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GPs must reduce admissions to receive full funding under voluntary contract

GP practices that fully sign up to NHS England's new voluntary GP contract will see their funding decrease if they fail to reduce admissions.

NHS England board papers today reveal that there will be three levels of sign-up to the 10-15-year contracts, which will allow practices to hold on to their GMS contracts alongside the new contract if they so wish, but will also give the option of becoming fully integrated into a 'multispecialty community provider' - which will provide secondary care services as well.

There will also be a watered down contract for practices working in an alliance to provide certain services.

NHS England said the fully integrated model will include a 'gain/risk share' for acute activity, meaning that funding for the organisations will depend on reducing acute admissions.

The contract will also include a capitation element based on the size of its patient list, and a performance element to replace QOF - as already announced by then Prime Minister David Cameron - and the secondary care equivalent, CQUIN.

The GPC warned that there were risks to practices signing a local time-limited contract.

As previously revealed by Pulse, the contract will also span a much longer time period, from 10-15 years.

Notably the board paper does not mention the seven-day access requirement announced last year by Mr Cameron when he first set out his plans for the contract.

The board paper said: 'The fully integrated contract will be a new simpler hybrid of a standard NHS contract and a contract for primary medical services. It will set national and local service requirements and standards.

'It will last much longer than a normal NHS contract: 10 or 15 years. The contract sum comprises three parts: (i) a whole population budget for the range of services covered; (ii) a new performance element that replaces CQUIN and QOF; and (iii) a gain/risk share for acute activity.'

NHS England's definition of a multispecialty community provider (MCP)

NHS England's board paper says MCPs will 'combine the delivery of primary care and community based health and care services' including 'planning and budgets' while also incorporating 'a much wider range of services and specialists wherever that is the best thing to do'.

Key features of the 'fully integrated' MCP model include:

  • Holding a single whole population budget across the range of services it provides, based on the GP registered list - the MCP covers the sum of the registered lists of the participating practices, plus the specified unregistered population;
  • Built around ‘care hubs’ of integrated teams, each typically serving a community of around 30-50,000 people (but NHS England says that all the 14 MCP vanguards now serve a minimum population of around 100,000);
  • A place-based model of care which serves the whole population, not just an important subset such as people over the age of 65;
  • Operates at at the whole population level, aiming to 'bend the curve of future healthcare demand' by addressing 'the wider determinants of health and tackle inequalities';
  • Builds a 'coherent and effective local network of urgent care' for people with 'self-limiting conditions';
  • Provides 'a broader range of services in the community that are more joined-up between primary, community, social and acute care services, and between physical and mental health' for people 'with ongoing care needs';
  • Delivers an ‘extensive care’ service for 'small groups of patients with very high needs and costs'.
Source: NHS England board paper

NHS England said these models could build from a GP federation or super-partnership, be entirely voluntary, and not mean having to give up the GMS contract.

The board paper said: 'It opens up the prospect of new options for how GPs and other clinicians could relate to the MCP, but will not compel an existing practice to leave the security of its GMS contract in perpetuity.'

Dr Brian Balmer, BMA GP Executive member, said: 'The BMA will be looking at these proposals in detail, but we remain concerned that there are number of risks to GP practices who might sign a local, time limited contract.

'We would prefer that NHS England moves ahead with an MCP that allows different forms of contractual arrangements, so that innovation and flexibility is encouraged, while retaining a registered list based service that has been one of the great strengths of general practice.'

NHS England also announced it would expand its 'vanguard' programme of support for developing MCPs as well as the trust-led Primary and Acute Care System.

The board paper said: 'To accelerate progress and support double running costs, a national New Care Models funding stream will contribute to supporting additional future MCPs and PACS. In 2017/18 we expect to

'This autumn NHS England and NHS Improvement will be inviting applications for national support for future MCPs, PACS and acute care collaborations, linked to the next phase of sustainability and transformation planning.'


Readers' comments (42)

  • Reducing admissions .The implication is we admit patients to hospital who could be managed at home . In our review of referrals to hospital it was found that all people who were kept at home ended up going anyway but were sicker and arguably should have gone sooner .

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  • It sucks.

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  • Took Early Retirement

    Think also the headlines: "My mother was left at home to die by the GP because that way he/she would be PAID more".

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  • It sucks in so many ways. See Paul Cundy's post.

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  • They are paying the price for making the public paranoid and encouraging "see your doctor" for this and that condition.
    Cutting the budget for an increasing population and more elderly patients is not sensible.
    Get real. The system will not work if patients demands are not addressed. Stop blaming everyone else.

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  • No thanks. It will not succeed.

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  • Serious conflict of interest and puts patient at risk. That will be no then

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  • Peter Swinyard

    Conditional contracts like this suck like a Dyson. Michelle and Paul are quite right. This is not the contract that we need. In all honesty - if you reverted to the intent of the 2004 contract AND FUNDED IT PROPERLY and left GPs to organise themselves to provide best care for their patients, politicians would be so surprised at how well we do that they'd claim all the credit for themselves. But the GP slice of the NHS pie has dropped from 11-13% in 2005 to about 5% in the last DoH accounts - figures may be +/- 1-2% but the trend is true - and you cannot go into a BMW garage, want all the bells and whistles on a 5-series and offer the salesman £20000 for a £40000 car. They laugh. So do we. Or cry.

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  • sounds a great idea, because we spend all our day sending patients to hospital just for the fun of it.

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  • Dear everyone

    IF they are looking for a reduction in admissions when you take up a new contract in 2017, then you should all be proactively admitting every case of the sniffles this year.

    I will not be taking up this new contract so am okay.

    That is all.

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