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Independents' Day

GPs should be paid on proportion of appointments they provide, says Conservative health group

GP practices could be paid for the proportion of appointments they provide per patient, in plans that will be put to Jeremy Hunt by a Conservative health policy forum.

The ideas - developed by senior members of Conservative Health and to be put to the health secretary ‘soon’ - are designed to incentivise practices who offer better access to patients.

Practices who provide additional services such as ECGs and phlebotomy for patients would also be paid more under the proposals.

Dr Paul Charlson, vice-chairman of Conservative Health, and a GP in Yorkshire, revealed the ideas when speaking to Pulse at the Conservative party conference in Manchester.

He told Pulse: Practices who provide good care provide more face to face time with patients. We could pay practices who have higher numbers of appointments for the number of patients on their list.

He added that the system should be reconfigured so that the practices that offer the most services to patients are paid the most.

He said: To earn a lot of money as a GP you can have very few partners and refer all your patients to urgent care centres. What we want is to pay the practices who are doing the work, not the ones that aren’t.

‘For example, if you have a ECG machine and do phlebotomy, you are providing a better service for patients, but it costs you money.

‘No ECG machine and not doing phlebotomy is less convenient for patients, but the practice doesn’t have to pay for it. So incentivising is a solution for gaming. Whatever system you create there’ll be another way to game, but at least this will reward work.’

But Dr Richard Vautrey, deputy chair of the GPC said incentivising higher numbers of appointments would be rejected by GPs as ‘micromanagement’.

He said: ‘I don’t think any more micromanagement of general practice would be welcome- when you start telling practices what they can and can’t do. Saying how many appointments they should offer will not be welcome- they should be trusted to get on with it and be judged by outcomes. There will be differences between practices that will be largely down to historic differences in funding.’

He welcomed the idea of more outpatient work being carried out in primary care, but said it was problematic that ‘the resource isn’t flowing to support that work.’

At the conference yesterday, health secretary Jeremy Hunt also laid out plans for GPs to pilot extended access in the evenings and at weekendssaying that the move would restore the ‘family doctor’.

Dr Charlson said he supported this move as the absence of continuity of care led some patients who could have attended their GP practice to attend A&E.

He said: ‘Hunt also wants to move back to the towards the family GP. The move to practice lists rather than a named GP has made patients anxious. They thought “Who is looking after me?” This and lack of access has made some patients attend A&E inappropriately.’

But one prominent Conservative MP, the GP Dr Sarah Wollaston, disagreed, telling Pulse yesterday that the Government risks ‘over-promising and under-delivering’ with its £50m pilots of extended and weekend GP opening.


Readers' comments (19)

  • There are so many reasons that this would not work that I don't know where to start. This idea has more holes in it than Swiss cheese! Firstly what is an appointment? Does it include telephone triage, extras at the end of the day, emergency or just pre-booked slots? Practices are configured vastly differently according to massive variations in local need. What happens to unfilled slots? Does it matter what time of day they are available? Can we cross cover other GPs patients not on the appointment list? Putting in extra appointments can also cause supply led demand increasing strain on the NHS. Not only this but it provides a perverse incentive not to grow practices as you will be penalized for this until it becomes economical to buy another GP session. In some places GPs simply are not available (it's harder to recruit in the inner city and isolated country), penalizing such practices could prove disastrous to a poorer population. The potential for abuse of such a system is endless and I doubt it would actually improve the care delivered - go back to the drawing board please.

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  • "To earn a lot of money as a GP you can have very few partners and refer all your patients to urgent care centre"

    Before making stupid comments like this he should really check the direct of travel between GP surgeries and Urgent Care Centres - - the whole Darzi notion has failed totally and whilst many have closed we have been left with several white elephant centres on large PFI contracts that we are still paying for.

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  • The proportion of appointments (appointments/patients) would presumably be corrected for list size so payment = cash x (appointments/patients) x patients

    Simplifies to cash *appointments. This would be PBR for practices with payment per appointment.

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  • Or Fee for Service

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  • GP's are paid to care for patients ,if they cannot meet the demand for appointments they should be forced to close their books immediately.
    So many GP's earn extra money by providing other services e.g. 'minor ops' at the expense of appointment slots, because they get paid more for that service.
    They need to decide what their role is and look after the patients on their general register.
    Triage by phone is clearly a barrier to appointments, GP's decide if they want to see patients and often miss crucial symptoms because they cannot see the patient. Every examination starts with a visual check which cannot be done by phone. some folk can't hear well, some have difficulty explaining their symptoms, but as long as GP's can find an excuse not to see you, they think that is fine.
    GP;'s will lose the support of their patients which is why they are in the mess they are in today.
    I no longer care what happens to my GP because he no longer cares about my health. I don't want or need my GP to work 7 days a week, folk that work are entitled to time off to see a doctor and using SKYPE is not a secure environment to discuss personal / sensitive issues.

    I want my GP to look after the patients on its books, to close its books when it cannot meet demand and most of all, to offer me choice re which doctors is allowed to care for me, patient choice is vital. Just because somebody trains as a GP doesn't mean they are trustworthy, so allocating a doctor is just not good enough.

    The BMA needs to do something about the 900 doctors with criminal records, including sexual abuse before they can expect us to trust them all.

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  • It's hard to make sense of the verbal diarrhoea above. If you don't like your GP practice, change. I doubt they'd be sorry to see you leave.

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  • Troll haha.

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  • Obviously a daily mail reader.

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  • Using appointments to decide funding is silly, but instead funding should be based on true items of service billing. That we, we would get paid for what we did. Alternatively, if as the DM readers / trolls would like to believe, we wouldn't earn anything at all. Sounds fair to me.

    The all you can eat £80/yr healthcare buffet has to stop.

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  • Interesting 8:08
    In my local area two practices have tried to do exactly that. NHS England has told one that they cannot close their books and the second is still under review. The truth seems to be that NHS High Command is not keen at all that GPs stop taking on patients, even when the GPs themselves think that it would be the safest thing to do.
    (Anonymous as I don't want to reveal the two practices without their permission)

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