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GP contract overhaul ends MPIG and reshapes QOF

By Gareth Iacobucci

The GP contract is to be radically reshaped, with the QOF reduced as a proportion of pay, the square root formula scrapped and moves begun to phase out the MPIG.

GPs will also be handed a raft of new outcome-based QOF targets and will lose payment for the GP Patient Survey under a complex and far-reaching package of changes to the contract.

NHS Employers announced it had agreed with the GPC a fundamental overhaul of the GMS contract, to apply for 2009/10 in England, Scotland, Wales and Northern Ireland.

At the centre of the deal is a new formula for ‘differential uplift' of the various components of the GMS contract.

The global sum, QOF, enhanced services and correction factor payments will be increased in the ratio 7:5:5:2. Locum and seniority payments will be frozen.

But the two sides could not come to an agreement over the overall size of the uplift, to be decided on by the Doctors' and Dentists' Review Body.

The deal spells doom for the controversial QOF square root formula. NHS Employers said in a statement it would be revised to ‘increasingly reflect the prevalence of long-term health conditions among local populations'.

This would ‘help address health inequalities by ensuring proportionately greater funding for practices in areas of high deprivation'.

The agreement will see reallocation of 72 QOF points as part of a refocusing on outcome targets. There will be a new indicator for reducing early cessation of treatment in depression, extra points for drug treatment in heart failure, CKD, diabetes and COPD, and a new indicator for offering choice and advice on contraception.

The GPC had vowed to oppose cuts to MPIG correction factor payments without suitable compensation.

But Barbara Hakin, GMS lead negotiator for NHS Employers, said: ‘We are particularly pleased to have reached agreement in reducing GP reliance on the MPIG. Although it was a disappointment not to have been able to agree an uplift to the contract, I think both sides regard this agreement as fair – and one that brings substantial benefits to patients.'

GPC chair Dr Laurence Buckman said: ‘This helps develop funding in a way that recognises our most needy patients. GPs know the contract needs to be more stable and less dependent on corrective mechanisms.'

Health secretary Alan Johnson said: ‘Today's agreement begins the move towards a fairer funding system for practices, based on the number of patients on a practice's list and the health needs of the local population. It also introduces improvements to the QOF to recognise and reward high-quality patient care and a stronger focus on health outcomes.'

GPC negotiator Dr Peter Holden said there would be a ‘shake-up' of the square root formula and confirmed payment for the patient survey would go.

And he warned GPs to brace themselves for a tough deal: ‘The idea is, whatever the uplift, everybody gets something. But people need to remember whatever happens is bound to be flavoured by the credit crunch.

‘The other thing to stress is the whole thing is a package. Nothing is agreed till everything is agreed.'

Dr Peter Holden, GPC negotiator Dr Peter Holden, GPC negotiator

People need to remember whatever happens is bound to be flavoured by the credit crunch.

Negotiations still to go to the wire between GPC and Government Negotiations still to go to the wire between GPC and Government

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