We recommended you reject the latest Welsh GMS contract offer

GP contractor pay

We asked that the Welsh Government invest £10.8m into contractor GP pay in recognition that last year’s non-agreed pay uplift fell short of the DDRB’s recommendation and the omission of GP practices from Welsh Government’s 22/23 pay enhancements for secondary care doctors.  

Taken at face value, this element of the offer would appear to meet the DDRB recommendation; however, once you dig deeper and take account of insufficient expense uplifts and cost pressures, the intended pay award is wiped out. 

Expenses  

Practice expenses include Salaried GP and staff pay, and all other general business costs (consumables, energy, premises costs). 

Salaried GP and practice staff pay

We support fair pay for all employees, particularly those on lower incomes, having negotiated the concept of Statement of Financial Entitlements (SFE) mandated salaried GP and staff uplifts in past agreements. However, financial underinvestment in recent years means that many practices are in the position of employing a significant number of GMS staff on, or near, National Living Wage rates. We absolutely support a fully funded award that goes over and above National Living Wage increases, but the proposed investment does not meet the costs of the increased rates from April 2024 (9.8%) and also allow for a further uplift of 6% on top.  

Another consequence of the increase in wages for the lowest paid is the knock-on effect on practice pay structures and bandings, which must be increased to maintain a differential recognising additional responsibilities of staff. 

General business expenses

We asked for a sufficient expense award of £8.9m that allowed practices to cover unavoidable practice costs and could realise the DDRBs recommendation for contractor GPs.  

We calculated the investment needed into non-staff expenses just to keep pace with the impact of inflation (at April 2024) was £2.3m. Last year’s non-agreed investment did not account for extraordinarily high inflation and created a shortfall of around £6.6m nationally. We pushed for this to be rectified, but the decision to ignore this compounds the defunding of practices and leads to permanent real terms cuts in GP pay. 

There needs to be a significant increase in the uplift for expenses in order to fully cover the costs of this mandated application, and the consequences on pay banding for all practices staff. This would require an overall investment of £27.2m for staff pay. 

Why does 6% not mean 6% 

On the face of it, the Welsh Government has complied with the DDRB’s recommendation with a 6% pay uplift intended for GPs. However, as outlined above, it is extremely unlikely that GP partners will see any reasonable increase to their pay as a result of this proposal, despite the DDRB explicitly stating that they ‘…expect uplifts to be sufficient for the full value of our recommendations to be reflected in earnings for contractor GPs’ (Para 1.120, p20 of the 2024 report). 

This expense shortfall, given the terms on offer, is £22.2m on a national basis. Independent GP contractors, as business owners, do have a degree of control over how they are paid, yet practice incomes are capped. The only available method of control is to reduce expenses (e.g. reducing staffing levels, staff pay or non-essential service provision). However, certain costs are fixed and ultimately practices must continue to provide GMS services to its patients.  

This offer will inevitably mean practices need to review or reduce their staffing levels.  This will have a detrimental effect on patient care and access to general practice, as practices will have to function with fewer staff. The failure of successive contract rounds to deliver uplifts which delivered real terms pay uplifts led the DDRB to conclude they are ‘not clear that the current arrangements take sufficient account of recent high inflation’ (Para 12, p.2 of the 2024 report).

What does the offer mean for the average practice? 

The proposal will affect each practice differently. Practices will have different list sizes, different numbers of partners and their teams will be structured in different ways with varying approaches to skill mix. The global sum per weighted patient would be approximately £124.73 or around 34p per patient per day. This would also be subject to the usual weighting process applied by NHSW SSP. 

We can however use national workforce data on Admin/Non-clinical staff to illustrate the average impact of the impact of statutory wage increase, which has not been fully funded in the proposal: 

• We estimate that an average practice (8870 patients) would face an increased expense of £15,000 each to pay the increase for national living wage increases even before applying the mandated 6% uplift. 
• The knock-on effect on pay structures by increasing various bands could cost approximately £38,000 for the average practice. 

Without being fully funded, this would significantly erode the intended pay award for GPs and could even put the financial viability of practice finances at risk. Health Boards have received additional funding to accommodate these increases.

Absence of our asks