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Problems with new contract are starting to frighten GPs

Many GPs fear that cracks are beginning to appear in the contract ­ here Dr Bob Button explores those areas that are giving cause for real concern

Like an increasing number of GPs I have a genuine fear that we are not about to enter the golden age some felt the contract promised. The problem is that PCTs have too little money to implement the contract we were expecting.

Enhanced services are generally felt by most people to be a crucial part of the new contract. But the interpretation of enhanced services has been variable across PCTs. I refer in particular to the tendency for expenditure to include 'must do' items, such as walk-in centres, in the total from which they must fund these services.

It would appear PCTs might have great difficulty in introducing the out-of-hours opt-out as early as they would like, again because of funding constraints. The commissioning of Saturday morning surgery opening from practices appears to be one that is giving the PCTs particular cause for concern. It is already the case that they are hoping surgeries will open without requiring any extra funding.

The benefits of the new contract, and its ability to reduce demand on the GP, depend very much upon GPs refusing to do work unless it is commissioned and funded. I believe GPs may find themselves in difficulties about refusing to provide services to patients that they have provided in the past, especially if the PCTs do not directly commission them.

A significant area of the country is now covered by largely PMS practices. But there has been a dearth of information about how these practices are able to transfer to the new contract, what the arrangements would be with respect to quality payments and whether they would get MPIG payment and how it would be calculated

There are two preparation payments expected this year. One is a sum of up to £5,000 towards the cost of summarising notes. The second is to do with the work necessary to enable practices to bid for particular quality initiatives in the future, and this could be as much as £9,000 per practice.

Unfortunately there is no clarity about how these payments are going to be made. A suggestion being considered is that they should be paid quarterly in arrears. What is more important perhaps is that the paying agencies are unaware of where the funding may be found.

The 'pay rise' that GPs were expecting this year, which has been calculated at approximately 12 per cent, is still not agreed with the Doctors and Dentists Review Body.

As a result there can be no assurance that the money is going to be available at the end of the September quarter.

IT funding, supposedly 100 per cent, is being held up by no funding being distributed to the PCTs. This has had the effect of making some PCTs retreat to the same reimbursement arrangements as last year. Inevitably this is dissuading practices from investing in computer equipment and software, enabling them to reduce the number of returns that have to be done manually, so they can perform at optimum levels under the new contract.

Another problem is the question of the manner in which payments are to be made to practices. At present an Exeter software system is used for making payments via the local primary care agency. This will still have to used for about two years in order to cope with the back claims and payments that will be allowable under the old GMS contract.

The rewrite that is necessary to change from an individual GP-based item-of-service system, to a practice-based and very largely non-IOS payment arrangement is no mean undertaking and does not appear to be very far advanced in development. This leads to the awful prospect of a confused computer system that may make mistakes in both the old GMS and the new GMS contracts.

Premises funding which has been widely trumpeted has not yet materialised. In fact I'm given to understand that some of the premises funding arrangements may not even come to fruition despite having been announced in advance.

Couple this with the possibility of an increased tax with regard to new leases and the picture is very depressing.

Has the real effect of the new contract been to make PMS appear a more acceptable alternative to GMS? This may have been the Government's intention all along. I cannot see the Government persisting with two contracts, and on balance I'm quite sure they would prefer for the whole profession to be in PMS.

Problems envisaged with the contract

Enhanced services

Funding constraints could be a problem


Funding constraints could be a problem

Preparation payments for summarising notes

Confusion about how payment to be made

Preparation payment for work involved in bidding for quality initiatives

Confusion about how payment to be made

Pay rise for GPs

Not yet agreed ­ no assurance it will happen

Payments to GP practices

Confusion about how payments to be made

Premises funding

Nothing has happened yet

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