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Welsh practices set for £2.88 per patient cut to global sum

by Léa Legraien
1 April 2019

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The Welsh Government is planning to cut the global sum by more than £11m to deliver the state-backed indemnity scheme, Pulse has learned.
In a letter sent by the Welsh BMA GP Committee to GPs and seen by Pulse, it was revealed that the Government has decided to reduce the global sum by 3.2% or £11.3m – the equivalence of £2.88 per patient – in order to fund the indemnity scheme.
The BMA called the situation ‘absolutely ridiculous’ and warned that if it goes ahead industrial action could follow.
Last May, it was announced that Wales would follow England’s lead in introducing an NHS indemnity scheme for GPs to tackle spiralling costs.
Welsh health minister Vaughan Gething then said the scheme would be aligned as far as possible to the plans in England so that GPs in Wales – and those working across the border – would not be at a disadvantage.
But in the letter sent to GPs in Wales yesterday, the BMA said: ‘Global sum will be reduced by £11.286m to deliver the state backed indemnity scheme. The Welsh Government has determined these figures based on receipts of subscriptions of 2017/18.
‘You will also work out that GMS partners are paying for this and it doesn’t exactly send the right message to attract sessional GPs to become partners. It is worth noting that all other practice staff as with hospital doctors will have indemnity without any financial contribution, as will locum doctors.
‘This means that GP principals are in the unique position of being the only NHS professionals making an ongoing contribution to the indemnity bill for running the NHS in Wales.’
It added: ‘In an attempt to avoid imposition, we will still try to and find an agreed way forward and to that end we have submitted an alternative proposal for Welsh Government and Health Boards to consider. It is not yet clear if they will buy into this alternative offer although they have not ruled out further negotiations.’
BMA GP committee member and former GP Survival chair Dr Alan Woodall – speaking in a personal capacity – said the move is a ‘ridiculous, enormous pay cut’ and a significant step backwards that will impact patient care and push GPs to leave the profession.
He said: ‘They are planning to take what amounts to 3.2% of the global sum from all GPs in Wales to pay for our NHS indemnity, which effectively is an enormous pay cut and also in terms of patient care.
‘In England, they have their indemnity covered with a 1% rise in global sum whereas in Wales we suffer a £2.88 cut per patient, which works out about a 3.2% cut. It is absolutely ridiculous.’
He added: ‘We’re already one of the poorest funded primary care services of the four nations and that further erodes our capability to do it. The profession is extremely angry with the attitude the Welsh Government has produced.
‘The promise we were all getting from the Welsh Government was that Welsh GPs would not be treated worse than their colleagues in England and they’ve clearly backtracked on that fully. If you look at the settlement in England compared to the one offered in Wales this is a significant retrogressive step.’
Dr Woodall said negotiations between the GPC and the Government are still ongoing but the committee may have to consider industrial action if the Government does not amend its ‘shocking proposal’.
He said: ‘In my personal opinion, if we don’t get a substantially revised indemnity offer that matches what England has been offered, GPC Wales should be asking the membership to consider whether or not we should take industrial action.’
‘The amount of funding they’re talking of reducing us by, to pay for indemnity, will lead to practices handing back contract, staff redundancies and GPs deciding “what’s the point being a partner?”.’
‘It seems to be, that they’re driving a nail into the coffin of independent general practice and there is a desire to see the end of the independent contractor model and force us into salaried. Many of us will be seriously considering whether this is worth continuing with.
‘It really is a shocking proposal they’ve come up with and needs to be radically reverted,’ he added.
RCGP Wales joint chair Dr Peter Saul said: ‘Whilst we are pleased that a state backed scheme will be introduced in Wales on Monday, we support our colleagues at the BMA in their quest to ensure that there is sufficient support in place to counteract the reduction in the total funding allocated to general practice to pay for it.’
A Welsh Government spokesperson said: ‘We will be writing to all GP’s today to update them on negotiations with GPC Wales and clarify a number of points.
‘Whilst negotiations are ongoing, we are unable to comment further.’
They later added: ‘We have made an offer to GPC Wales covering a range of matters in the GP contract, including the introduction of the state-backed indemnity scheme, involving significant overall investment into General Practice.’
In February, NHS England announced the global sum price per weighted patient in England will rise from £88.96 in 2018/19 to £89.88 in 2019/20 – meaning practices will get an extra 92p. 
Last year, an RCGP analysis showed that general practice in Wales receives the lowest proportion of overall NHS spend when comparing the four UK nations.
This story was first published on our sister publication Pulse