Half of GPs call for contract renegotiation

Exclusive Nearly half of GPs think that the GP contract needs completely replacing, with many calling for QOF to be scrapped and for practices to be given greater control over out-of-hours services, a Pulse survey has found.

A survey of 309 GPs revealed that 49% believe the 2004 GP contract should be renegotiated as it is ‘out of date’ amid declining income and a growing recruitment crisis.

This year’s negotiations for the 2014/15 GP contract saw the monthly global sum payments rise to £73.56 per patient and a reduction to QOF of nearly 40%, which the GPC said would remove ‘box ticking’.

But respondents to Pulse’s survey, carried out earlier this month, said the negotiations did not go far enough to reduce bureaucracy.

Dr Hadrian Moss, a GP in Kettering, Northamptonshire, said that core services have changed beyond recognition since the 2004 contract was introduced, and should be re-priced to prevent surgeries from failing.

He said: ‘The 2004 contract defined what were core services and what was considered “extra” work that practices could undertake if they had capacity to do so. The situation many practices are in now is that extra work is a necessity in order to survive.’

‘The GP workforce is finite and this model is therefore unsustainable. The future for general practice as patients currently know it is very bleak.’

A report, drawn up jointly by the Nuffield Trust and King’s Fund think tanks in July last year, suggested that NHS England introduce a brand new contract ‘in parallel to the GMS contract’ to incentivise GPs to form networks or larger groups to provide services to improve mental health, elderly care and social care. NHS England said at the time that the report would be ‘helpful’ in forming its longer-term strategy for the NHS under the Call to Action banner, which it is yet to release.

However several survey respondents called on QOF and the ‘waste of time targets’ to be abolished, while others voiced frustration at the DES-related ‘bureaucracy’.

One GP partner wrote: ‘It is no contract at all: it binds GPs but not NHS England. The Government is allowed to change the rules, parameters and income as they see fit and we have no recourse – hardly the contract of independent contractors’

Some cited the need for GPs to have more flexibility in the services they choose to provide, and the ability to reclaim responsibility for out-of-hours services.

One GP locum respondent wrote: ‘The opt-out from 24 hour responsibility has been a disaster (for patients). We need to take it back, but only if it is adequately funded. We also need a contract that stipulates minimum acceptable manpower levels.’

Dr Andrew Thomson, a locum GP from Forfar in Scotland, said: ‘All contracts reach the end of their useful life and this one is rapidly heading in that direction. The 2004 contract was a great step forward, but successive Governments have managed to paint the contract as a tool to deliver additional income to GPs, rather than the true intention of trying to deliver additional resource to GP Practices.

‘I would like to see future GP contracts that have the ability to limit the transfer of un-resourced work around the health service.’

NHS Alliance Chair Dr Michael Dixon told Pulse that it was ‘completely inevitable’ that the GP contract would be scrapped within the next ten years.

Signs that the contract is losing relevance for many GPs are already evident in Devon and Cornwall, he said. Dr Dixon described the recent decision of Somerset practices to ditch QOF completely as ‘the ‘beginning of the waters coming through the floodgates’.

He added: ‘The contract hasn’t kept up with general practice, which has extended its remit. A lot of GPs are looking for simpler contracts, and they’d like more flexibility in terms of what they can do instead of being hemmed in by tick boxes.

‘The absolute priority must be to support practices to take on more and to make it easy for them to do so. I think the local contract is probably the best way.’

But Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, told Pulse that the problems that have affected general practice since 2004 are due to underfunding of the contract, rather than the contract itself.

He said: ‘Inevitably, [the contract] hasn’t delivered in a lot of areas it should have done. It needs some changes, rather than complete renegotiation. In particular, it needs some sustained, targeted investment to increase capacity in general practice.’

‘We have to get the Government to understand that general practice is a solution, not a problem. We’re fed up of being told that we’re to blame for everything, or the contract is to blame.’

Just over a quarter (26%) of respondents to Pulse’s survey said that they thought the contract should not be renegotiated, while the remaining 25% said that they didn’t know.