Big questions of the month: The BMA’s negotiated global sum uplift, and how ARRS is hitting GP locums

Pulse summarises October’s talking points – the BMA’s efforts to get practices enough money to cover staff’s 6% pay rise, and why locums have reason to resent the additional roles scheme

Has the BMA negotiated a good payment deal for practices?

‘The reality is it’s about a third less than the funding required to give all our staff a 6% increase.’ 

Berkshire GP partner Dr Michael Mullineux did not accept the BMA’s view that negotiations over a global sum uplift for English practices had been ‘satisfactorily concluded’. 

In July, ministers promised practices a funding uplift to cover the 6% pay awarded to salaried GPs and other practice staff by the DDRB. Following negotiations with ministers, the BMA secured a 2.39% additional increase in the global sum, backdated to April.

So, how did the GP Committee agree to a 2.39% increase when GPs must provide a 6% pay rise to staff? This is where it gets complex. At the start of the current contract, the BMA and NHS England agreed that around 44% of global sum funding typically went towards staff expenses. As practices already received a 2.1% global sum increase in April 2023, they needed an extra 3.9% uplift to the staff element of the global sum (44%) to cover the 6% pay rise. This equated to a 2.39% increase to the global sum. Confused? You should be.

But the 44% is fairly arbitrary, and the actual amount spent will depend on each practice’s circumstances. As a result, Dr Mullineux said giving all staff the 6% rise would mean ‘partners funding out of their own pockets’.

Lancashire and Cumbria LMCs chief executive Dr Adam Janjua wrote to local practices saying he could not ‘in good conscience recommend that they give all staff 6% if it eats up partner income’. He said practice viability was ‘paramount’. 

In Scotland, the BMA described the £60.4m uplift to core funding allocated by the Scottish Government – equating to a 7% increase in the global sum – as  ‘insufficient’. GPC Scotland chair Dr Andrew Buist told Pulse the practice expenses element fell well short of inflation. 

And in England, a further setback came in an NHSE bulletin on 5 October. While urging practices to give staff the 6% pay rise ‘as soon as possible’ it revealed the funds would not reach them until November. GPC England chair Dr Katie Bramall-Stainer called the delay ‘deeply regretful’, advising practices facing cashflow problems as a result to ‘approach their ICBs regarding a bridging loan’.  

The BMA admitted the uplift was ‘ultimately not enough’ but said securing it via the global sum meant it would be recurring for future years.

Is ARRS causing a problem for locum GPs?

It is only just over a year since Pulse reported GP locums were being offered daily rates ‘in excess of £1,000’ in a ‘seller’s market’.   

That market seems to be well and truly closed and locums now find themselves being asked to cut their rates amid a significant reduction in available shifts.

This sea-change is being put down to the rise of the Additional Roles Reimbursement Scheme (ARRS) in England and the increasing number of roles available under it.

ARRS provides funding at PCN level for staff such as clinical pharmacists, physician associates and physiotherapists.  

Ruth Hennessey, recruitment consultant at the GP Locum Agency, said this year had been ‘worryingly quiet’. She added: ‘I would say there has been approximately a 60% drop in usage. So yes, locums are struggling to find work.’ 

One GP told Pulse locum work had ‘literally disappeared overnight’ and that after four years as full-time locum they’d had to contact a charity for financial assistance. The locum said the ARRS scheme had seen general practice ‘flooded with ANP/CP/PAs, resulting in no need for highly qualified doctors’.

GP spokesperson for the Doctors’ Association Dr Steve Taylor said the fact that locums are struggling at a time of soaring workload and recruitment problems in general practice suggests practices now simply do not have the money to pay for them. 

‘Funding into primary care has been funnelled into PCNs and ARRS roles rather than to practices,’ he said.

National Association of Sessional GPs chair Dr Richard Fieldhouse agreed: ‘There are definitely areas where locums are not being valued, and instead they are being supplanted by other types of roles.’

And this seems very much the direction of travel in primary care. As part of the NHS long-term workforce plan, NHS England announced in June that it would be introducing more than 20,000 clinical staff into general practice under the additional roles scheme by 2036/37. 

Dr Fieldhouse told Pulse the profession was being ‘undermined’. He warned that practices needed to consider the future role of GPs.

‘GP practices need to think that when they are hiring a GP that is an investment in their future workforce.’