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Out-of-hours opt-out back on table due to Carr-Hill chaos

The £6,000 per GP price-tag for ditching out-of-hours has been thrown into doubt after the GPC announced it was renegotiating the figure as part of the contract salvage operation.

Negotiators have been

forced to reassess one of the most popular parts of the contract because the opt-out cost is linked to weighted list sizes. But GPs have warned a new out-of-hours deal could further jeopardise the contract.

GPC negotiator Dr Laurence Buckman said a new costing was needed for GPs who abandoned the Carr-Hill formula in favour of the practice income guarantee.

'The opt-out price was sorted out as a ratio of notional list size, but as notional lists may not apply any more we may have to rethink it for everyone, winners or losers,' he said. 'The principles whereby it worked out as £6,000 on average do not apply now.'

The talks with the NHS Confederation will consider whether the price would be based on a practice's average notional list size, its actual list size or the number of partners.

How part-time and full-time GPs would be accounted for will also be considered, Dr Buckman added.

The National Association of GP Co-operatives denoun-ced the contract renegotiations as 'shambolic'.

Vice-chair Dr Prasad Rao said the hold-up could cause a six-month delay in opting out because it would set back PCOs' preparations to take over out-of-hours.

'A number of GPs can't wait to opt out. If they get this one wrong I can see GPs throwing the whole contract out,' said Dr Rao, a GP in Stoke-on-Trent, Staffordshire.

'We are now into this financial year and PCTs have their money ­ they are not budgeting for the out-of-hours opt-out now.'

Dr Gwion Rhys, a GP in Nefyn, Gwynedd, said GPs were happy with the current pricing. He added: 'Given the Carr-Hill formula is an unfinished mess, if they are now backtracking on the successful parts, we must ask what we're being left with.'

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