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Gerada: Contract changes threaten patient care

Exclusive: The chair of the RCGP has waded into the row over the Government’s proposed contract changes, warning that the QOF is ‘out of control’ and the planned withdrawal of MPIG poses a ‘serious risk to patient care’.

Dr Clare Gerada told Pulse she was concerned that the planned phase-out of MPIG removed an important protection for GP practices ensuring that they would not be allowed to go bust even if their income plummets.

She said that this move was part of a drive to remove barriers to new providers of GP services, such as private companies.

Dr Gerada also said that she was concerned that the QOF was getting ‘out of control’ and was distorting the care that GPs provided, and needed ‘concerted effort’ by the GPC and the RCGP to reverse mission creep.

The intervention marks a watershed for the RCGP, which normally tries to remain impartial over contract negotiations, and comes at a sensitive time, with the BMA preparing its response to the Government’s proposals on how the GP contract should change in 2013/14 published last week.

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Dr Gerada said: ‘The important issue here is [that] the removal of the MPIG means that there is a serious risk of patient care being undermined.

‘MPIG is a device to ensure continuity of GP services by preventing them suddenly going broke. Its removal will have the effect of restoring that risk.

‘I worry that the Government has an agenda that means that it is not protecting GP practices (and NHS hospitals) from going bust. Some say this is because the economic models that they use to justify privatisation insist that there must be minimal entry and exit barriers to the new NHS mixed markets, so that new providers can start providing services with the minimum of formalities.’

‘For new providers to be able to enter the market, old ones have to be able to leave it, and the removal of the MPIG is the removal of such a barrier.’

She added: ‘The practical implications of such a change are significant beyond the GPs who will be driven out of business by it: the replacement providers are likely to be insurance companies or outsourcing companies about whose services quality concerns have already been raised.’

With regards to the QOF, Dr Gerada said on the social networking site Twitter: ‘Few QOF targets are meaningful. They distort care towards what “medicines” can Rx.

‘QOF is risking driving out caring and compassion from our consultations. We need to control it before it gets more out of control - need concerted effort by GPC and RCGP.’

Readers' comments (18)

  • This puts added pressure at the coal face which is already under duress. It is understandable that the government want to get value for money and squeeze GPs but I fear that this will result in challenges to delivering optimal patient care....and perhaps more so where some GPs are used to receiving high earnings.

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  • QOF is totally out of control. I work in an area of deprivation-a number of my patients smoke, drink and pitch up at Casualty too often, they don't follow medical advice, DNA appointments etc etc. How can I make them start acting like some wealthy commuter in leafy Surrey?????????

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  • I work in an area that is generally not deprived. My patients still pitch up at casualty too often, and are also very demanding of services generally. They are very quick to complain eloquently if they do not get what they want - and get it quickly.
    You can't win!!

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  • What is the MPIG situation for Clare Gerada's very large practice - I think we need some openess here.

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  • Drachula

    Go for it Clare. More of this please.
    QOF distorts true patient care for the elderly, the depressed, palliative care, etc.
    Small family practices with high quality care will suffer from loss of MPIG whereas big impersonal high referring practices will be OK. What would you rather?

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  • It is difficult to be clear about the real motive behind this talk when you are a sky high earning " GP " employing over 200 salaried dcotors.

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  • Anon @ 4.13 and 4.38. what seems to be the problem with what Clare's saying? She's in favour of keeping MPIG despite it probably being irrelevant to her personally. What's your point? And why use quotation marks when calling her a GP? She does plenty of clinical work.

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  • Thomas Craig

    Our practice was never on MPIG. It was introduced for high spending practices. Sine it was started to be phased out our practice has benefited enormously. Practices need to become more efficient

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  • Tom Caldwell

    Excellent on Clare and the RCGP for making a stand. I think we need some leadership because lets face it the BMA is achieving nothing. Keep it up Clare I think you are superb.

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  • Practices with smaller list size and lower economy of scales will suffer the most. Maintaining high QOF , reducing admissions, meeting CQC requirements and moreover worrying about financial side.....what else do we need in general practice ..

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