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Staff pay to increase by 2% and QOF streamlined under imposed GP contract

by Rima Evans
29 February 2024

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General practice funding will rise by 2.2% overall and include a 2% pay uplift for GPs and practice staff in England, under the contract for 2024/25.

A letter from NHS England sent out earlier today stated there will be extra investment of £259m taking general practice funding to £11,864m from April.  

Initially the Government had put an offer on the table of a 1.9% increase to GMS funding, which the BMA voted down.

Although the 2% planned growth for staff pay (including for GP partners, salaried GPs, practice staff and ARRS staff), NHS England said a further uplift may be made following the Government’s response to the Doctors’ and Dentists’ Review Body.

The BMA has warned the contract – which has been imposed by the Government for the third year in a row – represents ‘another year of cuts to total practice income per patient funding’ and will mean reduced access for patients, practice closures and staff redundancies.

Other changes outlined in the deal include QOF being streamlined to ‘reduce bureaucracy’ for practices, with 32 of the 76 indicators suspended and income protected from 1 April (see also box below). This means 42% of QOF indicators will no longer be live.

‘For the income protected indicators, practices will be awarded QOF points based on their performance in previous years, while points for the remaining live indicators remain conditional on their performance in 2024/25’, the letter signed by Dr Amanda Doyle, national director for primary care and community services at NHS England, says.

In addition, QOF aspiration payments – funding given in advance of achievement – will be increased from 70% to 80% to ‘support practice cash flow’.

Further detail about the new QOF arrangements will be released in updated guidance published soon. 

Meanwhile, the Government public consultation on the role of incentive schemes in general practice and which asks whether QOF should be scrapped remains open until 7 March.

Other financial arrangements set out under the contract include:

  • Cutting the number of Investment and Impact Fund (IIF) indicators from five to two.
  • Funding from the three retired indicators, relating to flu and access, to be redirected into the Capacity and Access Payment (CAP), which will rise by £46m to a total of £292m.
  • The Capacity and Access Improvement Payment (CAIP) to be paid to PCNs at any point in the year in monthly instalments to increase financial flexibility. This will happen once the networks confirm to their ICB that all the PCN practices have put in place ‘one or more of the three individual components of the Modern General Practice Access model’.
  • The Weight Management Enhanced Service to continue in 2024/25, with total funding worth £7.2m. Practices will receive £11.50 per referral.

The future of recruitment and retention schemes in general practice is also being considered, NHS England said.

It added that it ‘will now begin the process of implementing the 2024/25 contract changes with detailed guidance and further information to be published in the coming weeks’.

Dr Katie Bramall-Stainer, chair of the BMA’s GP Committee England, said general practice business model is being ‘squeezed to non-viability’.

‘We are told by Government that the work of GPs and their practice teams is “hugely valued”. But actions speak louder than words.

‘For this contract to match 2019/20 funding, it would need a 8.7% uplift. Instead it’s another effective cut of 1.9% and a third consecutive imposition’.

She added: ‘We fear that the Government has lost its final opportunity to avoid a preventable chain of events that will be viewed with anxiety and concern by the 1.39 million patients who consult their GP surgery each and every day.’

Andrew Pow, board member of the Association of Independent Specialist Medical Accountants (AISMA) said it was a ‘disappointing announcement’.

He explained: ‘While the contract is based on an assumption of 2% pay growth for staff, practices face significantly higher wage growth from April as a result of the near 10% increase in the minimum wage. This will also filter through to other pay bands.

‘The contract uplift allows for inflation at 1.68%, yet inflation is running at 4% in the economy. While energy costs may be on a downward trajectory and loan interest costs have hopefully flatlined, these costs remain far higher than they were a couple of years ago and were not funded in contract uplifts in the previous two years’.

As a result, Mr Pow said, practices will need to look carefully at staffing costs and maximise the use of the ARRS scheme. He warned that in many cases partners will have to consider reducing their drawings.

There were positives, he added, such as more of the QOF being paid in year and changes to the Capacity and Access payment, which will help cashflow.

‘PCNs have also been given more flexibility in how to allocate funding. It will be essential for practices to work closely with their PCNs to optimise the use of these resources’.

Mr Pow said the prospect of a further uplift following the DDRB review is a carrot that has been dangled but that this is still far away and could be viewed ‘as kicking the can down the road’ given a general election is due.

To see an overview of other changes to the GP contract for 2024/25 see here.

Changes to QOF for 2024/25

1. A total of 32 indicators will be income protected. These account for 212 of the 635 points that can be earned through the QOF scheme. These include:

  • The 19 register indicators across a range of clinical areas (CAN001; CKD005; CHD001; HF001; HF001; HYP001; PAD001; STIA001; DEM001; DM017; EP001; LD004; MH001; OB003; OST004; PC001; AF001; AST005: COPD015; and RA001).
  • All six Quality Improvement indicators
  • Indicator MH021 in the mental health area: Providing physical checks to mental health patients, such as smoking status, alcohol consumption and BMI
  • Indicator DEP004 in the depression area: Reviewing patients with a new diagnosis of depression
  • Indicator AST008 in the asthma area: Recording smoking status of patients with asthma
  • Indicator COPD014 in the COPD area: Referring patients with COPD to a pulmonary rehabilitation programme
  • Indicator SMOK005 in the smoking area: Offer of support to smokers with respiratory or certain mental health conditions
  • Indicators CAN004 and CAN005 in the cancer area (which means all cancer indicators are now income protected): Cancer patients who have had a Cancer Care Review within 12 months of diagnosis; and Cancer patients who have had the opportunity for a discussion and informed of the support available from primary care, within three months of diagnosis.       

The indicators selected for income protection ‘have been assessed by a Clinical and Technical Reference Group chaired by NHS England as carrying a lower risk of deteriorating patient outcomes from income protection’, NHS England has said..

2. Updating of Indicator CHOL002 in the cholesterol control and lipid management area. This will align it with the new NICE NM252 indicator definition, addressing the current discrepancy in which the QOF target for reducing cholesterol levels is more stringent than new NICE guidance.

Source: NHS England contract letter for 2024/25