GP TechLead

In a resounding vote of no confidence, GPs in England have overwhelmingly rejected the proposed contract changes for 2024/25. The British Medical Association (BMA) held a referendum, with a turnout of over 61% and a staggering 99.2% of participating GPs voting "no" to the contract. 

The recent unveiling of the revised GP contract by NHS England has sent shockwaves through the healthcare community, igniting a fierce debate. While some elements of the contract have garnered cautious acceptance, the British Medical Association's General Practitioners Committee (BMA GPC) has expressed strong disapproval of several key points, raising concerns about the potential impact on patient care, workload management, and the overall sustainability of primary care.

The proposed 1.9% uplift to the GMS contract in England has ignited concerns within the general practice community, raising critical questions about its impact on both financial sustainability and patient care. Examining the details of this offer and its potential ramifications reveals a complex scenario with far-reaching consequences. 

The recent announcement of a substantial increase in the minimum wage (up to £11.44 from £10.42) has sent shockwaves through the healthcare sector, particularly among GP partners. While this move aims to uplift the lives of low-income workers, it could inadvertently jeopardize the financial stability of general practices, threatening the very foundation of primary care in the United Kingdom.

The global sum for GP practices in England has been increased from £102.28 to £104.73 per patient, in order to finance a 6% staff uplift. This is roughly a 2.4% increase. Negotiations between the Department of Health and Social Care and the British Medical Association (BMA) concluded last week, and the BMA's GP Committee said they had done so 'satisfactorily'. The global sum is a fixed amount of money that GP practices receive per patient registered with them. It makes up the majority of a practice's income, and is used to fund all aspects of primary care, including staff costs, premises, and equipment.

On the GP social media, locum GPs are angry that they are unable to find jobs because other allied healthcare professionals are undercutting them. Locum GPs are fully qualified GPs who work on a temporary basis, and they are often used to fill gaps in the workforce when a GP is on leave or sick. However, in recent months, there has been a growing trend of allied healthcare professionals, such as nurse practitioners, paramedics and physician assistants, taking on GP roles.

Has the season of strikes ended? In the news, many professions have now ceased their strike action. Teachers have now accepted a 6.5% pay deal meaning they will not strike anymore. Nurses, paramedics and 999 call handlers accepted a 5% pay increase as well as a one off payment to end the strikes. The nurses were actually in favour of continuing to strike but the turn out for their ballot was too low to legally allow more striking. Firefighters didn't strike but they accepted a 7% backdated pay increase and 5% pay increase this year. 

Lots of interesting news came for doctors this week in the form of the Budget and also an announcement from NHS England. Jeremy Hunt, the current chancellor of the Exchequer who is control of the countries finances, was previously the infamous health secretary who battled the junior doctors back in 2016. Since then though, he has claimed that he more sympathetic to doctors and has claimed that he will solve the NHS pension issue for high-earning doctors. Well in this announcement on the 15th March has gone some way to solving it.

With the whole NHS seemingly crumbling, it wouldn't be a stretch to say that primary care was valiantly holding up a failing system. Emergency departments with long waiting times, paramedics, physiotherapists and nurses striking, junior doctors likely going to strike, waiting times for elective procedures at all time highs - there is only so much this system can take. 

Money is seemingly what is forever talked about in the news. We're constantly told we're in the cost of living crisis and that we're only steps away from the breadline. There are a few reasons for this, the war in Ukraine, the Covid pandemic and the period of relative boom with historical low interest rates. Those used to super low mortgage rates of less than 1% are now shocked that they are coming back to 'normal' interest rates of 5-6%. However it's not just mortgages that are now more expensive, it's everything such as milk and eggs. This has lead the inflation rate for this month to top 11.1%, the highest its been for 41 years. This makes it hard for us to afford everyday items as our wage has definitely not gone up by that amount. This disparity has led to the many strikes that have happened this year (trains, royal mail) and may lead to more in the next few months (nurses, doctors). 

Everyone is striking these days. The train drivers are always doing it. The posties are doing it this month. There are barristers and firemen talking about striking. More interesting in our case is doctors. The government has reccommended a 4.5% pay increase to doctors. However, not to all doctors. GP partners and doctors in training are not included in this deal. 

For most NHS workers, especially doctors, there may be less consideration for financial planning for retirement. There may be a thought that the NHS pension will be enough and actually with annual allowance considerations for high earners, further contributions will be not tax efficient. However there is another savings vehicle that could be used that seems to be often ignored for retirement, that is the Lifetime ISA (LISA).

Ever tried to get your NHS pension statement from the total rewards statement website? It's a total lottery if it will work. One day it will give an error and say the website is down, rarely you manage to get in (but then the numbers are wrong) and sometimes you get a funny error like below. Not helpful to those that are self-employed.... Very useful total rewards statement website. No reply back, been 2 weeks now. Very efficient system...

I was having a discussion recently about what can those not relying on an NHS pension can do for retirement. Workplaces are legally required by law to give a pension, and though most of the time you should definitely take it (it's effectively extra income if your employer will add to it), it may not be invested in the appropriate funds or might be charging high fees. The two main methods most talked about are Stocks and Shares ISAs (Individual Savings Account) and SIPPS (Self-Invested Private Pensions). They effectively are tax wrappers that shield the growth of the equities within them from tax. Below Are my takes on the pros and cons of each of these products, and when they may be appropriate for some.

Been busy with life so not posted for a while, so much has happened in the world since I last posted. Putin has gone true megalomaniac and invaded Ukraine, and if reports are true, they are doing a valiant job holding him back. Things were already very expensive prior to the war due to Covid but with sanctions flying from the western nations to Russia, it has made things like petrol very expensive. Certain foods are also set to rise, with the bulk of sunflower oil and wheat coming from these two countries, things like bread and livestock which need as feed, will become more expensive. Drivers have already noticed, with petrol prices through the roof, I'm sure we're a few weeks away from 200p / litre. Rishi Sunak tried to stem this tide with his announcement today, increasing the NI limit and taking 5p off fuel duty. Covid seems like a long lost friend...

Previously I discussed the proposals to change the amount of that employees contribute to the NHS pension. Those on lower incomes will be contributing more and those on higher incomes will contribute less. This was meant to be rolled in this April 2022, but this is now going to be started from October 2022 with the final changes to the employee contributions in April 2023.

The annual allowance allowance calculation for the NHS pension is confusing. I wrote about it here but I still have to go back to refresh my knowledge about it. The hard bit about working it out for tax purposes is to think that it's not the monetary amount you contribute, but its the annual growth of the your pension pot. The maths involved makes my head hurt. 

As I write this, I'm stuck awaiting a PCR test for a cough that has come about suddenly. I'm sure it's not Covid but got to make sure, the numerous lateral flows are all negative. It does mean that I'm away from any family this Xmas as PCR test results are taking the maximum 72 hours to come back; previously it was no more than 24 hours. Must be a combination of the extra testing this time of year, the increase cases due to Omicron and possibly less people working in the labs this holiday season. Omicron cases hit over 120,000 cases a day which is mind-blowing, no doubt some form of lock down will happen post-xmas. 

GP Practices have had a few financial obstacles put in its way this year. Firstly there was the 3% pay rise for staff which I have covered before. But more recently, there was an increase in National Insurance (NI) contributions and in the budget last week, an increase to the minimum wage to £9.50 an hour. Financial experts feel the NI changes alone will mean an average loss of £15,000 a year  to the average GP surgery. I feel NI is a very confusing tax to understand compared to income tax, so I thought I'd try to break it down as easily as I can.

Going back to my previous introductory  NHS pension post , employee contribution to the NHS pension was tiered dependant on your earnings. Below was the previous banding and employee contribution rates.