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Practices GPs are independent contractors remunerated for the provision of NHS services via a complex system of fees and allowances and direct refunds. The new contract introduced in 1990 altered the terms of service for GPs as well as the balance of the remuneration structure. The 1990s saw many changes in the NHS, including the creation of an internal market for healthcare and the introduction of GP fundholding. Further NHS reforms are underway, building on the concept of local commissioning but abolishing GP fundholding. The late 1990s witnessed the emergence of private GP surgeries in locations such as railway stations or shopping complexes, the establishment of walk-in NHS medical centres and the nurse-run 24-hour telephone helpline, NHS direct. July 2000 saw the publication of the Government's NHS Plan which set out measures for the radical reform of the NHS, some of which had been announced previously and some of which were new. The Plan sets out ambitious targets for improving the health of the nation and delivering health care and promises more NHS staff to make this possible. During the opening years of the 2000s a package of measures was introduced aimed at improving morale in the profession, reducing the workload and addressing the problems of GP recruitment and retention. In October 2001 negotiations on a new GP contract began. The Doctors' and Dentists' Review Body recommends each year an amount that the average GP should earn (the Intended Net Average Remuneration). To this is added an amount to cover indirectly reimbursed practice expenses. The fee scale is structured to deliver these two elements through allowances, capitation payments, item of service fees and so forth. If GPs as a whole earn more than intended in any year, this 'overpayment' is deducted from the pay award in subsequent years. Following the introduction of the new contract in 1990/91, many GPs earned considerably more than had been intended. The 'balancing mechanism' was suspended in 2001/02 and 2002/03. The number of unrestricted principals working in the NHS has gradually increased over the last decade and there has also been a move away from the single handed practice towards larger partnerships. GPs' workload is likely to remain heavy in the future as a result of the continuing trend for services previously provided at secondary level to be shifted to the primary care sector. The latest NHS reforms may also increase administrative and management burdens. Only general medical practitioners registered with the GMC may work in the NHS. Before practising as a GP, a doctor must complete a three year vocational training period. Once qualified, GPs might start up on their own or join an existing practice. Suitable practice premises must be provided - in many cases these will be owned by the GP/s. Patients are seen at the practice premises and home visits will also be undertaken. The average number of patients registered per practitioner has fallen over the years to a current average of around 1,800 (England). Scotland has the smallest patient lists. As well as providing general medical services to their patients, GPs may also undertake other NHS work as well as non-NHS work. A number of factors may affect the amount received each year in fees and allowances, chief among these in many cases being the failure to maximise item of service fees or to claim everything to which the practice is entitled. The NHS fees and allowances due to the GP are paid by local Health Authorities/Boards, monthly, quarterly and as claimed. Fees for some non-NHS activities, such the completion of certificates, may be paid in cash and care should be taken to ensure that these are fully recorded. The financial performance of the individual GP may be reviewed against the Intended Average Net Remuneration recommended annually by the Review Body and delivered through the fee scale. However, net income actually received by the GP may vary considerably from the average for a number of reasons, including practice size and patient profile, the range of services provided and the efficiency with which fees and allowances due to the practice are claimed.
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For further information or to become a part of our winning team contact us at: Hadrian House, Front Street, Chester Le Street, Co. Durham, DH3 3DB Te: (0191) 388 3377 Fax: (0191) 387 1745 Email: straughans@straughans.co.uk Straughans Limited (trading as Straughans) is a limited liability company registered in England and Wales under No 0354727. Registered office: Hadrian House, Front Street, Chester le Street, Co Durham, DH3 3BB | ||
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