Change to GP contracts in Northern Ireland 'the biggest for decades' and will help stem closure of GP surgeries says Dr Alan Stout

​Dr Alan Stout (chair of the BMA’s GP committee in NI) told the News Letter that a new contract for GPs unveiled by the health minister today will effectively abolish a long-standing £10,000 “tax” on each GP's head and so will start to "stabilise" the loss of doctors.

This is "huge", he said, adding that the last time there was such a big change to how GP practices do business was back in 2004.

Compared with everything else over the past 20 years, today's announcement "is way beyond anything we've seen before: it is very significant, and it needed to be significant".

There are two stand-out changes.

One is getting rid of the requirement for GPs to pay out of their own pockets for an "indemnity".

This is effectively a kind of insurance, and is legally-required for anyone wishing to practice.It costs around £9,000 to £10,000 per year, but in the rest of the UK it is paid for by the government, not out of GPs' own salaries.

Asked if this is the main thing in today's announcement, Dr Stout said: "Oh yeah: absolutely. It's so important to our GPs that are here, and so important in retaining them and trying to attract people from elsewhere as well. It's the most important part by far."

He said the present arrangements are a de facto £10,000 "tax" on being a GP, and that this had made NI look unattractive to doctors.

Making the government responsible for paying this is "a really important move... we really do hope it'll start to stem those closures" of GP practices.

The second major thing is that doctors will no longer be reliant on hitting targets based on how well their patients are doing (something called QOF, details below) in order to get funding.

• HOW GPs DO BUSINESS RIGHT NOW

Here is how GP practices get funding right now:

Firstly, they get "core funding" – like a lump sum for every patient on their books.

This varies from about £75 to £120 per year, based on a formula that considers things like their age and how deprived the area is.

(There is no incentive to just keep adding patients for the simple reason that this "core funding" is not enough to cover their costs, said Dr Stout.)

Secondly, ever since 2004 GP practices also get money by hitting targets for how well their patients are doing – something called QOF, standing for 'qualities and outcomes framework'.

This means, for example, targets for the blood pressure and cholesterol levels of heart disease patients (all of which is recorded via computer).

Dr Stout said that this QOF system could skew the workload of some GPs; for instance if a practice is just a few per cent shy of hitting a target for diabetes then the doctors would devote time and energy to solving that problem (which could mean calling patients in for review, or over-prescribing medication), rather than lose all the revenue for that target.

As of today’s announcement, this is now being done away with. Instead the money from QOF will be provided as “core funding” instead.

Thirdly, GP practices get paid for providing "enhanced services" like specialist clinics for joint injections, etc.

• HOW COME I CAN’T GET APPOINTMENTS ANY MORE?

So why has it become so difficult to get a GP appointment in recent years?

Dr Stout said that A) not enough GPs are being trained up and B) those that are trained are leaving for the Republic of Ireland or overseas where they can earn more (he said that Northern Irish GP salaries are typically between £90,000 to £110,000, but the average in GB is £130,000).

Right now the BMA estimates there are the equivalent of 948 full-time GPs working in Northern Ireland, for a population of almost two million.

About 20 years ago each GP would have handled about 1,300 to 1,400 patients, but now the average is somewhere around 2,000 per GP.

What is more, that cohort of 2,000 patients is now older on average.

And to make matters worse, so are the GPs – Dr Stout said that roughly half of NI's GPs are aged 55 and over.

Overall, Dr Stout (who has practiced since 2001, and is based at The Arches in east Belfast) said: "What we hope this will do is start to stablilise our practices. That's fundamental. That's the absolute number one thing.

"What we know though is its not going to suddenly be a magic panacea for all the problems we know about accessing a GP. [But] it will really start to build that foundation... [and] that's what's going to change the system, long term. It'll make people less likely to look to move."