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Should the national GP contract be scrapped?

Dr Richard Ma says local contracts would benefit GPs and patients, while Dr Beth McCarron-Nash argues that the national contract still offers vital protection for practices

Dr Richard Ma

YES

Time is running out for the national GP contract and I can’t say I’ll be sorry to see it go. More than a third of CCGs have made a bid for full responsibility for primary care under co-commissioning in England (see page 27), and the devolved nations have already begun to develop their own versions.

It’s been a decade since the ‘new’ GMS contract was introduced, but a variety of flaws have rendered it unworkable.

Take the QOF. Touted as rewarding practices for the ‘quality’ of their clinical work, it has instead turned consultations into contrived conversations aimed at ticking boxes. This has affected doctor-patient relationships and also distorted clinical priorities. For example, time spent on recalling patients and conducting physical health checks in the mental health domain might have been better used for case management to reduce the risk of relapse and distress.

 Already, GPs in some areas are contemplating a future without the QOF. NHS Dudley CCG is looking to offer practices the chance to replace parts of it while NHS Wirral CCG is looking to drop the framework altogether.

Other elements of the contract have been exploited to make GPs implement political gimmicks, rather than to benefit patients. For instance, the resources spent on the patient participation DES, something of dubious value for patients and practices, could have been put to much better use. Of course, local commissioning won’t be completely free from local politics, but it is better suited to the needs of the local health economy.

Local commissioning is also beneficial because it recognises there are ways to improve outcomes other than financial incentives. For example, our CCG is trying to reduce the prevalence gap of long-term conditions like diabetes, hypertension and COPD by improving case-finding by GPs. And Tower Hamlets GPs have demonstrated how commissioning through managed networks has added value to current QOF targets and improved cardiovascular outcomes for patients. Local contracts can also tackle health priorities that are directly relevant to the patients they serve. 

We all want to improve the health of our population. Only by dropping the national contract and embracing the powers of local commissioning can we do that with fair and reasonable financial compensation.

Dr Richard Ma is a GP in north London and a doctoral student at the London School of Hygiene and Tropical Medicine

 

Dr Beth McCarron-Nash

NO

In the current economic climate, losing the protection and benchmark of a national contract would be potentially disastrous for primary care. 

Only a national contract can protect the interests of GPs and their patients and it is the solution to the myriad of pressures facing practices.

As CCGs take on responsibility for commissioning primary care, of course the national contract will evolve (I envisage much greater local variation and population-based funding), but it is still a vital guarantee of a unity of provision across the NHS.

Increasing unfettered contract variation with wholly local contracts and performance management risks widening variation in income and workload for GPs, as well as health inequalities for patients. The wise way forward is to lobby for a properly funded nationally agreed core ‘offer’ to all practices, with enhanced, locally commissioned services wrapped around practices or localities.

The core offer would cover day-to-day practice appointments, and we are working hard to make sure this gets much more investment. Local enhanced services could include improving care for vulnerable patients, extending access, and funding extra GPs to ease pressure in practices. CCGs already have the ability to do this but are struggling to make the necessary disinvestment in secondary care needed to fund community services. 

Problems with the national contract lie not in the system itself, but in how it has been systematically devalued and underfunded by government and used to micromanage GPs. During last year’s contract negotiations we managed to keep out many unworkable and unacceptable proposed elements the Government may have been able to ram through in local deals, on top of reversing much of the imposed contract changes.

Local contracts will have the same centralised diktats from the Government hanging over them, but with no national negotiating structure to support them; CCGs co-commissioning hasn’t been dubbed a ‘poisoned chalice’ for nothing.

By standing together, we can act against the worst excesses of government policy, rather than risk being picked off one area at a time. National protection alongside local flexibility and enhanced investment is our solution. We lose that protection at our peril.

Dr Beth McCarron-Nash is a GPC negotiator and a GP in Cornwall

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Readers' comments (7)

  • Divide and conquer, and naive GPs rush to take part in it! The problems with the contract are not because it is a national contract but because the GPC is a poor negotiator. You don't solve a problem by scrapping the bit that isn't the problem. Poor as the GPC is, I am sorry to say that my experience of an LMC is that is much poorer still, and local contracts will mean huge variation in pay and conditions around the country depending on how good or fawning the LMC is to authority, and how human or nasty the local NHS manager is. Very soon a good number of Gps and LMCs will be clamouring to get national support against their bad local contracts but it will be too late, the Govt will have divided and conquered and it won't go back on that!

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  • Agree thoroughly with 11:48 - divide & rule - this is a policy being very effectively used against the medical profession by our political masters and there's always some sap that welcomes it with open arms....

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  • The national GP contract is not perfect but local CCG contracts opens a can of worms which we as GP,s will never be able to put back into the can. There will be utter chaos!
    Before the CCG's we had PCT's and FHSA... these organizations are not immune to political whims and fancies ..the latter 2 were consigned to history or the dustbins ..and no doubt the CCG's will also have its day and be consigned to the dustbin once it's purpose is served .. The core NHS contract should remain as is and the local / enhanced services that envelope the core contract should be locally driven.. I am sure the CCG's will be called by another name in a few years time depending on the political will and the finance situation of the country

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  • National health service: national GP contract.

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  • I see that no one has mentioned that 2004 contract divided GPs by making them salaried and now those salaried Gps I know no longer care one way or another, they are exploited by partners with their own financial interests. Interesting that the partners dont even see how we are already divided so effectively

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  • All contracts to provide NHS services supposed to be open to any willing provider, the same should apply to GP's.
    Anyone would think the only problem the NHS has is GP's, yet they have been battered from every angle, every second of every day.
    The NHS / CCG's want all GP's 'under their thumb', only then will they be happy and dictate what every GP has to do regardless, even down to working 24/7, nothing would surprise!
    I suggest the NHS start treating GP's with respect, after years of hard training they are treated like naughty schoolchildren … these are highly skilled professional folk, with more skills than any pen pusher in the NHS … surely they deserve better treatment?

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  • The problem is that too many GP's get paid to care for patients on their list, but have more than they can manage. All GP' should b e restricted to the number of registered patients according to the hours they are available to see their own patients. Too many GP's work very few hours in their practice as they go off and o private clinics etc.

    Restrict the number of patients perGP to the number of hours they are available to see patients, then if they cannot meet demand, allow the money to follow the patient and pay the care provider who picks up these patients e.g. drop in centres, A&E etc.

    Why pay a GP to care for patients if he / she hasn't the time to do so because of external commitments?

    In one practice five GPs with 12000 patients work a mere total of 30 hours between them!

    For this reason I feel GP's should be contracted to the NHS to provide an agreed number of hours per week, with lists / income restricted accordingly … only pay them for what they do …. maybe then patients could get the appointments they need because the GP is where he / she should be, in the practice!

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