BMA contract negotiations and revised GP contract: a briefing for PCN clinical directors
On 6 February 2020, the BMA’s GP Committee for England gave its backing for a revised package of GP contract measures for 2020/21. This comes just three weeks after it rejected an initial offer from NHS England and NHS Improvement. This briefing gives headline points on the BMA's contract negotiations and revised GP contract.
Key points
- PCN service specifications significantly revised and improved.
- More clinician roles added to the Additional Roles Reimbursement Scheme, including mental health workers from April 2021.
- Between 2020/21 and 2023/24, the scheme will expand to 26,000 additional roles.
- All roles to be reimbursed at 100%, freeing up the existing £1.50/head to contribute to much-needed management support for PCNs.
- Further new investment including GP recruitment and retention support.
- Overall this will mean more funding available at practice level.
Background
At a meeting held on 6 February, the British Medical Association's (BMA) GP Committee for England gave its backing for a revised package of GP contract measures for 2020/21. This comes just three weeks after it rejected an initial offer from NHS England and NHS Improvement (NHSEI).
Full details of the deal struck between NHSEI and the BMA’s GPC can be found in the contract agreement document.
What has changed?
There will now be a significantly revised approach to the service specifications. Final requirements for three of the service specifications for 2020/21 have been fully revised and are significantly shorter at 3 pages in total.
NHSEI has reduced the number of specifications to be introduced from April 2020, with just three now set to take effect in 2020 (structured medicines reviews (SMRs), enhanced healthcare in care homes and early cancer diagnosis). Specifications for personalised care and anticipatory care have been postponed until 2021.
Further changes include:
- The volume of SMRs undertaken will now be determined and limited by clinical pharmacist capacity.
- GPs will no longer be expected to carry out fortnightly care home visits and PCNs will be free to decide which staff deliver weekly reviews of care home residents. It will be introduced from October 2020 with a £120 per care home bed payment per annum.
- PCNs cannot be contractually responsible for any failure by community service providers for non-delivery of their part of the service.
The revised GP contract will have several benefits for PCNs:
- A requirement for CCGs to recycle existing funding on Local Enhanced Services (LES) and Local Improvement Schemes (LIS) within primary care.
- Salaries for all roles under the Additional Roles Reimbursement Scheme (ARRS) will be fully funded. Crucially, this will free up the existing £1.50/head to contribute to management support for PCNs.
- £173m (rising to £1.4bn in 23/24) to allow PCNs to employ a wider range of additional staff.
- Increased flexibility around which additional roles can be employed, including pharmacy technicians, occupational therapists, community paramedics and, from April 2021, mental health professionals. This will deliver an additional 6,000 staff.
- £40.5m (rising to £300m in 2023/24) available through the Investment and Impact Fund to support delivery of the NHS Long Term Plan.
- New locum support scheme to fund CPD in return for a contribution to PCN work.
Reaction and the PCN Network perspective
The PCN Network welcomes the NHSEI engagement on the specifications and initial reaction from most clinical directors to the revised contract has been positive. Many have told the PCN Network that the increased funding and flexibility will allow them to better meet local needs. The inclusion of mental health workers under ARRS has also been widely welcomed.
The PCN Network is pleased that the key recommendations of our briefing Equipped for Success? What Clinical Directors Need for Effective Primary Care Networks have been taken forward by NHSEI. These included increased funding for management support, a more realistic timeframe for the introduction of service specifications and a recognition of how clinical needs will differ significantly by area.
With more investment, PCNs can therefore expect more scrutiny. It is right that value for money will be expected from use of public funds. These changes will facilitate PCNs to develop and the PCN Network will be supporting PCNs at all levels to achieve the best outcomes.
The NHS Confederation has established the PCN Network to support primary care networks across England. Find out more about the network and how you can get involved.
