The government will increase funding for general practice in England – known as the global sum – by 7.4% to fund pay rises for employed practice pharmacists and other practice staff.

But concerns have been raised around whether this will be enough to fund the 6% rise recommended, and over a shortfall of funding for pay rises for those employed through the Additional Roles Reimbursement Scheme (ARRS).

An internal letter from the British Medical Association (BMA) to its GP Committee (GPC) members in England, seen by our sister title Pulse, said the ‘aggregate’ rise to the global sum will incorporate a 2.7% uplift already awarded in April.

However, it warned that the 7.4% increase, while above current inflation, did not meet the BMA's aim of an uplift 'that restores real-terms GP Contract income to 2018/19 levels', which the GPC estimated would have required a 10.7% uplift.

Last month, the government accepted the recommendations of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), confirming that there will be a 6% increase ‘to the salary scales, pay ranges and the pay element of contracts’ for GP partners, salaried GPs, and practice staff.

NHS England later said that the uplift to the global sum is calculated to cover all practice staff, and they therefore ‘firmly expect’ GP partners to award the full 6% pay rise to practice staff.

The BMA’s letter emphasised that the DDRB only covers doctors and dentists, and that ‘staff pay is a matter for employers as Independent Contractors’, regardless of the government’s ‘expectation’ for partners to honour the uplift.

It said, however, that partners ‘will want to reward staff’ during a ‘challenging time’ for general practice, and that many practice staff, and national organisations such as the Royal College of Nursing, ‘use the annual DDRB Award as a benchmark’.

Dr Graham Stretch, a pharmacist partner in a GP surgery, and president of the Primary Care Pharmacy Association (PCPA), said the new funding – which translates to an increase of £7.77 per weighted patient – would mean that the money would not be distributed equally to every GP employer.

'Some practices will win, and some will lose,' he said.

Dr Stretch added that as the PCPA president, he would want to see pharmacists appropriately renumerated for the hard work and value they contribute to practices, while acknowledging the difficult financial position that GP employers were in.

In its letter to GPC England members, the BMA reiterated that the uplift was ‘capitation-based, dependent upon the size of a practice’s weighted registered list’.

‘It is not calculated based upon the actual staff salary costs of any practice,’ the letter added.

‘Staff expenses may have a general link to practice list size, as larger practices tend to have more staff, but practice staffing costs are more dependent on the clinical and administrative composition of staff, their seniority, their qualifications and expertise, and, of course, any recruitment constraints that may exist locally. Wage costs also include on-costs.’

And Dr Stretch suggested that some practices would be more able to pass the uplift on to staff than others, because practices, like community pharmacy contractors, were in a deficit regarding their core contract.

'It's analogous to the pharmacy situation: by adding extra payments for extra services, without addressing the core contract, you're always in position of doing more work to try and claim [income] just to balance the books,' he explained.

The letter also highlighted funding discrepancies for ARRS staff – employed on a scheme which primary care networks (PCNs) can use to reimburse the salaries of some staff, including pharmacists and pharmacy technicians.

The BMA said that for ‘ARRS staff on AfC contracts these are normally reimbursed in line with AfC salary scales’ – which this year has been uplifted by 5.5%.

In April, the total funding uplift to GP contract investment was based on a ‘planning assumption of 2% pay growth uplift to the overall ARRS’.

As such, the GPCE has said that ARRS staff would be entitled to an additional 3.5% on top of this 2%.

‘At present, the extra 3.5% will therefore be an unfunded cost pressure for the overall PCN ARRS budget,’ the letter added.

Last year, reimbursements under the ARRS were uplifted to match the AfC pay increase of 5%, but there was no overall change to the total funding available.

Dr Stretch added that he was keen to ensure that the recent move to add GPs to ARRS did not impact on existing ARRS roles, including pharmacists.

The uplift to the GP global sum comes as GP teams across England have begun 'working to rule' as part of collective action initiated by the BMA.

Dr Stretch emphasised that pharmacists working in general practice should not work beyond their individual competencies amid collective action by GPs, and advised pharmacists to follow advice given by their unions.

Aspects of this article first appeared in our sister title Pulse