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GPs face twice-yearly contract reviews under new competition drive

GPs face twice-yearly contractual reviews and measures to allow patients to more easily move between practices, under Government plans to kick-start the primary care market.

Ministers have ordered PCTs to impose a raft of new targets on practices and to publish school report-style ‘balanced scorecards' of performance.

Patients will be able to change their GP practice at the push of a button via the internet, if they are unhappy at how their GP has scored.

In a major new phase of the Government's flagship World Class Commissioning strategy, GP practices will face mid-year and end-of-year reviews of performance.

They will be rated on indicators including QOF data, GP patient survey results, prescribing figures and quality of premises, and scorecard data made publicly available.

A Government document, Improving GP Services, was circulated to PCTs last week.

It instructs them to carry out: 'a formal, senior-level accountability review with every practice, assessing performance over previous 12 months', plus a 'formal mid-year review'.

PCTs must draw up 'a balanced scorecard for each primary care provider', with information 'published regularly to all contractors and the public'.

GPs will receive an annual letter from PCTs which 'could include an overall 'traffic light assessment of performance', with ratings published on trusts' websites.

The document also warns that ‘it is difficult for people to move their registration between providers' and reveals plans for a national online registration system: ‘You can help by enabling patients to move their registration online, and the DH is looking at how this might work nationally.'

And the Government calls on PCTs to ramp up competition in primary care with a new wave of APMS procurements.

It says: ‘The APMS contract gives you the flexibility to introduce additional capacity and adapt traditional models of service delivery to local needs and priorities.'

The plans have been unveiled against the backdrop of PCTs performing poorly against the Government's World Class Commissioning targets for stimulating competition in the primary care market, as Pulse revealed in November.

GPs will also be offered incentives to tackle high-priority areas such as CHD, extended opening and improving patient satisfaction.

Dr Laurence Buckman, GPC chair, warned the Government risked ending up ‘with a health service that spends its time searching its soul rather than delivering services to patients'.

He said he was having talks with the DH to ensure 'sensible decisions' were made, warning: ‘Some of the ideas they are very enthusiastic about will not get them what they want – that is more choice and access.'

Dr Buckman also criticised plans for online registration, which he said would discriminate against people without access to computers: 'If we have complete online registration that will wreck the Government's health inequalities agenda.'

A Department of Health spokesperson said: 'The document is about improving the commissioning of GP services and is therefore aimed at PCTs. It describes good practice, and the range of incentives and levers available to PCTs to ensure their GP services meet the needs of their local population.'

Practices will be graded twice a year on a balanced scorecard, based on access, QOF scores and other indicators Practices will be graded twice a year on a balanced scorecard, based on access, QOF scores and other indicators The plans in summary

What are the plans?
The document is aimed at holding PCTs to account for failing to ramp up competition among GP practices and to give patients more choice of services.

Why is the Government releasing it?
PCTs have so far come up short in delivering the DH's ambitious World Class Commissioning agenda. Initial figures from Year 1 show concerns about the strategy in two thirds of trusts, with many particularly deficient in meeting the Government's desire to stimulate competition.

What will the impact be on GPs?
- Practices will face two contractual performance reviews per year, with results to be published on PCT websites.
- They will also have to achieve ratings on balanced scorecards in areas such as QOF data, GP patient survey results, local prescribing data and premises quality.
- Patients will be able to switch practice registration online.
- PCTs will be expected to commission a new wave of APMS services
Source: Improving GP Services, DH

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