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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)

  • Azeem Majeed

    All methods of funding primary care providers - whether based on capitation, workload or performance - have strengths and limitations which are debated endlessly in health policy journals. Countries that have payment systems based on fee for service also have problems and some are considering changing to give capitation-based funding a bigger role. However, as we have seen in the UK, capitation-based funding also has problems when the payments that primary care providers receive are not sufficient for them to meet all the demands placed on them by their health system.

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  • Payment per task is the way forward. Nhs pays for items bought from pharmacy. We don't have a price per random thousand items from pharma . The technology already exists to make it possible for the payments to be directly proportionate to the work done. We also need to have payments up front so that additional clinical hours can be purchased by the practice without harming cash flow

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  • Contrasting appointments with services given by pharmacists or dentists is not appropriate..they don't generally spend much time 'talking' something which is difficult to cost and would be pretty unacceptable .how would it go.....10mins with person gfeeling suicidal....say £mega dosh on top of ordinary appointment due to saving the nhs potential hospital cost...........ugh it's getting rather grotesque .

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  • This idea was mooted at the LMC conference as a simple maths model and lost.
    The problem as shown was that if patient list size is the criteria it leads to increasing workloads as the population ages with no increase in pay. It was also shown that the fee per consult has halved in 10 years and will continue to fall.
    It leads to MPIG and such bizarre arcane calculations that bankrupt GPs who are still doing 12-13 hours a day seeing 40+ patients.
    The system is clearly broken as GPs are leaving abd recruitment is down.
    The list size system is at fault as proposed at LMC.
    But, sadly, the motion lost.
    Ultimately, we have to move away from an unremitting demand led patient list. Otherwise, there will be no GPs.

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  • ha ha 29/5/14 11.04pm GP partner. You miss the point - you WILL all be salaried GPs..

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  • A good method of recognising workload, but there has to be some recognition for time spent as well as raw numbers. A system based on raw consultation numbers would even more favour your area 1 only , 1 problem per consultation doctor. As a patient, I want to deal with all my problems at once. I hope for enough time to answer my concerns and to understand the logic behind treatments recommended for me. This will improve my compliance and allow me to make the best health decisions. I like to do this for my patients too.--
    Now: what about hourly pay for GPs - what an innovation?

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  • Bob Hodges

    Currently, if my practice were paid 'per 1000 appointment' we'd need a tariff of about £17-20k to maintain out funding. Out of that we'd pay all our costs, pensions and taxes, then take some home at the end.

    We'd spend 45% of the day doing appointments to ear money, then spend 55% of the day doing everything else for free.

    The main danger is that when one starts to put a 'price' on a consultation (the maths is easy) then it makes it painfully obvious that 'the taxpayer' is getting the deal of the century and GPs are being mugged.

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  • We need to increase the percentage of the NHS budget that goes to general practice - anything else is pointless and just shuffling paper. If the total amount of funding remains unchanged this is pointless. Infact it's missing the point and confusing the issue. It's about total funding - not pretending the problem can be fixed by yet another 'clever' reorganisation promoted the latest wizz in the spot light. We need to argue in a clear united voice..'increase the proportion of the NHS budget going to primary care' ..clever ideas to shuffle money from one pot to another might feed the ego of the person proposing it but it's basically empty unless there's more cash...simple

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  • I think many practice could be better organised and even better educated on what practice nurses can and should be doing.

    I find it odd that some GP practices with 5+ GPs have one nurse and some single GPs have 2 yet mine with 3 cannot "afford" a HCA, nor can they "afford" to allow their reception staff to have a lunch break.

    Everyone could benefit, more job satisfaction, respect and motivation if skill mix were better utilised. I work for GPs who do not seem to be interested in my ability to do more, after all, they sent me on the "course" but keep trying to do it all themselves and missing QOF. Well, things I could do like minor illness, chronic disease etc.

    A well trained HCA at around £8 an hour can do half of what your nurse does i.e. smoking cessation, BPs, ECGs, sometimes ear irrigation and flu's, B12's...
    ...then the nurse is freed up at around £18 an hour to do all the GP routine stuff. I have a special interest in mental health and have had more training that most GPs...
    ...then the GPs could have longer appointments to deal with the complicated stuff at how much an hour?

    Include your nurse/s in the team and find out what they are capable of and reorganise instead of staying on the Arc and seeing only GPs as the solution.

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  • i could generate 20 a year for each patient but then my other patients would not see me. as pointed out the difficult ones take long -so we cut the easy to the old spanish or portuguese or chinese style ..
    print rx as talking and out 3 mins

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