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Continuity of care at risk in contract

GPs will provide better quality of care under the new contract but continuity of care to patients could be compromised, advisers to the negotiations said last week.

They also predicted that GPs will have to use new computer software which prompts them with advice during consultations if they want to progress through the quality markers.

Professor Martin Roland, director of the National Primary Care Research and Development Centre, told the London conference that quality incentives in the contract would increase computerisation of practices and lead to more GP specialists.

But he added that continuity of care would suffer because practices would have to merge or expand.

'There are risks to the continuity of care and the holistic approach of general practice,' he said.

'There will be more nurses and larger teams and more mergers of practices. Small practices will struggle in that environment.'

His views were echoed by the head of the expert group providing evidence for the quality framework.

Dr Colin Hunter, a GP in Westhill, Aberdeenshire, said many of the quality markers related to chronic disease management and required GPs, nurses and other practice staff all to be involved.

'At the moment the framework is light on indicators for continuity of care but that's because they're very difficult to get an angle on.'

Dr Hunter said updated IT would help continuity by improving record keeping and reliable transfer of information, but it would be a 'big change' to get GPs to record information on computer during a consultation and to accept prompts for advice.

'The clinical software system is to facilitate the collection of the data, as well as clinical support that prompts the GP to do the right thing,' he said.

GPC negotiator Dr Laurence Buckman said GPs would be able to choose whether to use the software or not.

'Some GPs like prompts and some do not,' he said. 'Those who do not like them will turn them off. I certainly will not be using them because I find them annoying.'

Computers will improve quality but care may fragment, an NHS Confederation/RCGP conference in London was told last week

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