26 Devolved nations report Practices facing huge cut in global sum Negotiations between GP leaders and the Welsh Government are taking place over reductions to the global sum to pay for the state- backed indemnity scheme, after ministers proposed cutting the core funding by more than £11m. A letter sent by the Welsh BMA GP Committee to GPs, and seen by Pulse, revealed the Government had decided to reduce the global sum by £11.3m – equivalent to 3.2% or £2.88 per patient. The plan met with outrage among GP leaders when it came to light at the end of March. They called the situation ‘absolutely ridiculous’ and hinted at industrial action if the plans go ahead. In a separate letter sent to practices on 8 April, the Welsh Government confirmed it was in discussions over the plans. It said it wanted ‘to reach an agreement that is fair and proportionate for all parties’ and that ‘all parties remain hopeful that an agreement will be reached shortly, which will involve significant new investment and a net increase in funding for all practices’. The letter confirmed a meeting between the Government, NHS Wales and the BMA Wales GP Committee was due to take place on 10 April. Its outcome had still not been revealed as Pulse went to press. The letter said that, because the new indemnity scheme in Wales was introduced on 1 April, practices ‘will still see a reduction in global sum payments for this period’. It confirmed any payment changes as a result of the negotiations would be backdated for 2019/20. A Welsh Government spokesperson said: ‘Together with GPC Wales and NHS Wales, we have written again this week to update GP practices. Negotiations are ongoing and we remain committed to reaching an agreement that is fair, proportionate and results in an overall uplift to the GMS contract for this year.’ The BMA letter, sent to GPs in Wales at the end of March, said: ‘You will 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 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.’ BMA GP Committee member and former GP Survival chair Dr Alan Woodall, speaking in a personal capacity, said the move amounted to a pay cut, Pulse May 2019 adding that the state-backed GP indemnity scheme being introduced in England was being funded at the same time as an increase to the global sum. The Montgomery GP said: ‘In England, they have their indemnity covered, whereas in Wales we suffer a £2.88 per patient cut. It is absolutely ridiculous. ‘In my personal opinion, if we don’t get a substantially revised 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.’ West Wales: weekend suspensions of out-of-hours services Out-of-hours services at ‘crisis point’ Out-of-hours GP services across Wales are struggling and in northern and western regions the shortage of GPs working in these services has reached ‘crisis point’, the BMA has warned. A Pulse investigation has found there were 125 instances when there was no GP cover in the Hywel Dda University Health Board area in West Wales in 2018, up from 42 in 2017. BMA Wales GP Committee deputy chair Dr Peter Horvath-Howard said action was urgently needed to provide a safely staffed service. ‘Shortages within out-of-hours GP services are reaching crisis point in North and West Wales, and it is a major problem all across Wales,’ he said. • GP staffing problems worsen at hard-hit out-of-hours services, page 16 Scottish Government to fund pensions hike The Scottish Government has committed to funding the full hike in employer pensions contributions, following warnings from the BMA that failure to do so would have an ‘extremely damaging’ impact on GP practices. Last December, the Scottish Public Pensions Agency announced the rate of employer pension contributions would rise from 14.9% to 20.9% from 1 April to match the increase in benefit costs. A letter sent in March by public finance and digital economy minister Kate Forbes to the Health and Sport Committee said the UK Government had previously committed to ‘fully cover the increase’ for NHS employers. But Ms Forbes warned that the funding from the Treasury will not be enough to cover the full costs and that Scotland would have to consider ‘how the shortfall will be met’. The BMA warned that failure to fund practices could affect recruitment and retention. However, following the pressure, the Government relented. BMA Scotland GP Committee chair Dr Andrew Buist said: ‘We have a solution for the pension issue for Scottish practices. They began to receive notification... that the additional 6% for the staff based on the previous month returns, will appear in their [next] statement.’ The Scottish Government said they still do not have guarantees around the funding from the UK Treasury. But Dr Buist added: ‘There still appears to be an ongoing dispute between the Scottish Government and the Treasury as the exact amount of money to be transferred. But that should not concern practices.’ Belfast now hit by practice closures The issue of failing practices is truly frightening Dr Alan Stout Even Belfast is being hit by practice closures, having previously been shielded from the worst of the crisis in Northern Ireland, the chair of the country’s GP Committee has warned. In a speech at the UK LMCs Conference in Belfast in March, Dr Alan Stout said waiting lists were rising beyond four years for some specialties. He said ‘delayed discharges and issues with social care and the demographic challenges that we are all familiar with’ were also mounting problems. ‘Most relevant to today are failing practices, particularly as a result of simply a lack of GPs and the workforce crisis,’ he added. ‘This is truly frightening. Six months ago, just about anywhere outside of Belfast was struggling – and now we are seeing significant issues inside Belfast too. This is most concerning as we always knew that Belfast would be the last to suffer.’ However, Dr Stout went on to stress that despite the country still not having a government in place, some progress was being made. This included all GPs now being part of a federation, investment from the Department of Health, and the introduction of funded full-time pharmacists into practices.