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GPs vote down call for change to contract payment system

A motion to move away from the model of funding based on patient list size was voted down by LMC leaders in York today.

The motion called for the introduction of a payment-by-results system, which would pay GPs based on the amount of work they undertake rather than the size of their patient list, but a large majority voted it down.

Dr Jim Kelly from Kent LMC, proposing the motion, said that the current contract was to blame for the current workforce crisis.

He said: ‘This motion forces politicians to accept responsibility for ratcheting up demand. If they promise 48-hour access, they will have to pay for it. At the moment, there is a disconnect between what we get paid, and [what] they promise. They can promise the earth, because it comes back to us. If they promise something they bloody well have to pay for it.’

Dr Richard Vautrey, deputy chair of the GPC, had argued against the motion.

He said: ‘There is no new money, so we will be carving up the existing resources. A payment-by-results system will not deliver what you want to do.

He added: ‘We need more resources to make the core contract work in the way it was intended’.

Motion 50 in full - all parts lost

KENT That conference believes the capitation funding formula for GP services is unfit for purpose and calls upon the GPC to negotiate a Payment by Results based contract because the current system:
(i) fails to resource actual workload
(ii) fails to recognise the ever increasing demand for access, and complex care
(iii) fails to incentivise practices to invest
(iv) exacerbates the current inequity in NHS resources between secondary and primary care
(v) is the biggest single reason for the current recruitment crises.

Readers' comments (9)

  • How short sighted of Dr Vautrey.

    We are suggesting this not just based on current funding but also to safe guard us against continuing rise in work load. To quote the lack of government resources as a reason for voting against this makes no sense at all - is he trying to protect the DoH or us?

    I can now understand why GPC fail us year on year. They are not interested in negotiating to help the grassroots, they seem more interested in not offending the government.

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  • "Turkeys vote for Christmas (again)!"

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  • David Bush

    I cannot see how being paid for the amount of work you undertake can be described as 'payment by results'. The better organised and more efficiently run practices will achieve better results for less work by 'working smarter not harder'. This should be rewarded, not the GP with a massive list who sees patients all day in short appointment slots, with no view to chronic disease management etc.

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  • "This motion forces politicians to accept responsibility for ratcheting up demand. If they promise 48-hour access, they will have to pay for it. "............i am sure the politicians are quaking in their boots! NOT!

    The LMC conference seems to be a talking shop and not enough immediate action. Its not going to be enough for many good GPs walking away.

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  • the term payment by results is wrong but if they mean a tariff like the hospitals work too - i think it is worthy of looking into. I don't want to be paid for each cancer i cure - a result... but a fee for each sore throat, each smear, each palliative care patent. Yes i would hire more doctors and do more work. I might even just open evenings and weekends to pull in more income vs now where every patient through the door is costing me money. risks ?will it bankrupt the system - perhaps but 1. no doubt I'm cheaper than a&e and an admission 2. they will just keep dropping the tariff but that in itself will be interesting as it will be public and i can't see them pricing a visit at 10p. if they do the public will soon realise why they get 10 seconds not a caring sympathetic person.

    i think we should trial it!

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  • A large number if GPs have already voted with their feet and are being paid for the number of hours that they work, or patients seen.
    It called lucuming!
    The real problem will come when there are no GPs left who are prepared to work under the current GMS contract.

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  • GP Locums and Locum agencies demanding such high rates ,there is a very real risk of making yourselves unaffordable to cash strapped practices that your greed will ultimately be your downfall

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  • Drachula

    The GPC does appear to be out of touch here. There does need to be a significant reward for amount of work done, but probably not as a fee per consultation, or that as only part. We do a lot of paper reviews, and this would need funding too - not all work is face to face, and it will become less so.
    Beware, however - we would have to get a LOT better at coding.

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  • Sounds like you want to go back to an items of service payment syetem!!!

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