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The latest
developments in medical finance:
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GP
dynamising factors out
An interim factor
of 7.2% will be used to uprate GPs' pensions for 2003-04,
it was announced today. Details were given in a letter
 to all
GP practices from the NHS Pensions Agency. The BMA welcomed
the 'significant increase in the value of GP pensions'.
GPC chairman Dr Hamish Meldrum said: 'This will be the
first of a series of rises reflecting the considerable
increase in resources made available under the new GP
contract'. He called the interim figure 'conservative'
and forecast the actual factor used to uprate pensions
would be around the estimated final figure of 8.8%.
Dr Meldrum said if
that was the case then pension payments would be recalculated
and the higher amounts backdated to the date of retirement.
'GPs who have not retired in the period from 1 April
2003 to 31 March 2004 should focus on the actual factor,
which will give the true increase in the value of their
pension. Actual factors are expected to be available
early 2005'.
However, the BMA warned
there was a 'very small possibility' that the actual
factor would be under 7.2% because the interim figure
was an estimate based on the best information currently
available. In that unlikely event, pension payments
would be adjusted down to the correct level'.
The letter states:
'GENERAL MEDICAL PRACTITIONER
DYNAMISING FACTORS FOR YEAR 2003-2004
Annex 2 of Technical
Newsletter (TN) 5/2004, described a revised method of
calculating the General Medical Practitioner (GMP) Dynamising
Factors (DF) for year 2003-2004 and subsequent years
under the new GMS contract. The new arrangements will
apply to all GMPs, including those in Personal Medical
Services (PMS). Under the revised arrangements the DF
will be based on the actual rate of increase in GMP
NHS pensionable earnings. The increase will be determined
by measuring the rate of change in certified NHS pensionable
profits for all GMPs, when their accounts for the relevant
year are closed.
Pensions awarded or
estimated before GMP accounts are closed for any year
will be calculated using an interim DF. The interim
DF will be applied to pension calculations in the same
way as DF in previous years but the figure will be revised
when final data is available. Any pensions in payment
affected by the change in DF will automatically be adjusted
by the Pensions Agency.
The interim DF for
any year will be set at a conservative safe level, agreed
by professional and NHS employer representatives and
will aim to provide a confidence level of 90% with the
expectation that the final figure will always be higher.
This means that any final adjustment to benefits in
payment should be upward and pensions will be re-calculated
and pension and lump sum arrears paid, backdated to
the date of retirement. In the unlikely event of a lower
final DF being appropriate, Paymaster, the Agency's
payroll partners, will write to the members affected
with details of how they intend to recover the overpayment.
Professional and NHS
employer representatives anticipate a rise in average
GMP pensionable earnings of around 8.8% over the year
to 31 March 2004, which, if borne out, would be the
final DF for 2003-2004. Using the agreed 90% confidence
level, this translates into an interim DF for the year
of 7.2%. The interim DF for year 2003-2004 has now been
agreed between Professional and NHS employer representatives.
The final DF for 2003-2004 will be notified as soon
as possible in a future Technical Newsletter.
MEDICAL PRACTITIONER
DYNAMISING FACTOR FOR YEAR 2004-2005
Professional and NHS Employer representatives are currently
discussing the appropriate GMP interim DF for year 2004-2005,
and the agreed figure will be notified in a future Technical
Newsletter.
MORE INFORMATION
You can find a copy of this Newsletter on the Agency's
website at www.nhspa.gov.uk. Any enquiries about the
Newsletter should be made to your usual Pension Centre
contact.
Yours sincerely,
Howard Robinson
GPs
trade time for money
Bartering under the
new contract has given GPs an extra two and a half hours
a week - but no more money.
The doctors, in Leeds,
have agreed a deal with the city's PCTs to continue
a list of services including postoperative care and
suture removal in return for a new form of payment in
kind. For their part, the PCOs will recognise out-of-hours
as starting at 18.00 hours rather than 18.30 as defined
by the new contract.
Many practices voted
for the deal in a ballot and now GP leaders will be
watching closely to see if it is successful and whether
other areas may try and agree similar arrangements.
Doctors
face more research on pensions
Doctors nationwide
are to be asked for their views on retirement and NHS
pensions. Findings will be valuable to the BMA as the
NHS Confederation leads a review of the NHS Pension
Scheme in England and Wales on behalf of the Department
of Health. The survey will quiz doctors about their
retirement intentions and whether they will be affected
by a proposed change in the normal pension date. It
also asks doctors to select their preferred choices
from a list of possible changes, improvements and reductions
in benefit levels and to consider whether the current
types of scheme are still appropriate. The BMA said
its survey was in addition to a wider survey being run
by the NHS Confederation across the whole of the NHS
workforce, including approximately 1,000 doctors.
More
GP financial change causing concern
The prospect of yet
more substantial financial changes to the way GPs operate
is causing some concern among senior doctors.
Many GPs are still
grappling with aspects of the latest round of changes
to the doctors' pay system contained in the new GMS
contract, but health department officials have signaled
that a further round of significant measures could soon
be on its way. Concern has been voiced at some key areas
of the NHS Improvement Plan white paper, which warns
GMS and PMS practices to expect to see practice-level
commissioning from April next year.
Doctors who have looked
at the small print available so far are worried how
general practice will be able to cope with another potential
headache so quickly after the new contract. A national
conference organised by the BMA and scheduled for three
months time is expected to look at the improvement plan
in detail. Some of the plan's proposals amount to the
government's policy for this term and are not confined
to what it would want to do if it survived a general
election.
Further details of
practice-based commissioning from April 2005 are sketchy
so far but the GPC believes there are worrying implications
for family doctor commissioning in PCTs where foundation
trusts and the new payment-by-results finance system
are operating. Here, it claims, there is evidence that
acute trusts are exerting 'considerable pressure' on
PCTs.
In statement to LMCs
the GPC warns: 'Whilst the GPC acknowledges that the
proposals in the white paper are likely to be implemented,
it is feared that the document heralds the fragmentation
and contracting out of primary care services, with a
move to the concept of 'managed care' with implications
for chronic disease management and clinical care pathways'.
Various GP bodies,
including the Royal College of General Practitioners,
will meet later this summer to work out how they would
like to tackle this latest NHS blueprint for change.
A GPC paper outlining key areas for discussion highlights
the following areas of the NHS Improvement Plan which
may be of interest:
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The
return of fundholding.... 'GP practices that wish
to do so will be given indicative commissioning
budgets. This will provide GPs with further incentives
to manage referrals effectively with any savings
being reinvested in NHS services'. |
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PCTs
to get three-year instead of annual allocations,
to control of 80% of the local NHS budget, and to
have more scope for GP contract flexibility. |
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Plans
to recognise 1,300 GPs with 'special interests'.
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PCT
encouragement to make full use of all types of primary
care service contracts, such as APMS, PMS and PCTMS.
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More
GP-led primary care centres for commuters. Six are
planned for Leeds, London, Manchester and Newcastle-upon-Tyne
next year with a further batch elsewhere in 2006.
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Re-accreditation
procedures to be linked to annual staff appraisals,
and |
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Restrictions
on new pharmacy locations. |
Many more additional
changes affecting primary care doctors are mooted in
the white paper - but doctors have found little detail
to flesh out the detail of the plans.
GPs'
non-NHS fees increases
Fee rises of 10% are
being suggested by the BMA for GPs' non-NHS work. This
brings the hourly rate for work within the practice
to £176.50.
The rises, which have
only just been announced, take effect from 1st July
2004, although it will be too late now for practices
to re-charge the work at the new higher rate. Increases
have previously applied from 1 April. Suggested fees
are:
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Straightforward
certificate of fact without examination: £11.50 |
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More
complex certificate: £19.50 to £41.50 |
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Work
in surgery: extract from records: £44.00 |
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Report
on a proforma, no examination: £59.00 |
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Written
report without examination, providing a detailed
opinion and statement on the condition of the patient:
£88.00 |
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Comprehensive
clinical examination including report and certificate
or completion of necessary forms: £132.00 |
The fees rises are
broadly in line with what the BMA's professional fees
committee estimates to be the rise in pensionable profits
for family doctors in the current year. Non-NHS fees
rose by a similar amount last year as the BMA tried
to ensure their levels kept pace with projected rises
in GMS and PMS earnings.
Other fees, known
as the 'Treasury rate' scale which is used for central
government department and agency work, have also risen
and these are, again, effective from the beginning of
July 2004. They are:
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Certificates:
£12.00 |
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Records
extract: £30.50 |
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Report
on pro forma: £39.50 |
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Written
report: £60.00 |
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Medical
exam and in-surgery report: £88.00 |
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Three-hour
sessional work in the surgery: £356.00 |
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Hourly
rate for work outside the surgery, e.g. tribunals,
boards and lectures: £60.00 |
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