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A faulty production line

Are enhanced services really attractive to you?

Will the planned enhanced services improve care for patients, and will they be practical for GPs to provide? Each enhanced service has three key elements: first, the GP provides evidence of relevant competence (accreditation); second, the service is delivered to a defined group of patients according to certain specifications; third, the GP regularly reviews what has been done, generally through undertaking various audits.

Some would claim that the range of enhanced services is too narrow ­ how about enhanced ENT, cardiology or gastroenterology services for selected groups of patients, for example? Perhaps we can hope for additions to the enhanced services scheme before long. The principle of demonstrating competence and providing evidence of performance is also a good one. But the features of enhanced services should also be reviewed in the context of the new contract as a whole.

The new contract goes a long way to solving the weakness of the old one by replacing the tendency to penalise investments to improve quality with rewards for quality, but it will involve GPs in collecting much more information about their work.

The quality framework includes 76 clinical indicators, plus additional organisational and patient indicators. Add to this the information collected for the enhanced services, and the implications for general practice start to look significant. Practices must become efficient collectors and analysers of performance data.

Of course, practice information systems are rapidly improving, and resources, training and support are being made available.

Even with the new data requirements of the new contract, practices will not be collecting as much data as doctors in some other health systems based more or less entirely on fee-for-service or insurance funding schemes, but the data burden will be substantial.

What you make of all this will depend on your view of what motivates people in general, GPs in particular. It is often said money is the best way to get GPs to change clinical practice.

If you take this point of view, the enhanced services scheme will seem reasonable, despite all the data collection that will be needed. If you think things other than money motivate people, then the enhanced services scheme will not be so attractive. I fall into the latter camp. Provided people have enough for their needs, more money will not be sufficient motivation. People need inspiration and enrichment in order to see the value of doing things differently, or of doing more things.

So, enhanced services as they are currently planned will give some encouragement to some GPs who are already motivated to take on the responsibilities of minor surgery, violent patients, intrapartum care, and so forth.

The scheme makes it possible for those who are interested in these activities to undertake them, but it is unlikely to motivate others to become interested.

GPs will need to collect a great deal of data~

Professor Richard Baker argues that it wil be motivation, not money, that will sway GPs over enhanced services

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