The rules surrounding private healthcare services delivered by GPs have now changed, amid fears of a ‘blurring’ of the lines between NHS and non-NHS work.
As part of widespread changes to the GP contract, NHS England has decided to ban the advertising and hosting of private GP services from April 1.
The 2019/20 GP contract states: “To safeguard the model of comprehensive NHS primary medical care, from 2019 it will no longer be possible for any GP provider either directly or via proxy to advertise or host private paid-for GP services that fall within the scope of NHS funded primary medical services.
“NHS England will consult in 2019 on expanding this ban on private GP services to other providers of mainly NHS services.”
What the changes mean for GPs
It’s important to recognise that this doesn’t bar GPs from all non-NHS work. Indeed, a full range of services – from medical reports for insurance to physiotherapy and signing passports will still be a natural part of life for a great many GPs.
However, this stops practices from being able to charge patients for services that are free under the NHS or to get quicker access to their GP. It’s about making it completely clear as to what is available under the NHS and what isn’t – and therefore incurs a charge to the user.
There has been a rise in private treatments offered by GPs in recent years. The Guardian reported that demand for this has been growing after cuts and cost savings instigated by the NHS.
Private providers have offered GP access
Online private GP services have sprung up to offer people out of hours access to a doctor over the internet.
These services are reportedly particularly popular among millennials, with many young people preferring to pay than wait for an appointment. Practice Business noted that three quarters of patients in a network of private clinics were aged between 20 and 39.
It quoted Dan Faber, founder, DocTap, as saying: “Patients are out of patience and they are no longer prepared to wait for or travel to an NHS appointment. They want to see a doctor on their terms and they want to choose the doctor that they want to see. It is clear that the existing NHS GP model is outdated and is unable to service the new millennial generation who want convenience.”
Confidence in the GP service
The NHS England and the British Medical Association in a bid to ‘maintain patient confidence’ in the GP service and set a clear distinction between what is and isn’t allowed.
Dr Richard Vautrey, chair of the British Medical Association’s GP committee, said: “While the BMA represents the breadth of the medical profession, including private practitioners, we have been concerned at the increasing blurring in recent years between NHS and private GP services offered to patients, particularly with the opportunities digital technology is providing.
“This change will provide clarity for patients about what treatment is available on the NHS and what they have the option of paying for privately.
“Both NHS England and the BMA want clarity for patients about what are free NHS GP services and what are not, and we are determined to maintain patient confidence in the integrity of general practice.”
GPs need indemnity for all of their work
The new rules offer a welcome clarification on the dividing lines between NHS and private work. This debate also goes to emphasise that there is much non-NHS work that naturally falls at the feet of GPs – work that will continue unchanged.
This is important to bear in mind when it comes to the new state-backed indemnity scheme, which only covers cases of clinical negligence that come from NHS activities within the scope of the scheme. That means that any non-NHS work is not covered by the Government’s scheme and this is one of the many reasons why GPs will still need to maintain their membership with an MDO.
We’re delighted to be able to help our GPs to go about their work safe in the knowledge that they have the cover and support that they need.
We’re also confident that more GPs would benefit from joining the MDS family. However, we also know that GPs are busy people – we’re GPs too after all – and indemnity has, traditionally, not been something that many GPs have reviewed on a regular basis. Many of you had to settle for one of the ‘big three’ and stick by your choice out of necessity so that you were legally able to go about your work.
This is part of the reason why we set MDS up. We wanted to offer more choice and to break up an old system that didn’t seem fit for purpose. We vowed to give the best service and the best value for GPs and we’re proud to be doing that for our members.
Intrigued? Here’s what we think you’ll get from reviewing your GP indemnity in order to consider giving MDS a chance.
You can save money on your indemnity
Let’s not kid ourselves, we appreciate that everyone is after a good deal and that clearly means not paying over the odds.
We were staggered to see that the average cost of a GP indemnity had risen to about £8,000 a year – and we’ve been able to come up with a pricing model that has saved 10 to 30% a year for our GPs.
With so much scope for savings, there’s a genuine financial reason to have a review and ensure you’re getting the best value for money.
The Government is changing things
Even if you had no intention of thinking about your indemnity, the Government’s recent actions have made this a necessity.
From the beginning of April, a new state-backed indemnity scheme will be available to cover cases of clinical negligence.
While we welcome this – it’s important that GPs are aware that the cover will not extend to General Medical Council inquiries, NHS England investigations or inquests and court proceedings. It also doesn’t cover medico-legal advice or non-NHS work, so that means things such as DVLA work or employee medicals fall outside the state scheme’s scope. In short, there’s still an acute need for MDO cover.
The reforms – which are part of wider changes to the GP contract – are likely to naturally prompt a review of the cover you need and the obvious extension of this is to weigh up the policies offered by alternative providers too.
We’re just for GPs
We think that GPs deserve indemnity provider who understands their job, is proud to protect their professional reputation and is dedicated to serving their specific needs.
We don’t think the old established order was able to do that – they’re focussed on medical professionals more generally – and that’s why we’re created by GPs for GPs, offering that bespoke service that GPs deserve and need.
In our mission statement we vow to DEFEND:
• Defend and respect the GP voice
• Empower our staff
• Friendly customer service for each member
• Empathy with each member during a time of crisis
• Nimble, being agile to deliver a personalised approach whenever we can
• Desire to be the best
We feel that reviewing your indemnity gives you the option to consider the level of service you receive and embrace a GP-centred indemnity.
We’re offering a referral scheme
Our new referral scheme offers another great reason to consider reviewing your GP indemnity at the earliest available opportunity.
If any of our members refers another GP to us then – to show our gratitude for helping to grow the MDS family – we’ll offer both parties a 5% discount off their membership costs.
Our members can refer up to four GPs each – meaning that they can earn up to 20% off their membership.
Convinced? Why not get in touch so that we can explain our membership offering in full and help you to get the benefit of a cost effective indemnity that is especially designed for GPs.
The Government’s five-year contract for GPs marked the biggest reforms for our service for 15 years.
As we reported at the time, a key announcement involved the introduction of a new state backed indemnity scheme.
However, this was far from the only measure outlined. In this guide, we’ll give you a summary of the rest of GP contract and a flavour of the reaction to it.
New GP contract: The key points
NHS England’s announcement included:
- New recruits: 20,000 more staff will be enlisted to support GPs. These staff – a mix of pharmacists, physios, paramedics, physician associates and social prescribing link workers – are intended to help GP practices form a local ‘primary care network’. The theory is that GPs will be freed up to spend more time with patients and practices will be able to offer more services. Setting up these networks could cost £1.8 billion by 2023.
- Digital first: NHS England vowed that every patient will get the right to ‘digital-first primary care’ by 2021. This will mean increased provision of online consultations – and extra IT support to help provide this. Patients will also be able to get digital access to their full records from 2020.
- Reform to phone lines: With 111 calls able to make direct bookings into GP surgeries.
- Clinical reform: New changes were announced to the GP Quality and Outcomes Framework. The Government says these will look at diabetes, blood pressure control and cervical screening – with plans to focus on heart failure, asthma, COPD, and mental health in the future.
- Earnings transparency: Extra public scrutiny of NHS earnings – and a new process to prevent ‘unexpectedly high or low earnings’.
- Avoidable A&E: A new £300 fund should see GP practices benefit from their role in cutting avoidable A&E attendance and outpatient appointments.
The reaction to the GP contract
Understandably, this new contract has prompted a flurry of interest and reaction. Here’s a flavour of what some key figures have said:
NHS England Chief Executive Simon Stevens said: “This five-year deal unarguably represents the biggest boost to primary care in more than fifteen years, giving patients more convenient services at their local GP surgery while breaking down the divide between family doctors and community health services. It provides the practical foundation for the big service improvements in the NHS Long Term Plan.
“Patients across England – in towns, villages and cities – will all begin to see the benefits, beginning this year. And it allows us to keep all that’s best about British general practice while future-proofing it for the decade ahead.”
Ian Dodge, National Director for Strategy and Innovation at NHS England said: “General practice is the bedrock of the NHS, and the NHS needs general practice to survive and thrive. Through this comprehensive deal, the BMA and NHS England have sought to solve the big problems that general practice faces, and make it possible to expand services for patients.
“Having a Long Term Plan has allowed us to come up with a five-year funding deal for primary care, for the first time in NHS history. And it is also a good deal for taxpayers, with money going directly into extra staff and services.”
Dr Nikki Kanani, NHS England’s Acting Medical Director for Primary Care, said: “This Contract gives five-year funding clarity and certainty for practices while giving patients improved services. Primary medical and community care resources will increase by £4.5 billion by 2023-24 and rise as a share of the overall NHS budget. And this agreement confirms how much of this new investment will stabilise and transform primary care through general practice and the evolution of Primary Care Networks. It’s a game changer and signals the start of a new era for general practice.”
Health Secretary Matt Hancock said: “I want the NHS always to be there for us when we need it. That means better access to GPs. This new contract provides certainty and security for all those working in general practice, and better, more modern access for patients.
‘GPs are the bedrock of the NHS and I want every patient to be able to access a GP quickly and increasingly online. Today’s agreement, building on our Long Term Plan for the NHS, backed by an extra £20.5 billion a year, will make that a reality.
“Everybody should be able to access a GP when they need to, in a way that suits them – and from embracing digital technology, to providing more flexible options for booking and attending appointments – we are giving greater power to patients to get the care that is right for them.”
Chair of the Royal College of GPs Professor Helen Stokes-Lampard said: “Investing in general practice is investing in the entire health service – and this new contract promises to do just that, in the best interests of our profession, the sustainability of the NHS, and the care we deliver to more than a million patients a day across the country.
“We also welcome the focus on collaborative working with a range of highly-skilled members of the GP team, to support our work and free up our time to deliver care to patients who need our expertise – as well as with other practices in the same locality.”
Kent LMC chair, Dr Gaurav Gupta, told Pulse: “I think this five-year contract deal can help stabilise the profession and the state backed indemnity will go some way in easing the recruitment crisis. Practices need to be at the centre of and lead primary care networks for full benefits of the deal to be realised. Much more work is needed to make general practice sustainable for the future but this deal is a good step in the right direction.”
A spokesman for the National Pharmacy Association said: “We are fully behind the principle that multi-disciplinary working, designed locally, based around the patient and delivered in the community, is the best way to deliver transformative improvements in health care.
“So, we will work with colleagues across the sector to support our members to engage with primary care networks, which are becoming a very significant part of the NHS infrastructure.
“However, today’s announcement intensifies the dilemmas faced by community pharmacy owners who invest in training and development only to see people migrate to general practice. This is a risk that must be carefully managed, so that these new primary care workforce targets genuinely add to capacity.”
You can also read our reaction to the indemnity plans here.
What do you think of the GP contract? Do you support the Government’s plans? We’re keen to hear what you think.