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LMC writes to GMC with concerns over £95 per patient co-commissioning plans

GP and commissioning leaders have sought advice from the GMC about whether a pioneering local quality scheme would breach the regulator’s standards by financially incentivising GPs to modify their prescribing and referrals.

This week Pulse revealed how Bolton CCG had developed a ‘Bolton Quality Contract’ as part of its plans to co-commission primary care, which will top practice income up to £95 per patient for meeting key ‘quality standards’.

But Bolton LMC has told Pulse they supported the plans, but did have concerns that linking payments to changes in GPs’ practise could bring them into conflict with regulations.

The ‘Bolton Quality Contract’ will see practices’ core funding brought up to £95 per patient in return for meeting a number of ‘quality standards’, including practices agreeing to a transfer of work into general practice where this is ‘clinically appropriate’ and working proactively to anticipate and prevent emergency admissions, NHS Bolton CCG board papers revealed.

Before Christmas, the LMC and CCG wrote to the GMC asking them to evaluate any potential conflicts involved in incentivising practices to cut emergency admissions and manage prescribing.

The GMC had not produced a formal reply as of 2 February, though the CCG said it had had verbal assurance that the conflict was avoided.

But despite this the LMC told Pulse that they could not fully support the scheme without a formal written assurance from the GMC, and had written again asking for a response.

Bolton LMC chair Dr George Ogden told Pulse: ‘The problem we have with the KPIs, particularly on things like A&E attendances and prescribing, the intent of the contract is to reduce inappropriate A&E attendances, and to reduce wasteful prescribing.’

He added: ‘The CCG had quite clearly recognised there was a probity issue there, and had sought advice. They, apparently, had had verbal reassurance that it’s ok. But we haven’t had anything in writing, and standard 80 in the GMC guidance is about not accepting incentives to reduce your prescribing or referral, without clinical evidence. It does kind of sail close to the wind we think.’

‘It’s the unintended consequences issue.’

But Dr Ogden added: ‘It’s that type of issue that we’ve got a concern about. Not the standards themselves… It’s equalising everybody up, instead of levelling down, which is happening nationally. It’s putting £95 per patient in, there are really, really good things, we worked really hard and if we can get this guidance from the GMC through, we think this is a goer.’

Readers' comments (7)

  • Medicine prescribing/optimisation schemes have been in force for a few years now. I wonder why only now CCGs and LMCs are expressing concern.

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  • How much work will be brought into primary care? Before signing up, would be wise to look at hospital tariff costs, estimate how much would be saved, but also estimate how much it will cost primary care. For some services, the proposed £95 per patient may not be enough to cover the costs......back to square one!

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  • Took Early Retirement

    How naive of the LMC. Surely they must know the GMC's raison-d'etre is to issue an unhelpful reply so they can later take proceedings against doctors who "didn't follow their guidance"?

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  • £95 = one hospital OPD appt = One trip to A+E for UTI = 1 Private GP Consultation = 1/2 Private Consultant Appt = 1 yr unlimited GP care.


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  • Levelling up with tons of added work! Does it actually pay the GPs for the extra work embedded? Doubt it

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  • Intent of Bolton contract is good.
    CCG have to balence budget.
    KPIs, 40% of payment, include reduction in total prescribing, and total referrals and total minor a and e attendances and total OOH. While some af the prescribing is wasteful and some of the attendances will be "inappropriate" professionals will need to ensure any reduction in activity is done safely, clinically appropriately and within guidence standard 80 of duties of a doctor. Hence LMC and CCG request for guidence.
    Our practice does not think we can do this for at least two of the standards and so do not expect to achieve the headline payment.

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  • Practices need to be incentivised, especially if significant cost savings can be made on prescribing drugs. Why would a Practice 'switch' medication that saves the NHS 600K and be offered £150 for doing so? I would sooner see real incentives for practices where cost savings are reinvested in resources it does not have to be cash. If our practice was saving 600k I would want 200k to be reinvested in our operating costs which would make a real difference without the need for clinical and patient safety concerns

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