GPs with total NHS earnings above £150,000 per annum will be listed by name and earnings in a national publication, starting with 2019/20 income, NHS England and the GPC have agreed in a five-year GP contract deal for England.
In return for the increased transparency, core practice contract funding will grow by 1.4 per cent in 2019/20, and by £978 million per year by 2023/24, to encourage workforce development and, specifically, to pay salaried GPs at least a 2.0 per cent increase in 2019/20.
During the term of the five-year contract, the DDRB will not make recommendations on GP partner net income, nor, it is expected, on GP salaries until 2020. Recommendations on salaried GP payments will then be informed by affordability and in particular the fixed contract resources available to practices under the five-year contract deal.
The framework for the new five-year GP contract in England makes two specific provisions for rural GP practices:
- A change in the rurality index payment from April 2019 to apply to patients living within a practice catchment area only, rather than to all patients. There will be no further amendments to the Carr-Hill funding formula in 2019-20 to provide stability to practices; changes are not intended to reduce funding nor determine overall funding levels.
- Remoteness and rurality, coupled with a low population density across a large area, will be accepted as a reason for not adopting the 30,000 population primary care network model. Entitlement to take up the PCN model is automatic (DES contract model) and is backed by a recurrent £1.50/patient support, plus a new contribution to clinical leadership, amounting to a maximum of £1.799 billion by 2023/24.
Other provisions in the deal allow for:
- changes to the Quality and Outcomes Framework (QOF) to introduce a Quality Improvement domain incorporating prescribing safety and end-of-life care
- a new ‘Additional Roles Reimbursement Scheme’ for primary care networks (PCNs), backed by a ring-fenced £891m to pay for at least 20,000+ additional staff by 2023/24: clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics and social prescribing link workers. The payment is subject to the delivery of seven national network service specifications, starting during 2019/20, and covering structured medication reviews, enhanced health in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis
- a new, centrally-funded clinical negligence scheme for general practice will start from April 2019, funded through a one-off permanent adjustment to the global sum
- continued NHS IT funding through the new GP IT Futures programme, which replaces the current GP Systems of Choice. IT support for the Falsified Medicines Directive is not explicitly mentioned, but is expected to be covered by this.
- from 2019 NHS GPs will be banned from advertising or hosting private paid-for GP services that fall within the scope of NHS-funded primary medical services. A £20 million compensation payment will be added to the global sum for three years.