Exclusive NHS England has said it is willing to revisit GMS global sum calculations, as long as GP practices agree to share their payroll data with commissioners.
During a webinar for GPs earlier this month, NHSE said that it has discussed with the BMA ‘on several occasions’ the possibility for practices to share the data so that ICBs can ‘pass on the exact amount of funding’ required to cover pay uplifts.
In August, the Government decided to uplift the global sum by 7.4% to cover the 6% pay uplifts for practice staff recommended by the DDRB.
But during the webinar, NHS England said they ‘would be very happy’ to consider revising the global sum mechanism should all practices agree to submitting payroll data ‘on a regular basis’.
This was in response to a question on whether the 7.4% uplift to global sum would actually cover the pay uplifts for practice staff as recommended by the DDRB.
NHS England said: ‘The uplift to global sum does cover the full cost of pay uplifts to practice staff at national level. Global sum has been used as a mechanism for passing funding for pay uplifts for a number of years.
‘The alternative would be for all practices to submit their payroll data to their ICBs to enable them to pass on the exact amount of funding required to cover the pay uplifts; thereby avoiding “winners and losers” – i.e. some practices receiving more funding than required to implement the uplifts, while other receive less.
‘This has been discussed with the BMA on several occasions in recent years and it was felt that practices would be unwilling to share their payroll data with commissioners.
‘However, we would be happy to raise this again if it was felt that all practices would agree to submitting their payroll data on a regular basis.’
The GPC said that they would be willing to discuss a solution that ‘enables all practice staffing costs to be directly reimbursed’.
Earlier this year, it called for the Government to commit to a new GP contract to be implemented by April 2028 ‘at the latest’, with ‘sustained annual investment’ taking into account inflation, and uplifted year-on-year.
In an updated vision document, it said that ‘outdated funding formulae’ need to be replaced to accurately reflect the communities that practices care for.
In response to NHSE’s statement at the webinar, GPC England deputy chair Dr Julius Parker told Pulse: ‘GPCE’s vision for general practice outlines how it would be willing to discuss a solution that enables all practice staffing costs to be directly reimbursed via a new national contract for general practice.’
Medical accountant Andy Pow said that practices that are struggling financially might agree to share the payroll data, but there are concerns around confidentiality.
He told Pulse: ‘Part of the problem is that there is a huge breakdown in trust between GPs and the commissioners.
‘It is not very clear what the long-term agenda is here. When you start to ask for confidential data, people start to question what are you actually trying to do here.
‘If they just try and fix the National Insurance contributions issue just by giving specific practice on practice funding, it doesn’t actually solve anything, it’s a real sticking plaster to the problem.
‘We are at a point now where the contract needs to be revised, it is at least 20 plus years old.’
The RCGP previously called on the Government to ‘radically’ reform the current Carr-Hill formula.
The current formula is supposed to ensure resources are directed to practices based on an estimate of their patient workload, taking into account ‘drivers of workload’ and ‘unavoidable costs’.
And the BMA has also argued for some time that the formula is outdated, and that the national GP practice contract baseline fund has been ‘eroded’ over the years.
Perhaps we need to put the plumbers, electricians and cleaners on payroll too? Bonkers solution to the problem from NHSE again. Staff remuneration is not just made up of their pay and is not the only cost either that requires increased funding
What a ridiculous proposal..
It suggests only funding to pass on pay rises are compensated, not partner income?
Also, what about practices that have been forced to use innovative or lite models for triage, secretarial, admin work etc because costs had spiralled. They’ve had to have a lighter wage bill because of poor funding, but could be punished for it.
All this will lead to is creating an enemy out of the tiny portion of high earning GP partners.
Part of the plan to create an ICB salaried GP workforce
Refunds should not be individually calculated per practice. Seems like an enormous waste of resources to just calculate it.
It should be based on data that is already available with regards to the percentage of revenue spent on staffing and perhaps a small number of practices providing detailed information to work out an average.
Then the correct amount should be added to the global sum. There will of course be winners and losers, but the losers need to rethink their approach like every other business. If it leads to more productive care, that’s great.
For what it’s worth, my practice would be a loser from this approach – but it is still better than individually calculating payments.
Share payroll data – will help with pricing a salaried GP service
Wes says “rapid increase in PAs” – towards a salaried GP service
Darzi said “independent GPs great value for money” – pure misdirection to keep GP contractors off the scent, and hoping…
Agree that there will be ICB salaried GP service nationally, soon.
Meanwhile BMA action is unnoticed by anyone…
At least this is consistent with the NHS England doctrine that the marginal cost GP
Partner time is £0. So if a practice has 90% of work done by salaried and 10% by partners they will get more of an uplift than somewhere where 50% or work is done by are salaried and 50% by partners?
The fallacy of ‘if only we centrally planned a bit better’ lives strong with NHS Comrades.
Come to think of it this is all due to persistent beliefs that GPs are not to be trusted (but are still the solution for ever rising workload).
The central planners wont be happy until they pay for an embedded mid ranking party official to sit and observe each practice and constantly check for signs of bourgeoise tendencies so they can be reported to the Workers’ Committee For Health and reeducated. Probably.
Marginal utility is old hat in a failed neoliberal economic theory model being it has led to a financialised, managerial feudalist, casino capitalist system tilted towards ever increasing inequality and an ever increasing rich 0.1% that Adam Smith would not have recognised. We need new economic theorising that puts behind us previous failed ideas, both so-called left and right wing. And I’m sure Adam Smith, as a moral philosopher, would have been astonished by and would have supported a properly funded NHS as a public good (maybe not the crook Milton Friedman).
Both New Labour and the Tories have destroyed the independent contractor model – having said that, some rotten apples have also contributed to its demise and spoilt it for the majority decent contractors. Independent contractors are the model which I believe helped make the NHS the envy of the world when I first started but then it’s been run down and fragmented by successive Govts pandering to what we now know has been wasteful privatisation.
Now the only levers contractors have, if they have the unity and the guts, are tactics to frustrate or sabotage potential Govt policy (eg AI, PAs, payroll data etc) that is leading them to nationalisation of GP contractors, or to threaten Guernsey (or carry on paying BMA subs to “negotiate” sincerely).
In reply to the comment re: a salaried GP ICB workforce. I will gladly do what I currently do if they calculate my PAs correctly. I do 8 of our sessions, so timewise that’s 12 PAs. They can pay PAs for admin, CPD and supervising ACPs/registrars/students too.
So I’m either 10 PA and doing nothing clinical or I’m 15-16 PA doing what I do plus the extra work recognised.
No brainer.
Carr Hill Formula is an independent variable for GP Partner pay.
The higher the Carr Hill – the higher the pay.
And yet…. These practices continue to get proportionally more money.
GMS uplift… via WEIGHTED PATIENT LIST SIZE
DDRB increase… via WEIGHTED PATIENT LIST SIZE
NI extra costs … potential reimbursement by…. WEIGHTED PATIENT LIST SIZE
It’s genuinely insane and dangerous.
Happy to share payroll data and open books.
Well said @ AdamH.
I too am very reluctant to provide NHSE / ICBs with any of the sticks with which to beat us.
“Part of the plan to create an ICB salaried GP workforce” – you can see the mechanics of this happening already. The tighter they squeeze, the more practices end up having to surrender contracts as unsustainable and uneconomic. NHSE have no incentive to better the lot of GP partners, despite the opinion of Lord Darzi recently and I think that will become increasingly evident as a new GMS contract emerges / gets imposed. The hike in Employer NI is not the first, and won’t be the last, nail in the GP coffin being constructed by NHSE.
They will use a couple of the high earning partners and hit the rest of us with a lower uplift next time.
They will use a couple of the high earning partners and hit the rest of us with a lower uplift next time or worse, a clawback.
Near to none of this ‘Accelerated’ destruction of General Practice/Primary Care would be possible without PCN/or PCN CDs.
Via PCN CDs, control of Primary care has and is being surrendered to faceless NHSE/ICB managers often with little to no experience of working in Primary care or in fact in any other business.
PCN CDs argue that funding would be lost, and I personally would also lose hundreds of thousands in practice funding through ARR budgets and pointless PCN targets but so be it. PCN CD or PCN awards at lavish ceremonies do not make up for the damage and risks they are causing.
This is a case where this action is needed for the greater preservation of Primary Care for future generations so short-term losses need to shoulder for any progress to be made for future progress.
BMA action is well intended but having little impact and refusal to co-operate with PCN CDs and PCNs would certainly have impact.
I am not so certain myself that lack of funding is the only issue as complete universal ineptitude in management at all NHS levels remains a predominant factor.
Do we really envisage a continually failing, faceless NHSE and detached ICBs would withdraw all PCN staff – in this case of brinkmanship for the greater good, I think not, and there is already evidence for this.
And who will cover the cost of extracting the data in the form they want, sending it to them, and dealing with the resulting admin load?
Ditch the PCN DES and work properly to rule. Look at the list of what is not in our contract. It is most of what we do. We are basically unpaid for most of what we do, it’s unbelievable. Literally ditch the PCN, ditch those PCN staff and work to rule ie work to contract. And dump the rest back on the ICS. They will update the contract in an instant. It will flood secondary care. 25 patients per day and simple referrals for what’s needed. Nothing else. Have a good look at the BMA list of what’s not in the contract. And do not do anything that is not contracted. Seriously we have been working for free for a long time on most of what we do. ICS can negotiate someone to provide everything we are not paid for. They will find very quickly we are by far the cheapest provider and in fact I doubt they could find anyone else to provide most of what we do, unfinanced and outside the contract no matter what we paid. Work to contract. Work to rule. BMA have all their info of what’s not commissioned. Follow it.