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GPs should be paid per 1,000 consultations, says Gerada

GP practices should be paid based on the number of patient consultations rather than the number of registered patients, former RCGP chair Professor Clare Gerada has said.

Professor Gerada, who now advises NHS England on its London primary care strategy, said the current contractual model has failed to recognise the increase in consultation rates and needs to change.

Speaking to Pulse, she said: ‘I think the problem we have got at the moment is that we are paid per patients and I think we should maybe look at a different formula and be paid per consultation – or per thousands of consultations, or paid something that takes into account that the consultation work has doubled in [recent] years.’

‘I think it would be much more honest if we were paid by consultation rates than by numbers on our lists because I think what is going on at the moment is that there is no account being taken whatsoever for the increased consultation rate, which has doubled, and we just can’t keep absorbing all of this work.’

Her suggestion comes after delegates at the LMCs Conference voted against a motion suggesting a move to a payment-by-results system only last week.

But Professor Gerada said the ‘desperate’ times meant the profession has to explore contracting options.

She said: ‘My morning surgery, sometimes I just don’t know where to start. We need to completely re-look at the ways that GPs are remunerated. We need to open up a debate… about whether the way that GPs are contracted is the right way. It has served us well, but things are so desperate now that I think we have got to look at all options.’

Last year, while still in her RCGP role, Professor Gerada caused a debate within the profession with her suggestion that all GPs should become salaried.

The RCGP’s 2022 GP evidence pack published last year claimed GP consultation rates increased from three to six per patient over the last decade.

Readers' comments (54)

  • Absolutely, there needs to be a change! What that is, we need to look at all options.
    Payment per consultation/per 1,000 consultations is one idea, but also need to look at caveats - what is the limit in terms of number of problems per consultation (some come in with 3-5 problems, which is unfair on the GP trying to deal with this), how many medical problems is it safe to manage in one consultation, how long should a consultation be etc?

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  • Vinci Ho

    Please give a quotation at what rate/price GPs should be paid per 1000 consultation . Otherwise , the debate will be meaningless....:.:

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  • I have always felt that we should be paid by consultation as that is the bread and butter of gp land. We cannot always show a result when a patient comes in for counselling,advice or just a chat. If we are paid for the time spent consulting then that works. Why not be paid per consultation and allow so May consultations per patient?

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  • Fantastic idea, implement asap

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  • Sadly if it makes sense it is destined not to be considered appropriate by any politician. Grrrrrrr

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  • Great idea. Cure GP access problems overnight. Grant GPs licence to print money. Just employ more salaried doctors and make them pay for themselves by offering loads of appts.
    You haven't thought this through Dr Gerada.

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  • Excellent idea. Hospital services and Dentists are already paid like this. It is the only way to prevent unfunded work being pushed into primary care. The devil will be in the details e.g £3 per consultation will not win support. The ability to pick and choose whether to provide this on the NHS or privately, as Dentists do, would also help

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  • Took Early Retirement

    Clare is spot-on, IMHO, as she so often is. I agree, it COULD be open to abuse. Difficult one to sort out. I suppose it could be implemented and then CQC could be made to do something useful, like look at outliers. I bet the government would be very unhappy when they have to start paying for currently unfunded consultations, like the "GANFYD".

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  • I think systems could be put in place to stop gaming - such as ceiling to rate or rates adjusted for deprivation & complexity. But the current system is not fair to GPs who are reeling under the work.

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  • Dr Gerada, this is by far and away your best idea yet. Fundamentally no business model can endure without some relationship between work done and resources gained. I'd have thought it would be fairly straightforward to construct barriers to excessive claims and promote productivity, perhaps we have finally found a role for Monitor? This model would also translate very well to the private sector that the government seem so obsessed with so everyone is a winner!

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