GP practices ‘may be forced’ to use funds from the DDRB uplift to cover expenses or repay overdrafts instead of passing them on to staff, the BMA has warned.
Earlier this year, the Government accepted the recommendations of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), confirming that there will be a 6% increase ‘to the salary scales, pay ranges and the pay element of contracts’ for GP partners, salaried GPs, and practice staff.
This means that two of the main Global Sum income elements – ‘contractor income’ and ‘other staff expenses’ – will be uplifted by 6% in total, the BMA explained in a recent briefing document.
As a result, the payment per weighted patient that practices receive will increase from £107.57 to £112.50 – a 7.4% increase overall, compared to 2023/24’s figure of £104.73 – and this will result in an average additional income of around £49,000 extra per practice.
But the union warned that the final element of the Global Sum, ‘other expenses’, has not been uplifted further beyond the 1.68% already added in April 2024, meaning that practices will struggle to cover running costs.
In a briefing to practices, the union said: ‘This is highly unlikely to cover increasing practice running costs, given CPI inflation increased by 2.36% in the past year alone – and it is even more unlikely to make up for losses endured during previous years of high inflation.
‘As a result, practices may be forced to use additional funds from the DDRB uplift to cover expenses or repay overdrafts, meaning they are unable to use it all for pay rises.’
Despite GPC England’s request to do so in its evidence back in February, the DDRB did not recommend an uplift to cover increased non-staffing expenses faced by practices.
The BMA also explained that additional funding is distributed on the basis of patient list size, which ‘does not correspond directly to staffing expenses’, as some practices may have fewer patients per staff member, or employ staff on higher salaries, due to seniority or needing more locum GPs.
‘These practices are at highest risk of not receiving enough additional funds through the Global Sum payment per weighted patient to afford a 6% pay rise for all their staff, including contractor and partner GPs (as intended by the DDRB),’ the BMA warned.
The union also said that while the Carr-Hill formula ‘makes things inequitable’, there has been ‘very little time’ to discuss a different mechanism, such as direct staff cost reimbursement, or acquiring the necessary financial data from practices and come to an agreement with the new Government since the general election in July.
‘Such a change to the Global Sum and distribution mechanism would take months of negotiation before agreement could be reached,’ it added.
‘Going with any other mechanism would therefore have delayed the uplift. Practices with immediate cashflow problems would have had to wait at least another six months.’
NHS England has said it ‘firmly’ expects GP partners to award all practice staff the full 6% pay rise, but the BMA clarified that only practice employers have the authority to decide to uplift non-GP salaried staff based on affordability.
The document added: ‘This is particularly important for those who do not receive sufficient funding to do so and cannot afford a full or more than a partial pay uplift for every salaried staff member as a result.’
It added that the GPCE ‘could not have been clearer with NHSE and DHSC’ on the fact that using the same uplift implementation method ‘was going to go down very badly’ with a significant proportion of general practice staff, as well as their representative bodies.
The document added: ‘However, on behalf of the profession, GPC England needs to tread the line between maintaining the profession’s leverage as we approach the autumn and winter annual contract change negotiating window, and constructive, positive relations with the new Secretary of State for Health and Social Care and Primary Care Minister.
‘The profession will need to remain prepared to take collective action on behalf of their patients and their practices until significant progress is being made, GP and practice staff trust in policy decision making is restored and all key objectives are secured.’
Medical accountant Andy Pow told Pulse that in ‘many cases’ the uplift is not going cover staff costs alone.
He said: ‘A sizeable number of staff have also had to have more than 6% due to minimum wage policy of 10%, so this has not been factored in.
‘The PCN DES also just uplifts ARRS reimbursement by 1% so PCN staff rises won’t be funded. This is not delivering 6% contractor pay uplift.’
Doctors’ Association UK GP spokesperson Dr Steve Taylor agreed the uplift ‘won’t work for a number of reasons’.
He told Pulse: ‘Practices have had a cut of 20% £ per patient since 2016 in real terms, so have been running deficits for sometime.
‘Many practices are in perilous financial positions and the 6% uplift doesn’t cover other practice expenses which have risen significantly. It is a lot better than previously offered but the DDRB needs to evaluate the financial data better.’
Pulse has approached the Department of Health and Social Care for comment.
Last week the health secretary asked the DDRB to deliver its 2024/25 recommendation ‘at the earliest point’ to help speed up pay awards for next year.
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