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Gold, incentives and meh


A major report on the state of the NHS in Northern Ireland calls for an overhaul of the GMS contract to ensure it gives value for money ­ Ian Cameron reports

The new GMS contract 'has been a significant cost with little benefit in patient outcomes or GP morale', a major report on the NHS in Northern Ireland concludes.

The report said the contract did not offer value for money and should be overhauled to include tougher quality targets for GPs.

Author Professor John Appleby, who was commissioned by the Department of Health, Social Services and Public Safety, said the fact that GPs achieved 90-95 per cent of quality points begged the question whether 'the bar was set too low'.

He said: 'It is not clear if the better-than-expected performance reflects an improvement in quality or targets were insufficiently challenging.'

The Appleby review, the equivalent of the Wanless report on the NHS in England, identified a host of problems in the province. Professor Appleby, chief economist at the King's Fund, highlighted a lack of primary care integration.

GPs felt their 'critical role' was 'not appreciated' by the DHSSPS, but were themselves unaware of how other health professionals could help them improve their service, he said.

Average practice lists in Northern Ireland are smaller, yet the consultation rate is higher than the rest of the UK.

Prescribing costs are also higher ­ only 41 per cent of scripts dispensed for generics against 55 per cent in England.

Waiting lists, the highest in Europe, may have arisen from inefficiencies in the NHS rather than shortages and could be overcome by introducing practice-based commissioning, the report found.

Professor Appleby said improvements in health outcomes would come under further pressure without significant extra investment, and called for spending to be increased from £2.7 billion now to £6 billion by 2022.

GPs welcomed the overall conclusions but said the verdict on the contract was premature.

Dr Brian Dunn, GPC Northern Ireland chair, said: 'It was the Government who wanted to put new money into quality. The GPC would have been happier for it to go into global sums as there was no guarantee GPs would earn as much as they have.'

Dr Olive Buckley, a GP in Carrickfergus, Co. Antrim, said: 'Chronic disease management has definitely improved.'

The Appleby report's findings

·Health of the Northern Ireland population is lower and health utilisation substantially higher

·Massive inefficiencies in existing spending strategies

·Doubling of resources needed over next 20 years

·New GMS contract should be examined to ensure it gives value for money

·GPs' prescribing costs higher per head; more generic prescribing should be encouraged

·New strategy needed to reduce waiting times, including greater recognition of GPs' role

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