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Where does the DH's target cull leave GPs?

The abandonment of the Government's access drive will be a huge relief to GPs, but practices cannot afford to do without the cash that has accompanied it, says Pulse editor By Richard Hoey

By Richard Hoey

The abandonment of the Government's access drive will be a huge relief to GPs, but practices cannot afford to do without the cash that has accompanied it, says Pulse editor By Richard Hoey



General practice has all of a sudden got rather exciting.

We thought we were doing pretty well for news this week, with our exclusive that the Summary Care Record is to be scaled back, and a couple of interesting developments on the patient survey and GP federations (to come).

But then all of a sudden the Department of Health went and released its NHS Operating Framework, and in doing so turned on its head 13 years of previous Government policy.

So, no extended hours target. No 24-hour or 48-hour access targets. Not even an 18-week referral-to-treatment target, which will raise eyebrows, as this was one of the few NHS policymakers thought ministers might be under pressure to retain.

In fact, the only blue riband target involving GPs to survive the cull appears to be the two-week cancer rule, which perhaps suggests Labour's chillingly effective party election broadcast managed to hit home.

Officially, it's not quite that the targets are abolished… in official terminology GPs will simply no longer be performance-managed against them, although I'm not entirely sure what the difference is.

The new policy raises two key questions though. Firstly, what difference will the removal of the targets make? After all, the DH may no longer itself want to hold GPs to account for the access they provide, but it wants to make it if anything easier for patients to do so, and to step up competition between providers.

Will practices will choose to abandon extended hours and 48-hour access, now they will no longer get a bash over the knuckles for not doing so? My guess is, some will, some won't – and the most entrepreneurial and competitive probably won't.

The second key question is what will happen to all the money currently attached to the various access targets – particularly the enhanced service money for extended hours, and the QOF points for 24- and 48-hour access?

Presumably, both cash payments will go – but will GPs get any money to replace that lost, perhaps in the form of commissioning incentives?

If so, today may really be as exciting as it seems for GPs. If not, what appears, in the words of RCGP chair Professor Steve Field to be a ‘new dawn' could be nothing more than another round of unheaval and uncertainty.

By Richard Hoey, Pulse editor

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