalent in their local PCO (Stockport PCT is on average 3%). The net effect therefore on average will be a 2.7% reduction in Carr-Hill Global Sum allocations to Stockport practices. Since most if not all Stockport practices will be MPIG practices (Carr Hill losers) the impact of the change to registered list sizes will have NO impact on practice income. The MPIG correction factor will merely increase to cover the additional lost Carr-Hill income.

• No MPIG Quality Points Forfeited - In 2004 under the original MPIG the cost of the 100 forfeited quality points would have been approximately £7,500 for the typical practice. To fund this concession, however the typical practice will forfeit £5,750 of preparation monies. The net gain to the typical practice being £1,750 or £583 per GP. In 2005/06, 150 quality points are worth £18,000 less the forfeited £9,000 preparatory funds gives a net gain of £9,000 or £3,000 per GP.

• Prevalence Factor - Neither the nature nor the weighting of the prevalence factor has been established. Its impact is therefore impossible to calculate, suffice to say that if a practice has a higher than average prevalence of a particular condition their quality payment income will increase and conversely a lower than average prevalence will decrease their quality payment income.

• Quality Points not Linked to Carr-Hill Factor - The method for allocating quality payments to practices and therefore the value of quality points is now unclear. The previous link to the Carr-Hill allocation has been dropped but the details of the replacement allocation method will take time to determine.

The negotiators have confirmed that no further monies have been made available to fund these changes, therefore if MPIG GPs are to gain £3,000 each in 2005/06 it stands to reason that this money could well be clawed back through the revised quality allocation formulas.

Effectively GPs do not now know with any degree of certainty what their income will be under the New GP Contract.

As for PMS practices, Carr-Hill losers will not be entitled to MPIG protection should they ever choose to exercise their GMS return ticket. The GPC have stated that more clarification on the position of PMS doctors moving between PMS and GMS will be given only after a yes vote in the ballot. PMS practices will therefore need to decide whether this is sufficient encouragement to vote for the contract.

Since publication, your LMC officers have been concerned that almost all Stockport practices will require MPIG protection (as will 78% of practices nationwide) to sustain current income levels. Stockport LMC took an active role in demanding the renegotiation of many aspects of the proposed contract, as well as the deferment of the ballot to ensure the impact of any such changes could be fully assessed by all practices.

Unfortunately, the GPC chose to go to ballot before the impact of the recent amendments could be assessed.

GPs will therefore be voting on a contract, which has not been fully agreed or costed. The recent amendments mean that GPs cannot now calculate either their Global Sum or the income they are likely to achieve through the quality and outcomes framework.  Furthermore, PMS GPs have been told that the mechanism for them to return to GMS will not be discussed until after a “yes” vote in the ballot.

Your LMC officers will therefore be voting against the implementation of the New Contract.

Should GPs wish to discuss any aspect of the contract before voting please do not hesitate to contact any LMC officer via the LMC office on Old Telephone Number.

Chisholm/Farrar Letter Fails to Acknowledge Carr-Hill Flaws

GPC Chairman John Chisholm's joint letter with Mike Farrar (NHS Confederation Chair) of 17th April details how MPIG will work. Surprisingly however, it continues to support the introduction of the much maligned formula suggesting that it is as robust as it can be given the information currently available. From such comments it is clear that the negotiators have lost their objectivity and become consumed in defending what many GPs across the country consider a dead duck. 

The letter details the details the forfeited quality points arrangements practices will be subjected to under MPIG and unless I am completely missing the point - MPIG effectively negotiates away the first £18,000 pa of quality payments for 75% of practices from 2005/06. Bearing in mind one of the main selling points of the original contract was that much of the quality work was already being done and THIS was the substantial pay award the negotiators were so smug about having achieved it is unacceptable that the GPC negotiators have allowed the easiest 15% to be taken away in one fell swoop. The response that most of the work is already done in practice is a further insult, firstly it is not presently being recorded in the required manner and more importantly those randomly selected 25% of practices who for no other reason than luck fare well under Carr-Hill will be further advantaged - All MPIGs are equal but some appear more equal than others!

This is another fine example of dumping on General Practice! Following the failure to come up with a robust reliable formula for allocating resources the only thing you can rely on is that General Practice will pick up the cost of the failings - in this case the negotiation away of approximately £6,000 per GP of the proposed pay award - effectively doubling the cost of the Out of hours opt out for 75% of GPs

Full text of the letter is available by following this link.

MPig, Carr Hill & PMS - Now we have 3 Contracts!

It appears the conclusion of the GPC Meeting with the GPC negotiators concluded that a Minimum Practice Income Guarantee (Mpig) be offered to those practices (approx 75%) disadvantaged under the proposed Carr Hill formula allocation. Essentially Mpig will allow practices to formalize their current Red GMS earnings that directly translate to elements within the Carr Hill global sum. Practices would also have certain limitations on quality points available under the Quality & Outcomes Framework.  Further details are available from this link. The general idea being that practice's income under Carr Hill will eventually entice practices away from Mpig to Carr Hill. I guess on the basis that one of the aims at the outset was to produce a single contract for all GPs this means that eventually Mpig will eventually entice GPs away from PMS before Carr Hill entices them away from Mpig!!!

There appears to be a severe credibility gap here. Surely crystallizing current Red Book earnings will only serve to perpetuate the existing inequalities the New Contract set out to address. 

Many LMCs across the country are of a similar opinion and indeed 20 have exercised their right to call a Special Conference of LMCs to be held in London on 14th May 2003. The meeting has been called to enable LMCs to debate the current position and investigate how the negotiators allowed such a position to arise and how or if the new contract can ever be put to the profession for the vote.

Your LMC will be represented at this meeting and would be pleased to receive any comments or thoughts from GPs in the meantime.

Ballot Delayed - Global Sum Shambles

Farce became fiasco today (17th March 2003) when the GPC negotiators announced that the New Contract Ballot would be delayed temporarily whilst claims that the majority of GPs would actually lose monies under the proposed arrangements were investigated.

Unbelievably it appears that the Carr - Hill formula utilised to calculate the Global Sum which will form approximately 75% of GP income under the New Contract was not validated with real Practice information before the negotiators let it loose on their members.

Unfortunately, the New Contract is now suffering a credibility crisis; original aims including sole negotiating rights for PMS and GMS GPs, the end of enforced allocations, pension enhancements were all foregone in an attempt to cobble together an agreement to present to the profession. Subsequently, publication of the contract was delayed on 2 occasions whilst i's were dotted and t's crossed, then to add insult to injury global sum calculations released to practices across the whole country project large income reductions jeopardising the very future of General Practice.

The response of the negotiators is to delay the ballot in order to analyze the nature and size of the problem so that solutions can be put forward. Realistically, the negotiators have had the last year to put solutions forward, based on what they have achieved during this period what hope can there be for a satisfactory resolution during the temporary ballot delay? Perhaps it is not a ballot delay that is required, perhaps GPs should have the opportunity to vote on the contract as presented - a resounding NO vote followed by a resignation ballot is perhaps the only way to show Mr. Milburn that GPs mean business.   

GPC Frequently asked Questions

The GPC have posted a list of frequently asked questions and answers on their website. Although cumbersome to navigate you may find some useful information contained therein.

New GMS Contract Released - LMC Open Meeting March 27th

After much delay the New GMS Contract has been released. To date the contract along with 5 annexes are available from the BMA web page. Unfortunately, there are still many areas to price including Enhanced Services and the new seniority payments. We will advise you as soon as this information becomes available. 

Press speculation or Government Spin has indicated that GPs should receive a pay rise of between 10 - 50%. To date no information has been released which can substantiate this claim.

Unfortunately, the New Contract documentation provides misleading information in respect of the typical global sum for an average GP with approximately 1,830 patients of average health needs. Utilising the figures provided in sections 2.25, 2.37 and 5.22 the Global sum could be £85,000 per GP (based on the £6,000 out of hours opt out being 7% of the global sum), £97,200 (based on the £53 per patient global sum) or £111,000 (based on the £2,220 Vac & Imms opt out being 2% of the global sum).

Therefore, all practices will eagerly await confirmation of their Global Sum before they will have any idea as to how they might be affected by the proposals. Practices should then compare this gross income to their total current NHS income allowing for the change to direct funding of PCT Information Technology. Any shortfall revealed in this comparison will need to achieved through the Quality & Outcomes Framework. There is no guarantee that GPs will be chosen to provide the yet to be priced Enhanced Services. 

Early commentary has been guarded but generally negative. The failure to achieve sole negotiating rights for both GMS and PMS GPs, the failure to make real progress in the pensions debate and the failure to end enforced allocations are all significant downsides to the proposals released. Added to this the inability to date to truly identify the promised pay award despite the concession of a Quality and Outcomes Framework which will undoubtedly lead to Practice league tables and it is no surprise that GPs are yet to be convinced that they should support the proposal.  

We will update you with further information as it becomes available.

Revised GPC New Contract Road show 3rd March 2003

Stockport LMC has been advised that the new date for the GPC New Contract Road show is Monday 3rd March 2003. Once again the Reebok Stadium, Bolton has been chosen as the venue.

Further details will follow in due course

GP New Contract to be Delayed 6 Weeks - GPC Comment Below

A delay of six weeks in the timetable to produce the new GP contract has been announced by the BMA's General Practitioners Committee. The full, priced, new contract will now be announced on 21 February 2003 instead of 10 January 2003 as planned. Dr John Chisholm, Chairman of the General Practitioners Committee explained the reasons for the delay in the following statement.

"At the last GPC meeting, we informed the Committee of some difficulties in the negotiations that were threatening to delay the negotiating timetable. As a result we met John Hutton and impressed upon him the importance of the negotiating timetable and the potentially dire consequences of a delay in implementation. He acknowledged these issues but was clear in his response that the problems with data collection, financial modelling and some legal issues, which we outlined last month, would be very difficult to resolve quickly. Nevertheless, he reaffirmed his and the Government's commitment to the new GMS contract, which was expressed clearly in his open letter to us that we published on 12 December.

"However, since then it has become apparent that a delay in the negotiating timetable is inevitable. This is due to factors outside the negotiators' control. With much regret the full details of the new, priced GMS contract will not be available for the GPC meeting on 9 January and on this basis we have decided to postpone the roadshows that were planned for 13 to 31 January. The special LMC meeting set for 10 January will remain, however, and it is our intention to invite Ministers to this meeting. We will be writing to the profession today to explain this delay and will be setting up a discussion forum on the BMA website for GPs to send their views to the negotiators.

"As we highlighted last month, completing work on the financial allocation formula has been severely hampered by the lack of data available on practices' current resources, including gross fees and allowances and direct reimbursements of staff costs. Without this essential information it is not possible to cost and price the new contract or devise a suitable transitional scheme, and practices would not be able to compare their current and possible future resources. Obviously without this there can be no putative contract on which GPs could vote. The Department of Health statisticians have now gathered most of the requisite information, but the earliest any analysis of these data will be available is Friday (20.12.02). Given this, especially with Christmas and the New Year approaching, it will simply not be possible to undertake the necessary work, conclude negotiations on costing and pricing the contract, devise a secure and appropriate transitional scheme and have robust practice-level information to share with practices by 10 January.

"Another area of difficulty outlined last month concerned legal issues. Although many of the longstanding issues have now been resolved, there remains considerable reluctance either to resolve the outstanding issues or to engage speedily and determinedly in the legislative drafting process for amending the current regulations that would permit substantial implementation, at least on an interim basis, from April 2003.

"It is absolutely vital that we maintain the utmost pressure on the Departments to keep working on the financial modelling and legislative aspects of the new contract.

"The negotiators share the considerable anger and disappointment that the GPC expressed at the prospect of any delay and recognise that colleagues are not prepared to wait indefinitely for the outcome of the negotiations and a contract on which to vote. Indeed, the GP recruitment and retention numbers are deteriorating daily. With such stark workforce statistics at present, it is clear that without agreement to a new contract and implementation as soon as possible there is a very great risk that some areas will be without any general practitioners very soon.

"It is therefore evident that any delay in implementation means significant extra resources will have to be put in to general practice in April 2003 to support and reward doctors. This is absolutely critical. In addition measures which allow GPs to manage and control their workload are also an essential requirement. We need clear commitments to this effect from Ministers.

"It is now our intention that the negotiations will be completed by 20 February 2003, after which the negotiators will present the final contract package, including the pricing, to a special LMC meeting the following day and to the profession through roadshows, and will ballot the profession on its acceptability in March.

"Should it not be possible to conclude a satisfactory deal by this date, the negotiators will present to the GPC a range of alternative options to a new GMS contract.

"The negotiators will be focusing all their efforts over the next two months to secure a new GMS contract with full details and pricing for 2003-04 and thereafter. We are committed to delivering a new contract that is better for doctors and better for their patients. We have made a great deal of progress and genuinely believe it is possible to reach a satisfactory agreement. However, we have work to do on these fundamental issues, which we do not wish to compromise through undue haste. We must get it right. It is essential that the negotiators present to the GPC and the profession a fully detailed and priced new GMS contract that will achieve its intended objectives. Anything less is unacceptable."