montage

Archived News 2013:

18th March 2013

Doctors’ and Dentists’ Review Body

The 2013 report of the Doctors’ and Dentists’ Review Body (DDRB) was published on Thursday 14 March. The full report can be accessed through the following link:

www.ome.uk.com/DDRB_Reports.aspx

The DDRB has recommended an uplift of 1% for all doctors. Regrettably, the government in England has not accepted the DDRB’s recommendations in full for GP contractors and has decided to reduce the uplift recommended for this group.

The Review Body recommended a 2.29% uplift to the overall value of GMS contract payments, intended to deliver a 1% net uplift for GPs after allowing for staff costs and non staff expenses. This recommendation was based on a formula carefully constructed to recognise rising costs in general practice. The government in England has however imposed a reduction in the uplift recommended by the DDRB. The GP contract will receive a 1.32% gross uplift, which the government says is designed to deliver a 1% net increase to GP income by restricting increases in practice staff pay, also to 1%. It has not yet confirmed whether this uplift will be applied differentially across the various funding streams. If this is the case, some GPs will receive a lower uplift than others.

The GPC are bitterly disappointed but not surprised that the government has decided to interfere in the uplift deemed to be fair by the review body. The GPC believe that in view of rising expenses, this level of gross uplift is likely to deliver little, if any, net increase in income, even if the structure of the contract were to remain unchanged.

The impact of this 1.32% gross uplift must be seen in the context of the imposition of far reaching contract changes from April 2013. The government is expected to confirm these changes shortly. As the proposals currently stand, the GPC expects the detrimental impact of this year’s imposed contract changes on the income of most GP contractors to offset any uplift to contract prices. GPs will not forget this in a hurry and will bear it in mind when asked to put themselves out for the CCG. To expect GPs to happily participate in an agenda that involves cutting NHS resources, privatising the NHS, and then GPs getting the blame when it fails, shows that someone somewhere isn’t thinking very clearly. GPs may have to help them see through the fog of their own making.
Salaried GPs
For salaried GPs, the Review Body has recommended that the minimum and maximum of the salary range be increased by 1% for 2013/14. As a result of the DDRB’s recommendation, salaried GPs on the model salaried GP contract should receive an uplift of at least 1% to their salary.
GP trainees
The Review Body has recommended an increase of 1% to GP trainees’ basic pay. For 2013/14 the supplement for trainees will remain at the current rate of 45%.
GP trainers
The Review Body has recommended a 1% uplift to the GP trainers’ grant for 2013/14. This is in addition to the £750 per annum continuing professional development supplement.
GP educators
GP educators are to receive a 1% uplift to their pay scale for 2013/14

10th March 2013
Display Energy Certificates
The DH has confirmed that practices should show Display Energy Certificates. The Department for Communities and Local Government has published guidance on its website, which states 'a DEC and advisory report are required for buildings with a total useful floor area over 500m2 that are occupied in whole or part by public authorities and frequently visited by the public'.

Whether this includes GP practices appear to be open to interpretation, as they are not specifically mentioned in the guidance or the regulations (
2007 and 2012). It could be argued that GPs who own their own premises or occupy third party developer premises do not require one because the building is in effect owned by a private organisation (which are excluded according to the guidance), although GP tenants in PCT-owned premises could not be excluded. Our legal department has advised that the key crux of whether a GP practice is required to display a DEC lie in all the following being applicable to such a practice:

  • it has a total floor area of over 500 square meters;

  • it’s at least partially occupied by a public authority or an institution providing public service s (the second part is key here);

  • it is frequently visited by the public (which will be true for all GP practices).

For the purposes of a GP practice the definition of a public building is likely to include surgery premises, as GP practices are in receipt of public funds and provide a public service to large numbers of people who visit regularly.  In their opinion, it would be for the occupier of the building, rather than the owner to arrange the DEC (the use of the building will usually be dictated by the occupier so it would make sense for them to arrange same if the above criteria is applicable to them - however, the position might be different if a PCT owns the building, rather than a private landlord, in which case they will probably be responsible for obtaining and paying for the DEC.
The guidance states that where there is doubt over whether a DEC is needed, it is good practice to obtain one (
Guide to Display Energy Certificates and Advisory reports for Public Buildings). There are also fines involved in not displaying the DECs if deemed to be in breach of the regulations, but we are yet to hear of a practice being hit with such a fine.
Potentially, there is a benefit to having a DEC. They enable landlords and occupiers to see where energy could be saved. Reducing energy consumption will result in lower utility bill costs and will therefore save the NHS money in the long term (or a practice if it is not in fact claiming reimbursement for utilities charges). DECs and the accompanying advisory reports last for 10 years.



4th March 2013

Official lease documentation for practices in PCT-owned premises
GPC has previously advised LMCs that it is imperative that arrangements between GP tenants and PCT landlords are officially documented. The GPC position is that formalised lease arrangements will ensure that both parties (tenant and landlord) are protected by the terms contained within the agreements and are treated fairly throughout the duration of the lease.

Since advising LMCs to urge PCTs to develop formal lease arrangements, GPC has cautioned against unnecessary regional variations in these agreements. LMCs that have been approached by PCTs should not approve / endorse local lease agreements unless they are sure the terms contained within them are fair. For instance, the wording within a lease agreement should not transfer cost liabilities to practices (e.g. for external repairing or insuring) without recourse to apply for reimbursement costs under the provisions contained within the Premises Costs Directions. Furthermore, as independent contractors, GPs should always seek their own expert legal advice before signing any type of commercial agreement such as a lease.

Some lease agreements do attract stamp duty land tax (SDLT). The Department has informed us that this will be a one-off payment, but may not apply in every case (consideration will be given on a case-by-case basis). GPs should, however, still seek advice from the practice accountant. SDLT can be very costly and can cause cash flow problems if, for instance, it is not given consideration before agreeing to move premises. SDLT will continue to be reimbursable via the 2013 Premises Costs Directions (up to 100%), but this will require PCT / Area Team approval as they have discretion on all new reimbursements provided for within the Directions.

GPC understands that, following the transfer of premises ownership from PCTs, NHSPS plans to negotiate better deals on service charges for its premises estate. This could include utilities costs, cleaning, maintenance of communal areas etc.

Finally, the Department of Health and the NHS Commissioning Board have decided that it is impractical to obtain official documentation for all PCT-owned premises before 1
st April 2013 (i.e. the deadline for the transfer of ownership to NHS Property Services). The process will roll into the new financial year, so practices and LMCs have adequate time to negotiate lease agreements or agree on suitable updates to existing leases.




21st February 2013
Over the last couple of months we have been gathering Gps' views about the government's GP contract imposition proposals and those views have been incorporated into our formal response sent to the Department of Health (DH) today.

The changes would make it difficult for practices to maintain the level of care they currently offer while introducing an even greater focus on targets and box ticking at the expense of holistic, patient-centred primary care.  This is of particular concern given the recent conclusions of the Francis report published during the consultation period.

 
What we are calling for
You can read
our full response.  In summary, these are the key changes we are seeking:
  • ¥ The DH needs to return to the draft proposals developed between NHS Employers and the GPC for reducing variability in practice funding.
  • ¥ Correction factor money and PMS funding removed from practices must be ring-fenced and reinvested in general practice through the global sum. Outliers need proper consideration and practices needing higher funding for legitimate reasons should be excluded from the process.
  • ¥ Practice financial instability should be reduced by moving funding from the QOF organisational domain into practices' global sum equivalent or baseline funding.
  • ¥ Proposals for increasing QOF thresholds must be rejected – there should be public recognition that as a result, exception reporting will increase which is an appropriate clinical response to individual patient needs.
  • ¥ The changes to timescales for any QOF indicators from 15-12 months must be abandoned.  If imposed, the changes should be postponed to allow for IT system changes and development of guidance.
  • ¥ New DESs should not be introduced without new funding. The GPC has grave concerns about some of the elements of the DES but does, however, remain willing to work with the DH to make the DES specifications more workable and clinically appropriate and we have provided detailed comments on the proposals for DESs.
  • ¥ The proposal to transfer the responsibility for locum's employer superannuation payments to practices raises serious concerns.  The GPC opposes this and asks that, at least, implementation is delayed by 12 months. If pursued, the funding should be transferred to Global Sum Equivalent and PMS baselines rather than to global sum to allow a fairer distribution of funds.
  • ¥ Locums must have an easy way of checking that employers' contributions have been made.
  • ¥ If this is implemented, equivalence should apply to locums in all aspects of the pension scheme including death in service benefits and the ability to pension appraiser work.
 
Your feedback on the proposals

Well over two thousand of you attended the roadshows we held throughout the UK and very many have directly raised their concerns with Ministers and local MPs. Nearly 8000 GPs in England responded to our survey detailing what they consider the implications of the proposals will be for them and their practices. You can read the
full survey results.  The key findings are:
     
    The results of this survey are very concerning and provide us, the DH and other government departments with a clear picture of what GPs think about what is being proposed. I am particularly grateful to GPs who have helped provide this evidence and who have actively supported our position.
    It has allowed us to make it clear to DH that we expect decreasing morale, increasing stress and falling practice funding to have a real impact on both recruitment and retention in general practice.

    Our next steps

    We now await details of what the government decides it will implement and we will update you as soon as we have the information. In coming months advising and supporting GPs and practices on how to cope with what is implemented will be our key priority. Stay informed by visiting
    bma.org.uk/gpcontract

    Yours sincerely

     
    Dr Laurence Buckman
    Chairman

    General Practitioners Committee