Rising indemnity fees could lead to worst ever winter crisis, says new GP leader

Authors: Abi Rimmer 

Publication date:  01 авг 2017


The new chair of the BMA’s General Practitioners Committee has a long “to do” list, reports Abi Rimmer

The rising cost of GPs’ indemnity cover could lead to the worst ever winter crisis, as fewer doctors are able to afford to work, the new chair of the BMA’s General Practitioners Committee has warned.

Richard Vautrey, who became chair of the committee last month, said that, after a reduction in the so called discount rate, GPs would see an unparalleled rise in indemnity fees. The “discount rate” is the rate that people receiving lump sums for personal injuries are expected to get if they invest the money.[1] A reduction in this rate, which came into effect on 20 March, means that awards will have to be much higher to compensate.

Vautrey said, “One of the big issues is the issue of indemnity. We have secured, in the last contract negotiations, funding to pay for the typical indemnity rises that would have happened year on year. [However], we are now facing a situation that with the discount rate change we’re in we’re going to potentially see a rise for indemnity which is unparalleled, compared with previous rises.”

He said that if GPs were deterred from working extra sessions, such as in out-of-hours settings or extended surgeries, because of escalating indemnity fees, “we’re going to have a winter crisis that is a lot, lot worse than we have seen in previous years.” He added, “Doctors will simply not be able to afford to work in an out-of-hours session or to do an extra session within a practice, because the indemnity cost would be prohibitive.”

The whole system of GP indemnity was being called into question by rising costs, Vautrey said. “We are calling on the Department of Health to really address this situation urgently, and we have been in talks with them about how we can get a sustainable solution for general practice as a whole,” he said.

National indemnity scheme

One possible arrangement could be for all GPs to be protected by a national scheme, Vautrey said, with their own personal indemnity on top at a much lower cost. “The current situation where you have GPs paying thousands of pounds out of their income just to be able to work is not tenable in the long term,” he said.

Vautrey warned that medical defence organisations were currently holding off making big changes to their annual fees, “but they can’t hold off for much longer.”

He said, “If the government doesn’t act quickly, those big bills are going to be appearing in GPs’ letterboxes very soon, and that’s just going to cause absolute consternation among the profession as to how they can possibly carry on working in some settings with these prospective indemnity costs,” he said.

QOF reforms

Despite previously welcoming plans for the Quality and Outcomes Framework (QOF) to be phased out,[2] Vautrey said that the General Practitioners Committee was now working on a reformed version of the framework rather than scrapping it entirely. He said that after reductions in some indicators and the removal of others, many GPs now believed that they had a set of indicators that they could support. There was also recognition, Vautrey said, that QOF was heavily embedded in the way many practices worked.

He said that GPs had raised concerns about how the funding currently allocated to QOF would be used if the framework were to be scrapped, “because the existing work wouldn’t go away.” He added, “So the management of patients with diabetes, heart disease, and lung disease, for example, still needs to take place and still needs to be resourced.

“You still need to employ your practice nurses, your healthcare assistants, your practice manager and other staff; and QOF funding is crucial to the way that the practice works.”

Last month the General Practitioners Committee began balloting general practices in England on the potential mass closure of patient lists in response to the ongoing crisis facing the profession.[3]

Regardless of the result of the vote, Vautrey is clear that a combination of workload pressure, a lack of investment, and workforce problems will still need to be tackled. “We need to see the government really taking those issues much more seriously and address them quite quickly, otherwise we will be back in the same situation in another year’s time with people saying, ‘We’ve still not seen tangible benefits from the promises the government are making.’”

Industrial action

If GPs do vote to take action, the BMA will begin the formal process of balloting them on industrial action, Vautrey said. However, he added that it was important that practices made it clear what level of action they were willing to take.

“What we don’t want to do is repeat what happened with the pensions dispute,” Vautrey said, “where large numbers of people said that they were prepared to take action and then when we actually pursued that they didn’t take the action that they said they would—and that made us look weak.

“We don’t want that scenario again. So we need to know exactly what practices are prepared to do, and then they need to follow that through.”

Richard Vautrey: potted history

1988—Qualified in medicine, Manchester University, 1988. Completed GP training in Manchester and Rochdale, then spent 18 months as GP in Nigeria

1994—Becomes a partner at Meanwood Group Practice, Leeds

1995—Elected to Leeds Local Medical Committee

1999 to 2008 – Medical secretary, Leeds LMC

2001—Elected to BMA General Practitioners Committee as representative for Calderdale, Kirklees, Leeds, and Wakefield

2004—Becomes GPC negotiator

2008—Assistant medical secretary, Leeds LMC

2007—Elected deputy chair of GPC

2013—Elected to council of Royal College of General Practitioners

2013—Stands for chair of GPC but loses to Chaand Nagpaul

2014—Elected to BMA council

July 2017—Elected chair of GPC

References

  1. Rimmer A. Next government must tackle GP indemnity costs, royal college says. BMJ  2017;357:j2429. [Link]   [Link] .
  2. Iacobucci G. General practices achieve 95% of QOF points. BMJ  2016;355:i5834. [Link]   [Link] .
  3. Iacobucci G. GP leaders ballot profession on mass list closure. BMJ  2017;358:j3374. [Link]   [Link] .

Abi Rimmer BMJ Careers

 arimmer@bmj.com

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