·Ensure fair allocation of resources to primary care ·Devise a better career structure and pathway for GPs ·Revise the quality and outcomes framework
·Devise a better career structure and pathway for GPs
·Revise the quality and outcomes framework
As the NHS Confederation and the BMA begin to see the effect of their objectives regarding the new contract, it is timely to give some thought to where the next agreement might take general practice and primary care. The best place to start would seem to be where we left off: by addressing those objectives we failed to address totally in the current deal. I would identify four.
One: equity of resource allocation to primary care. We wanted to create a level and fair allocation of resources to practices in order to introduce incentive payments for achieving high-quality and positive health outcomes. Our position was clear. If practices were to be rewarded for quality, then they needed to have equitable resources to deploy as determined by a formula linked to patient need and workload. Despite a significant move in this direction, we underestimated the need to protect incomes during this shift of resources. Also, by introducing MPIG, we have unwittingly tolerated a situation where, at its extreme, some practices with equal patient need still have up to twice the resources. This cannot be right and we should move to correct this next time.
Two: a better career structure and pathway for GPs and primary care health professionals. Again, we did make a start here and the introduction of sabbaticals alongside developing incentives through enhanced service contracts for some specialisation of skills will start to make some impact. But clearly more can and should be done. As demands change rapidly from both the consumers and the technologists, creating space for continued learning, refreshment and respite are crucial for maintaining a healthy and committed workforce.
Three: revision of Q&O. We have already created a mechanism for updating the framework in line with the best available evidence but I would like to see further changes, and fundamental ones too. My intention would be to ensure the framework reflected the full range of problems presenting to primary care. There are two groups in
particular I would like to see covered, patients with depressive illness and patients requiring holistic personalised care who get so much from primary care yet whose care has little coverage in the research evidence.
Four: a greater emphasis on primary prevention and public health. In line with the forthcoming white paper, I would like to see incentives for practices to build genuine partnerships with patients and their communities. In doing so we should establish and reward better facilitation and education skills in primary health care teams to enable patients to change unhealthy lifestyles and create community- and patient-led group support.
In my view all of these changes could be introduced without fundamentally affecting the structure and principles of the existing contract.
As to the more radical agenda, I believe it lies in the structure and ownership of primary care provision.
It is clear that more health care will be delivered in the primary care sector and that the Government believes further contestability and the introduction of payments by results in this sector will incentivise higher quality.
In part I agree with this sentiment and support increased contestability with encouragement for new market entrants to the sector, particularly in areas where the volume and complexity of the workload has been unattractive for traditional general practice.
In summary, my desire is to build on the best that we currently have, such as single patient registration and the development of comprehensive disease registers. The plan then would be to add new incentives for primary prevention, tackling lifestyles as well as diseases, and greater reward for expanded, enhanced primary care services.
Mike Farrar is ex-chair of the NHS Confederation contract negotiating team