Wales; health boards overspend by £1m on directly managed practices

According to figures obtained by BMA Cymru Wales, health boards in Wales have overspent by in excess of £1m operating directly managed GP practices – with excess costs largely put down to a reliance on locum sessional GPs and salaried GPs

In 2017/18 Betsi Cadwaladr University Health Board, the largest operator of managed practices, overspent by more than £1.3m – increasing from a deficit of £0.24m in 2016/17 – while Hywel Dda University Health Board, the second largest operator, overspent by £1.1m.

The budget for running directly managed practices is based on the cost of running practices under general medical services (GMS); however, the BMA observes that both health board areas relied heavily on locum sessional GPs and salaried GPs – with an average spend of £226,851 per practice in the Betsi Cadwaladr health board area.

BMA Welsh GPs committee chair Charlotte Jones said:

“These figures confirm what we have been saying for some time. The cost of operating directly managed practices is not sustainable.

“BMA Cymru Wales has always been clear that the most cost-effective way of providing primary care services is via the independent contractor model providing GMS services. It is better for patients, providing them with the continuity of care they deserve and provides better value-for-money to health boards and ultimately the taxpayer.

“We know that health boards are actively seeking to return practices to GMS status and this is something we welcome. However, we cannot overlook the fact that there are still practices in Wales who are at risk and are considering or have handed back their contract.

“More needs to be done so that these practices receive the support they need to remain in GMS status.

“We will continue to encourage health boards to support practices, all of whom are facing challenging times across Wales. This would include addressing last-person standing issues through active intervention on premises by taking over or guaranteeing leases, as well as addressing additional challenges and pressures to make partnership an attractive option for GPs now and in the future.”

Hywel Dda said it was reviewing all locum costs and is considering a cap, the BMA reports.

Jill Paterson, director of primary care, community and long-term care, said:

“Wherever possible, we are seeking to return managed practices back to independent status with a GMS contract and the first of these is due to complete in early 2019.”

Betsi Cadwaladr questioned the figures, released under Freedom of Information, claiming that not all relevant data had been included.

Chris Stockport, the health board’s executive director for primary care, said:

“There a number of reimbursements that the health board makes to GP practices such as for staff cover and costs associated with building improvements that were not included in this data for our managed practices, this data will be included in the future.”

Responding to the figures, the Welsh government said:

“While we have not seen the figures referred to, spending on managed practices is in part driven by the use of locums and is not the preferred approach.

“Work continues with health boards to move managed practices back to independent status to ensure a more sustainable solution.”

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