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GPs brush aside bonus slurs and brace for second swine flu wave

As GPs are handed huge task of immunising nine million, profession and national media give contrasting reactions.

By Gareth Iacobucci

As GPs are handed huge task of immunising nine million, profession and national media give contrasting reactions.

Negotiations between GP leaders and the Department of Health normally have more than a touch of Groundhog Day about them.

The result is normally pretty much the same – weeks of talks end with the Government forcing through a deal while portraying GPs as the bad guys.

So the wrangling over swine flu vaccination – one of the biggest challenges the NHS has ever faced – was always likely to prove highly sensitive for general practice.

The Daily Mail and other newspapers circled round the negotiations, eager to write stories about greedy GPs holding out for cash in the face of a national crisis.

But now at last a deal has been done, with GPs handed the huge task of targeting nine million people most at risk from the disease for vaccination, with future practice profits pinned on their success.

GPs, it was revealed last week, will get £5.25 for each does of the vaccine they give to patients – expected to be two doses each, although it could yet be one depending on the results of ongoing clinical trials.

The payments were met with largely negative headlines in the following day's national press, being described as ‘bonuses' that would be a further drain on a cash-strapped NHS.

‘Unbelievable' was the Victor Meldrew-like verdict of one anonymous PCT senior manager in the Health Service Journal.

But in truth the bare figures are part of an intricately complicated deal, designed not only to cover GP costs but protect them from the financial effects of what could be a tsunami of workload.

With individual primary care organisations aiming to vaccinate 2,000 patients a day and with entirely different priority groups to the annual winter flu programme, the task facing practices is immense.

Only if they cope, and cope well, will practices profit.

The biggest concession won by the GPC centres around the hugely controversial GP Patient Survey, conducted by Ipsos MORI, which is estimated to have cost GPs more than £35m in lost income this year.

The Department of Health has agreed that if GPs vaccinate a higher percentage of at-risk patients against swine flu than last year's national average uptake for seasonal flu vaccination (at least three percentage points more), the thresholds for survey questions PE7 and PE8 will be relaxed. The precise figure for last year's uptake is yet to be decided but it will include both over-65s and clinical at-risk groups.

GPC chair Dr Laurence Buckman believes ‘a substantial number of GPs stand to benefit' but only ‘if they do the work'.

‘PE7 and PE8 have been particularly notorious and most GPs feel very annoyed about them,' he says. ‘This is at least an attempt to take away the pressure. If you do as well as you did last year on PE7 and PE8, and you get the vaccination score, then you will do quite well financially.'

But, says Dr Buckman: ‘Our intention in these negotiations was about much more than just money. They have centred on freeing up time.'

The deal shelves plans for any new indicators to be added to the QOF next year, in return for the GPC agreeing that 28 QOF points will be moved to new work in 2011/12 and that it will discuss further changes to the QOF that year.

The Government has also agreed to postpone the collection date for data on childhood immunisations by six weeks to mid-February to allow practices time to carry out the swine flu vaccination programme first.

Discussions are still ongoing over the circumstances under which the QOF could be suspended.

A survey in today's Pulse suggests 71% of GPs believe the GPC struck a good deal, although not all agree.

Dr Helen Walt, a GP in Birmingham, one of the areas hardest hit by the first wave of the disease, says she is not satisfied with the outcome of the negotiations and expects her practice to have to suspend other routine work during the vaccination campaign.

‘The vaccination campaign is a complete travesty,' she claims.

Dr Fay Wilson, a GPC member and also a GP in Birmingham, says it is up to individual GPs to weigh up the pros and cons of the deal. ‘GPs will have to make a judgment,' she says. ‘ It's like any business. If someone says, here's a job we'd like you do and here's the package, if a package stacks up then fine. If it doesn't, you make a decision on that basis.

‘This is not compulsory for practices, so they have to make a business assessment. The GPC is neither recommending it nor not recommending it.'

It appears highly unlikely that many GPs will refuse to take part, with 97% of those responding to Pulse's survey saying they would.

But some big questions remain unanswered.

Dr Gavin Jamie, a GP in Swindon who runs a website devoted to QOF statistics, admits he is unsure how easy it will be to meet the target of increasing vaccination uptake by 3%, given GPs will be targeting different at-risk groups.

Dr Jamie says his practice will be specifically targeting younger at-risk patients in order to guarantee reaching the 3% threshold. ‘We're going to be sending out an awful lot more reminder letters,' he says.

Yet much depends on the support being given to GPs by their local PCOs, something our survey shows many GPs have little faith in.

Only 44% believe their PCO is sufficiently prepared for the second wave, which appeared to be beginning this week. And for those PCOs who were most advanced in their planning, it is now back to the drawing board.

NHS Barking and Dagenham had planned to offer local practices a LES for vaccinating at-risk patients, having already got 20 practices on board.

‘It's now a national price, so we will fall into line with that,' says a trust spokesperson.

GPC deputy chair Dr Richard Vautrey says the task facing GPs is ‘going to be difficult'. Take-up from the different priority groups, he says, is going to be hard to predict and much will depend on GPs getting the right support from the Government and their PCOs.

‘It's achievable, but it's going to be difficult. It all depends on the publicity. If there is a media campaign to undermine the programme or suggest it is not safe, that's going to reduce those who come forward. If there is strong publicity that this is a sensible public health measure, we will see patients coming forward in line with seasonal flu immunisation.'

For all the negative headlines, most GPs will be looking ahead to the next few weeks with an uneasy sense of entering into the unknown. They certainly won't be rubbing their hands thinking about how much money they could earn.

And with one Northamptonshire GP telling Pulse she had been told to get the latest advice on swine flu by tuning in to Panorama, this is likely to be a story with many more twists and drama to come.

The swine flu vaccination deal

• GP practices will be paid £5.25 for each of the expected two doses of the vaccine
• Practices will be granted a drop in the thresholds of the patient survey if they vaccinate a minimum of 3% more at-risk swine flu patients compared with the 2008/9 UK average uptake of seasonal flu vaccine. This will be a 10% drop in the upper and 20% drop in the lower thresholds of QOF indicators PE7 and PE8.
• The collection date for data on childhood immunisations has been postponed by six weeks to mid-February to give practices time to carry out vaccinations.
• LES funding will not be used to fund the programme.
• No changes will be made to the QOF. In return the GPC will agree to release the 28 points identified by NICE for recycling in 2011/12. New areas recommended by NICE for the QOF will be piloted from 2011.


Why was the deal not done as a straight payment?

The GPC says a payment like the £7.51 for seasonal flu would only have solved financial, not workload issues. It says concessions on access, QOF, and childhood vaccinations present ‘significant value'.

Will GPs who lost out on PE7 and PE8 in this year's patient survey be better off under this deal?

GP leaders claim a large proportion of GPs will be better off financially than they were after this year's patient survey, providing they meet the target of vaccinating 3% more than the national average uptake for seasonal flu vaccination last year.

Will swine flu vaccination be carried out at the same time as seasonal flu vaccination?

The Department of Health insists seasonal flu vaccine will go ahead as planned this month, despite concerns over possible delays. The DH says it will be up to practices to decide how to vaccinate patients.

Will PCOs who offered LESs to practices be able to proceed with existing arrangements?

No. All PCOs will now be expected to fall in line with national arrangements by offering the new terms under a DES. As a result, LES funding will not be used to pay for the programme.

GPs are bracing for the swine flu second wave GPs are bracing for the swine flu second wave

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