We must consider the implications of Government welfare cuts on GPs
GPs often find themselves between a rock and a hard place when it comes to financial planning, with unforeseen challenges throwing them off course and stretching out their already tight budgets. But it's also an experience our Chancellor knows all too well.
When Rachel Reeves stepped up to deliver her Spring Statement at the end of March, we already had a solid idea of what she would say.
With her fiscal headroom eroded by £4 billion and global economic shifts continuing to threaten the public purse, the Chancellor committed to wiping £6.4 billion off the health and disability benefits bill by 2029/30.
A restructuring of the benefits assessment process also fell under the Government’s plans. The work capability assessment was set to be scrapped, and assessments for health-related Universal Credit and Personal Independence Payments to be rolled into one to streamline the system.
The UK’s welfare and health systems are undeniably linked, so it’s reasonable to assume these changes will impact the NHS. The Government was quick to assure GPs that their workload wouldn’t go up – but I’m not so sure.
That’s partly because reassessments for anyone receiving incapacity benefits are now mandatory. It’s not much of a leap to conclude that this will pile onto GPs’ workload. Upping the frequency of assessments will inevitably increase the demand for GPs to provide medical evidence, and that means one thing: more people will need more appointments.
And it doesn’t stop there. With a tightening of the eligibility criteria, those previously signed off sick, who will no longer receive payments, will be keen to get back to full health and work faster. A surge in demand for GPs’ services is all but inevitable.
Of course, this is all happening against the backdrop of Wes Streeting’s primary care push. The Government has set about driving more care into communities and away from hospitals, taking a more preventative approach to the nation’s healthcare. While this is a sound approach, it means that GPs were already facing growing workloads even before the welfare cuts were announced.
It's true that the Government has taken steps to help practices cope. As February drew to a close, the Government and the BMA agreed on reforms to the GP contract for the first time in four years. It contained funding uplifts and an easing of bureaucratic targets and complicated financial schemes – all positive steps in the right direction.
The trouble is that the details of these contracts will only evolve over the next four years. In theory, practices now have more money to deliver more services, but the Government is fond of moving the goalposts. When it comes to providing clarity and access to funding as new updates are unveiled, practices have been repeatedly let down.
Whether it’s miscalculations, last-minute financial updates, or complex conditions on accessing funding – you name it, GPs have seen it.
Just last year, the Government announced they would fund a 6% pay uplift for all practice staff, but when calculating the funding to cover the costs, it made serious errors. The funding was calculated assuming that staff costs accounted for 40-45% of a practice’s income when the reality is nearer 60%, so the money received was far lower than it should have been. Ultimately, partners were left scrambling to make up the excess.
That is just one example of a previous funding headache, but there are too many to count. GPs are constantly firefighting.
Financial planning is made even tougher by the fact that money for general practice flows through an incredibly complicated system with far too many layers. We have the recently-axed NHS England to consider, Integrated Care Boards, Primary Care Networks, and the actual practices themselves.
So, you see, money has to move through countless bodies to reach GP partners. At every twist and turn, access to funding becomes more complex, complicating matters even further.
While the new contract means that, theoretically at least, GPs have more money to play with, it’s safe to say that, in practice, they’re not in for an easy ride.
No matter what commitments the Government makes, there’s no doubt that welfare cuts will drive up demand for practices. The ever-evolving and ever-more complicated nature of primary care funding means planning for that surge remains a challenge.
What GPs really need is for politicians to be honest with them, provide the funding they need to tackle the increase in workload, and reduce the bureaucratic hoops they have to jump through to access funding. Without tackling these challenges, the welfare budget slash could have severe implications for the UK’s primary care sector.
Katie Collin is a partner at Ramsay Brown LLP, a specialist medical accountancy firm providing tax and accounting services for the UK’s medical sector. Since joining the firm in 2017, Collin has provided invaluable technical and strategic advice, particularly to professionals across the UK’s Primary Care Networks – and consistently deals with complex issues such as superannuation, financial analysis, and restructuring for healthcare professionals. Collin has previously campaigned against the unfair reporting of GPs salaries and is an advocate for an overhaul of the pension processing system.
