Last week, the BMA’s General Practitioners Committee published its asks from the government that it has put forward for the 26/27 GP contract negotiations. It says these are designed to ‘protect and promote practices and GP workforce needs to ensure a sustainable and equitable general practice that serves patients and their communities’.
In return for an extra £50 per patient per year added to the global sum, the BMA is happy for this to be used by practices explicitly to grow an additional workforce and provide additional hours of work for the existing workforce. The ways that this can be done are detailed in a number of ‘workforce and employment support’ proposals which we have analysed from the point of view of the impact these might have on sessional GPs.
Ultimately, the BMA is hoping this will achieve a contract which:
- expands the workforce (with a goal of a maximum of 1000 patients per GP)
- ensures fair pay and funding
- improves working conditions and workload
- enhances recruitment, retention and training
- makes better use of the Additional Roles Reimbursement Scheme (ARRS), and
- allows autonomy at a practice/PCN level and with the sessional GP.
There are four proposals within this document which the BMA feels will help to achieve these aims.
1 Practice GP Employment Support Scheme (GPESS)
This scheme would replace the existing PCN GP element of the ARRS, allowing practices to independently recruit and retain GPs to provide direct patient care at a practice level. The GPESS would support NHS practices to hire and retain GPs more easily, with funding allocated directly to each practice based on list size, recruitment issues, and patient deprivation.
Funding for the scheme could be via a reimbursement mechanism such as an employment support grant ring-fenced exclusively for the employment of a GP at a competitive rate with flexible working arrangements to suit that GP. Enhanced support packages could be provided for practices in under-doctored areas to attract and retain GPs.
We often hear that practices would love to have more substantive posts for GPs, but that they simply lack the funding to do so, therefore this sounds like an excellent step forwards and should improve the GP un- and underemployment crisis whilst tackling health inequalities by providing more appointments to deprived populations.
2 Additional Roles Reimbursement Scheme (ARRS) GPs
Should the BMA not be successful in negotiating the GPESS, which brings additional GP employment reimbursement to practices from PCNs, it would like to negotiate some improvements to the GPs in ARRS system. This is because the BMA has expressed its concern about the inadequacy of these roles which it says are grossly underpaid and don’t provide patients nor the GP with any continuity.
It has been suggested that:
- these roles should now be offered to all GPs, rather than just those recently qualified
- there should be a limit on the number of practices each of these GPs works across, to help improve continuity
- the reimbursed salary be increased to reflect market rates and bring the pay in line with practice-employed salaried GPs
Again, these sound like positive steps to take should the government insist on maintaining the GP in ARRS system, as there will be parity with practice based colleagues in terms of pay and working conditions and better job satisfaction. These proposals also recognise that the underemployment crisis is not just affecting newly qualified GPs, but GPs across their entire careers.
3 Early Career GP Fellowships
There’s potentially some good news for newly qualified GPs, with the suggestion of an early career GP fellowship available immediately post-CCT. This would last 12 months and specifically fill vacancies in areas that are finding it difficult to recruit. These GPs will be offered tailored professional development, supervision, and mentorship from a named mentor, AND a financial incentive by way of a salary supplement, relocation allowance, or support for professional expenses.
4 Update and amendment of SFE locum reimbursement provisions
Locum GPs haven’t been forgotten in these proposals! The BMA recognises that practices sometimes struggle to find the funding for a locum particularly when a member of staff is on leave. The BMA would therefore like to negotiate enhancements to how practices are reimbursed for locums who are brought in to cover absence of permanent staff, so that there is reimbursement available for locum cover across the entire period of absence and during the return to work phase.
It is also proposed that practices receive reimbursement to bring in a locum GP to cover the first three months of any GP vacancy, while that practice tries to recruit.
This is good news for GP locums, who are ready and waiting in the wings to take on short term work to cover staff absences and vacancies – practices should then be financially able to take them on and stay on top of their workload.
In summary therefore, these new proposals do indeed sound like they will support the workforce and employment, for sessional GPs at all stages in their career – let’s see how receptive the government and DHSC are to them! Even if these suggestions don’t make their way into the core contract funding, there could be scope for ICBs or any future contract holders at scale to roll out similar schemes which could benefit the sessional workforce in a similar way.
