The year ahead
Authors: Helen Jaques
Publication date: 01 Jan 2013
Helen Jaques looks at what doctors can expect in 2013
It was in 2012 that the Health and Social Care Bill was finally passed into law and the BMA finally blew its top over pensions, but 2013 will be the year doctors begin to feel the full effects of both events.
In April general practitioners in England take over £65bn of the NHS budget to commission hospital, community, and mental health services. So far 34 of the 211 planned clinical commissioning groups have been authorised by the NHS Commissioning Board, and the remainder will be authorised in three further “waves” in January, February, and March. This new set-up in England will affect not just the GPs already involved in commissioning, who may be too tied up in red tape to enact real change, but also grassroots GPs, whose contracts will be held by the NHS Commissioning Board instead of by primary care trusts.
In fact, the general medical services contract for GPs is likely to cause a lot of problems this year. The Department of Health in England has set out a raft of changes to core funding, the quality and outcomes framework, and direct enhanced services that it intends to impose on the profession. The BMA’s General Practitioners Committee argues that these changes will increase GPs’ workload and cut practices’ funding, creating huge issues for a profession already dealing with a saturated workload. The extent of the changes proposed has led the BMA in Scotland to negotiate its own general medical services contract for 2013-14, and union representatives in Wales and Northern Ireland have similar plans.
Hospital consultants are likewise likely to feel the effects of the Health and Social Care Act as clinical commissioning groups move to renegotiate service provision. However, a bigger concern for hospital consultants will be the government’s reform of clinical excellence and merit awards and consultant pay. The report from the Review Body on Doctors’ and Dentists’ Remuneration suggests capping the number of doctors who can receive local and national awards and the sum of money they can receive. It has also called for a review of the consultant contract so that fewer doctors achieve the top salaries, something the government has agreed to go ahead with. Nevertheless, it seems that England and Wales will dish out clinical excellence awards in 2013 and Northern Ireland will not.
Hospital trainees have another set of reforms to contend. Postgraduate medical education and training will shift from deaneries to employer led local education and training boards, overseen by a new national body called Health Education England. Its chief executive, Ian Cumming, doesn’t think that there will be any “immediate” changes in the way that individual junior doctors are trained once this new system comes into place. Nevertheless, expect a choppy transition as local education and training boards subsume deaneries.
The government plans to review contracts for junior doctors in 2013 as well as those for consultants, after NHS Employers labelled the current contract “no longer fit for purpose.” Banding, extra cash if hours go over European Working Time Directive or New Deal limits, and pay protection are all up for debate in a bid to weight the system more towards basic pay and to focus the contract more on competency and team working.
Pension reform will continue to be a major issue in 2013, although not the front page news it was in 2012, given that hospital doctors in Scotland are not going to strike this winter. All doctors will have to pay more into their pensions from April, but doctors and other public sector workers are likely to receive a 1% pay increase in 2013, unless the government heeds the NHS Employers’ call for another year of pay freezes. The one piece of good news on the financial front is that the General Medical Council’s annual registration and retention fees for 2013-14 will be cut or frozen, but GPs will have to pay a new fee of at least £550 to register their practice with the Care Quality Commission.
One massive change that will unite all doctors in 2013 is the introduction of revalidation. After a decade in gestation, revalidation came into place on 3 December 2012, with senior doctors such as the chairman of the General Medical Council Peter Rubin first through the gates. Most doctors should have received notification of their revalidation date by the end of January, and the first 20% of “normal” doctors will start being revalidated from April. Whistleblowing will remain high on the agenda in 2013 as the long awaited Francis report into the failures of care at Mid Staffordshire NHS Foundation Trust is published at the beginning of the year.
Few in healthcare would have anticipated that 2012 would be such a tumultuous year for doctors, but it could turn out to be just an opening act for the huge changes ahead in 2013.
Competing interests: None declared.
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Helen Jaques news reporter