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The waiting game

GPC backs quality payments 'only at consortium level'

By Lilian Anekwe

Exclusive: GP negotiators have drawn clear red lines around the quality premiums paid to GP commissioners, saying they should be awarded at consortium level, and even then, not for reducing referrals or cost-cutting

GPC leaders told Pulse they would not accept any payments that directly linked either GP or practice income to consortia's financial performance, and that any payments should be invested in improvements in patient care.

The comments come after the BMA urged ministers to ditch plans for the incentives in guidance for shadow consortia on ensuring transparency and probity, published last week.

Negotiators said they had 'very serious concerns', about the Government's current proposals for quality premiums – performance-related financial rewards for GP consortia that commission successfully and stay within budget – and warned they ‘may threaten GPs' role as the advocate for the individual patient and their professional duty to place care of the patient as their primary concern'.

Pulse revealed last week that the quality premium had emerged as a key area of debate in the Government's NHS reforms listening exercise led by Professor Steve Field, with the NAPC and NHS Alliance generally in favour of plans to align clinical and financial accountability, but the BMA and RCGP largely opposed.

Dr Laurence Buckman, GPC chair, told Pulse: 'What we are not prepared to do is go along with things that are unethical. I'm most unlikely to refuse to negotiate on something that will make GPs money, but not on something that rewards GPs for budgetary performance.'

'If the health of the population improves – accepting that's something that is difficult to measure – then that should be rewarded but it should not necessarily go to the consortium to be given out to GPs. It should remain at the consortium level or above, to increase the budget and be invested in patient care.'

GPC negotiator Dr Chaand Nagpaul stressed the BMA would be unwilling to accept any compromises around quality premiums, and insisted they had to be dropped in favour of GP-led incentive schemes.

'Many areas have existing schemes that reward quality of referrals via peer-led analysis, rewarding practices for following local clinical pathways and incentivising clinical audits. So it is possible to deliver these schemes in a transparent way.'

'We would hope that the Government would recognise this is a dangerous path. It would not be to their advantage and we are assuming the Government would see the sense of not pursuing schemes that would engender mistrust amongst the public. That would be politically disadvantageous. The risks are so obvious.'

Dr Chaand Nagpaul Potential conflict of interest ‘red flags'

• Where GPs make decisions regarding the care of their patients to influence the quality premium they receive through their consortium
• Where enhanced services are commissioned that could be provided by member practices
• Where LMC officers are also key officials in the consortium
• Where clinical commissioning leaders have
a financial interest in a provider company
• Where GPs may refer their patients to a provider company in which they have a financial interest.

Source: GPC, Ensuring transparency and probity, June 2011

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