What we've learned from new contract preparation
For the past six months Dr Stephen Gardiner has been preparing for the new contract – here he discusses what he learned from the activity and change
We decided to work towards the maximum 1,050 points during the first year. We discovered that having extensive computerised records was a mixed blessing. There was a wealth of information available but it was not always Read-coded, and when it was the codes used were frequently not those used by the programs that would interrogate our system to determine our point score.
There was a lot of chaff in the records with possible diagnoses coded as the real thing and later inactivated but not deleted. We have therefore spent a fair amount of time adjusting templates and correcting 'wrong' codes to fit in with the searches.
We have also encouraged everyone to record symptom codes for such things as chest pain where angina is likely until referral for exercising testing has taken place. There has been no patient benefit from this work but, with a few hurdles still to overcome, we remain on target for the full clutch of clinical points.
The nomination of two partners and our practice manager as a core team has been very important in allowing regular GMS2 meetings to take place about twice a month without excessive disruption to the running of the practice.
Regularly checking our points using EMIS Population Manager is important for planning where we direct our efforts. The software is still less than perfect though and the latest version has now arrived with new criteria and searches that negate some of the work done so far.
For most GPs the loss of out-of-hours responsibility was the biggest boon offered by GMS2. But with only a very short time to go before the changes begin, there is still massive uncertainty about what will happen.
Our PCO has been very proactive in this area, helped by the existence of a network of co-operatives that have provided out-of-hours care for many years.
The proposed phasing-in of a new local service due to start on April 1 is reportedly on hold however, due to the intervention of our strategic health authority. We understand the problems are financial. The outcome may bring with it the most important lesson so far about what is to come.
While considering problem areas, our experiences of local negotiations have not always been fruitful. These range from errors in our global sum/MPIG allocation to disagreements about proposed enhanced services. The problems always seem to relate to inadequate financial resources and local politics.
We are clear though that the new contract must herald a change of attitude, with practices providing services that also create a profit to allow and encourage further development. Subsidising the NHS from our own pockets must stop and PCOs will need to realise this.
I hope we were not foolish to vote for an unpriced and unfinished contract at a time when the profession's collective power was probably at its greatest for a generation.
I also hope that as the contract matures it is able to focus not only on that which is measurable but on that which is important for patient care with evidence-based and achievable targets.
lCreate a core team
lRegularly review your Q&O points and concentrate resources where most rewards can be gained
lCheck accuracy of computer records and delete incorrect diagnoses, adding a comment for the audit trail as necessary
lUse symptom codes until diagnoses are confirmed
lSet up disease management clinics with templates that include exception reporting codes
lExpect last-minute problems and financial constraints
lCost new service provision properly and stop subsidising the NHS
Steve Gardiner is a GP in Bridgwater, Somerset