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The waiting game

GPC 'looking into' including payment by activity in contract negotiations

Exclusive The GPC has said that it is looking in to moving away from GP practices being paid according to capitation in the run up to contract negotiations for 2016/17.

Chair Dr Chaand Nagpaul told Pulse that the GPC were looking into the motion from the LMCs Conference that said the current payment system was ‘not fit for purpose’, and should be replaced by a ‘payment by activity’ contract.

However, he also warned about problems with such an approach, echoing the GPC’s opposition to the motion at the LMCs Conference.

Pulse can also reveal that changes to the Carr Hill formula - which determines how much each practice receives from the global sum, taking into account factors such as patient demographic - will not be made for the 2016/17 contract, despite previous suggestions they will be introduced next year.

Dr Nagpaul said that contract negotiations have been delayed this year, because NHS England has yet to finalise its mandate to NHS Employers, who negotiate on their behalf.

However, he added that GPC’s preparations for the negotiations have included discussions around payment by activity.

Dr Nagpaul said: ‘This motion has not been forgotten and it is part of something we are looking at now. What I said at the LMCs conference is that this is a very complex area and we have to be mindful also of the fact that the payment mechanism in secondary care is actually moving away from payment by result into other arrangements including capitation budgets.’

Changes to the Carr Hill formula had been mooted earlier this year, with NHS England and GPC involved in a review, which is being led by Tower Hamlets GPs, who told Pulse they expected changes to be announced in autumn.

But GP leaders have said that there will be no changes to the Carr Hill GP funding formula, which have been under consideration since 2007.

GPC deputy chair Dr Richard Vautrey told Pulse that the review group, which includes BMA representation, would report in time for the 2017/18 contract negotiations at the earliest.

He said: ‘We don’t expect the work to be done quickly. This is a big and complex project and if it is to be done properly then it needs the necessary time to do it.’

The advice comes as the GPC and the Government have not even begun negotiating the 2016/17 GP contract yet, because NHS England has yet to finalise its mandate to NHS Employers. Although commonly begun earlier in the summer, discussions are now expected to start later this month.

An NHS England spokesperson said: ‘NHS England is committed to reviewing the Carr-Hill formula which underpins the capitation payments made to GP practices under the General Medical Services (GMS) contract.  This commitment was confirmed in the wider New Deal for General Practice, which was set out in our Five Year Forward View.

‘We are working with the BMA’s General Practitioners Committee, NHS Employers, the Department of Health and academic partners on the review to develop a formula that better reflects the factors that drive workload, such as age or deprivation.  This work continues and we will communicate further in due course.’

Meanwhile it was revealed last week that GPs will be lured away from the national GP contract to join NHS England’s new models of care via simpler and more attractive conditions potentially undermining the contract and the GPC’s negotiating position.


Readers' comments (25)

  • We can be certain that the NHS is not going to leave an open check book with x pounds per appointment. They are not idiots. Just imagine how profitable our flu jab day would be - 1000 'appointments' in one day.

    If something comes it, it will only be as a tool to make our life more miserable. Think maximum budget remaining the same, duties remaining the same, but access to that max budget only achieved at 10 pounds per appointment. If you exceed your budget you do not get any extra. If you do not match your budget your income is reduced accordingly.

    The only benefit might be that a GP surgery who has used up all their paid appointments can argue their case if they are criticised for not offering enough appointments any more.

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  • How little brain do you need to work out the perverse incentives here..?

    Yay, pay GPs more to do lots of unnecessary follow up acts, and sod the access.

    One of the many reasons the NHS is such an efficient health care service (and on an international basis, it is), is precisely because it is paid by capitation. We have an incentive NOT to follow people up unnecessarily, and have plenty of other bureaucratic ways and incentives to make sure we do all the stuff we should be doing.

    Payment by activity will cost more and waste more.

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  • It would be better to keep the capitation fee but increase it to what is needed to retain and recruit GPs.

    We need to have confidence that we will not go bankrupt while working our socks off. We need the Government to stop trashing our reputation.

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  • Perhaps we should examine something like the Australian system. Don't trash the GPC at this stage who were opposed to item of service payment anyway. Back in the 70's I thought Maternity Medical Services claims was a very satisfactory system( by way of illustration.)

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  • don't think we should go the way of oz and Canada where itemized billing per patient but proportional funding to the volume of patients seen and cut all the beaurocracy. system needs funding better doesn't matter how. I work in Canada and don't follow up people unnecessarily. no reason to do in the uk as already bnusy enough so strange suggestion.

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  • I left UK to work in Canada. I've never been happier. Long gone are the home visits and never ending requests and phone calls. My on calls used to be he'll back in the uk, sometimes phoning 70 patients in a morning and seeing many more face to face with a few home visits thrown in for good measure, not mentioning repeat prescriptions and admin letters etc. patients here value my time, if they don't and for example DNA I charge them. They know exactly what each provincial government will cover - clinic visits, A& E attendances etc, and they also know what they will have to pay for - phone prescriptions, sick notes, twimc letters for work, insurance Medicals etc. I've only once in 3 years seen a patient turn up because they've lost their medications as we'll and I've seen the look of pain in their eyes when it's happened because the replacement asthma inhaler is going to cost them 100 dollars, hence they tend to look after their drugs much more, unlike in England where they pay a subsidized fee for their medications/ fixed prescription fee per item.
    Do I think is system is perfect...... No. I admit that I think patients have a better overall service in the uk, however out here I feel like a human being, a professional and not a burnt out rat on a running wheel. Another few years in England and I probably would have gone mad in my mid thirties as a Gp partner. There are many things in the uk to be proud of that their implementing out here too, but as far as I can tell, a capitation based system with ever increasing workload without adequate additional remuneration certainly isn't one of them.

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  • my locum agency gives some lessons in GPs dress sense…and your make up is so tacky.

    old haggards in a baby dress….we can secure a good job for you …if you have a lovely figure

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  • Took Early Retirement

    "This motion has not been forgotten". No it's the one on top of he bucket of faeces the government and their poodles in the BMA will tell GPs to eat next year.

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  • Just as everywhere else in the health service is looking at capitated funding....part of the problem in capitated funding in GP is that it is too little and too open the rest of the NHS capitated funding is for fixed delivery outcomes

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