NHS managers call for new GP contract

By Gareth Iacobucci

NHS bosses have called for the GP contract to be torn up and rewritten to include tougher contractual levers for dealing with poor performers, and incentives for GPs to work in federations.

The NHS Confederation also wants GPs to be offered incentives for taking greater responsibility for out-of-hours care, aligning them closely with the Conservatives.

The radical proposals are contained in Rising to the challenge, a new report outlining steps required to safeguard the health service against looming cuts.

In it, the NHS Confederation says: ‘We believe a new GP contract is needed to support reform, better integration and greater choice of GP.'

‘Specifically, it should include strengthening contractual levers to deal with poor or unresponsive services, creating incentives for practices to work federally and rewards for increased scale, allowing for much more effective integration with social, community and specialist care.'

Other suggestions include removing the MPIG, reviewing seniority payments, allowing greater local flexibility to negotiate GP contracts, and using practice accreditation as a basis for rewarding disease management expertise.

The report also calls on trusts to make ‘difficult commissioning decisions' to eradicate spending variations that have arisen from the Government's drive to increase capacity, which it blames for increasing demand from patients.

This appears to pave the way for more services to be de-commissioned, just days after Pulse revealed that one of the Government's flagship first-generation walk-in centres is to close after it was judged not to be delivering value for money.

‘There is much that NHS organisations can do to improve services and make efficiency savings,' it says. ‘Increased capacity at A&E and walk-in centres has led to increased utilisation of services.'

NHS Confederation chief executive Steve Barnett said: ‘The NHS has to play its part in rising to these challenges - both clinicians and managers need to focus, among other things, on rooting out inefficiencies in the system, reducing costs and redesigning services.'

Dr Sabby Kant, a GP in Northwood, Middlesex said it was realistic to expect the GP contract to be ‘tightened up', but cautioned against being too punitive with contractual monitoring.

‘It makes sense that GPs should tighten up, but one has to be careful that intervening is not negative.'

Dr Kant also warned against incentivising GPs to work in federations without proper piloting.‘There is a big danger of paying to incentivise collaboration without the system being in place,' he said.