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LMCs vote down proposals for GP payment by patient contacts

LMCs from across the UK have voted down a proposal for bringing in charges for the number of patient contacts alongside list size after it was suggested the controversial measure would encourage ’quantity over quality.’

Delegates at the LMCs Conference in Belfast heard today that radical change was needed to better support GPs as payment made through the contract does not reflect the number of times a patient visits a practice. 

However, following a heated debate, the motion was voted down by the majority of GPs. 

Proposing the motion, Dr Thomas Kinloch from Mid Mersey LMC said: ’Our contract is a complicated beast. Although the global sum is paid monthly, its value is only adjusted quarterly based on the number of patients registered at the start of the quarter. Patients who registered after the start of the quarter and leave before the end of the quarter are not attracting payment.

’That’s supposed to be fine because the global sum is supposed to average itself out: payments for patients who join during the quarter balance payments for patients who leave and payment for patients who see us daily are balanced by payments for patients who see us rarely. However, some patients have far more than average needs.

He added: ’Patients at end of life require the most intense and personal input. It’s fundamentally unfair on an overstretched GP workforce to expect such patients, who are righty at no fault of their own, to be managed without adequate resources. A system which resources practices for patients who both register and die in the same quarter perhaps through quarters global sum payment would surely support both practices and patients.’

Opposing the motion, Dr Remi Eliad from Hertfordshire LMC said: ’The payment per contact will encourage repeat attendances […] and arrangements for reviews and repeat rather than encouraging holistic and robust management plans.

’This approach of counting numbers will result in resources going towards quantity rather than quality.'

LMCs voted against the first part of the motion but supported the second part. 

Motion in full 

That conference demands that payments in any GP contract should:

(i) reflect numbers of patient contacts undertaken as well as size list - LOST

(ii) ensure that ractices receive payment for registered patients who die before the end of a quarter - PASSED

Readers' comments (5)

  • So the current system encourages quality and holistic practice.Now how many sessions do thes jokers do again.

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  • Took Early Retirement

    Stupid. When you go to the checkout at Tesco, you pay for the items in the basket. Systems like that work in Germany and large parts of Australia I believe.

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  • When will so called leaders will face reality. Are they representing GP or DOH ? Whose side they are on ?.
    So even after average number of visits per patient has gone up from 3 to 6 in last 10 years but has Global sum hasn't doubled in last 10 years. And our LMC representatives are ok with that. Who are they representing?

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  • Hospitals aren’t on the whole funded by a global sum anymore. GP’s are. So unsurprisingly there has been a shift of work from secondary care to primary care of the less profitable work. Fewer follow ups. If patients need to be seen again they will need a new referral and that comes with a bigger fee for the hospitals. The Commissioners haven’t felt the need to pay the GPs any more. It doesn’t seem that the LMC wants GPs to be paid for increased intensity of work, the increased contacts. More work that was done historically by secondary care is happening in primary care and the population is getting older and has more health needs. GPs need to be paid for the actual work they do it seems rather than counting the living and the dead on their registers. Having fee for service like the Australian system would threaten the profitability of many practices. If there is no list then people can go wherever and see whomever they choose. New players can enter the market if you don’t need an nhs contract. You just need a provider number and be registered as a practitioner and you can set up shop wherever you want like in Australia. Whether it would work all comes down to the items of service that the government would pay for and that the reimbursement values of those services. Could be as hard as brexit.

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  • Well said, Hard Brexit can solve all the issues 🇬🇧Believe. Let’s take back control !

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