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A faulty production line

Monitor calls for greater competition between GPs and walk-in centres

Greater competition for funding with walk-in and Darzi centres could force GPs to ‘raise their game’ and better respond to patient needs, claims a review by Monitor.

The review by the competition regulator found that commissioners were often closing walk-in centres as they believed they were ‘paying twice’ for primary care services when patients were registered with local GPs.

But they said that this was a missed opportunity to stimulate more competition between GP practices and walk-in centres and that ‘stronger incentives’ such as paying GPs only for the activity they undertake could improve quality and efficiency’.

The preliminary findings of the review found 53 walk-in centres have closed since 2010, 25 of which were GP-led (Darzi) health centres, 22 were nurse-led and six were commuter centres, it identified 185 walk-in centres still operating throughout England, 135 were GP led and 50 were nurse led.

But they said that commissioners may not be considering ‘the full range of options’ when deciding not to renew their contracts, and could use them to create ‘payment mechanisms’ that encourage ‘both higher quality and value for money’.

They also revealed that walk-in centre providers have raised concerns with the Monitor about conflicts of interest when their contracts have been terminated in favour of commissioning additional services from local GP practices.

It also suggests that NHS England could be designated the leading body responsible for commissioning walk-in centres – rather than CCGs - when the majority of contracts expire in 2014.

The interim report from Monitor details the preliminary findings of a review into the provision of walk-in centres by the NHS, with a final report due later this year, or early in 2014. A report that is deals explicitly with general practice and funding issues is also expected in early 2014.

It found that current arrangements gave GPs little incentive to improve services, although there was ‘some evidence’ that the introduction of a registered-GP service at Darzi centres had caused some GP practices to ‘raise their game’.

It concludes: ‘GP practices receive the majority of their income through payments that are based on the number of patients registered on their lists; their income is not directly affected when their patients choose to attend a walk-in centre (or other service offering primary care) instead of using their practice.

‘Thus, where their patients have a choice to use a walk-in centre, GP practices have little incentive to improve their services so their patients will choose to see them instead of attending the walk-in centre’.

It adds: ‘If payment mechanisms created stronger incentives for GP practices to encourage their patients to choose their services instead of using a walk-in centre, this competition for patients could drive GP practices and walk-in centres to continually improve their own services.’

It also states some GPs who refer patients to walk-in centres when they’re unable to offer a same-day appointments, are:  ‘using the centres to meet the needs of some patients for whom they are paid to provide primary care, rather than responding to what these patients want, for example, accommodating more same-day or convenient-time appointments.’

Catherine Davies, Monitor’s executive director of co-operation and competition, said: ‘GPs aren’t affected financially if a patient goes to the walk-in centre, so we think that the way the incentives work at the moment, patients aren’t benefitting from the competition between GP practices and walk-in-centres.

‘One option might be to have GP services which reflected patients attending, and consultations that occurred. But at this stage we are looking for people to make suggestions about how that could be improved.’

In a submission to the report, Jill Matthews, head of Public Health and Primary Care for NHS England, said they would welcome changes to the way payments are currently made: ‘The NHS is paying for these patients twice due to the capitated payment to GPs and activity payment to other care settings.

She added: ‘Considering the possibility of rebates on the capitated payment for activity in other settings and more flexibility to commission a mix of access choices for patients would seem a helpful improvement on the current situation.’

GPC chair Dr Chaand Nagpaul said: ‘Patients should have access to the care they need, when they need it.  However at a time of severe financial pressure in the NHS, commissioners need to ensure funding is properly allocated and used responsibly to avoid a duplication of services.

‘Commissioners will need to carefully assess existing service provision and local need when deciding the most efficient and cost effective way of delivering care, and whether or not to keep walk-in centres open.’

Related images

  • Darzi polyclinic - online

Readers' comments (20)

  • Of course it's nice to have an appointment when you want one . unfortunately since the banks have stolen all the money it is diificult to provide one . We must concentrate on providing what is necessary .

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  • When my local WIC does not sent 32% of its contacts to the scheduled GP appt a few days later (you know the one that the practice offered them before they took themselves off to the walk in centre and the Walk in centre agrees they can wait to have) and the 18% of its referrals that go on to AED, I might start looking seriously at it as possible competition.
    In the meantime it is " instant gratification" for the chaotic and feckless component of the local population, a different "client group" that lack the personal skill set and aptitude to participate in a "health partnership patient/GP model" the RCGP advocate.
    As such I view it as a welcome partner in the local health economy.

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  • How amazing that a monitoring organisation can say something so unguarded and inappropriate - of course walk in centres run all the usual chronic disease clinics child health clinics etc etc and are a comparable service = balderdash and bunkum -- please think before you write something so inflammatory - professional service should be run on the basis of need not on the basis of WANT

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  • 'paying GPs only for the activity they undertake could improve quality and efficiency’
    Bring it on!
    Do I get double when I see the patients that have already been to A+E and walk in centre because they wanted follow up or the patient didn't get great service.

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  • So Item of Service fees.

    Treasury will never allow it.

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  • We did not ask for Walk In Centres, nor were we consulted about their potential value when they were created. We correctly predicted that patients would treat it as the 'instant option' for minor ailments they would not normally bother a doctor with.
    I would love to get paid for all the work I do - especially all the out-of hours terminal care which I have done unpaid for almost 10 years.

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  • Fine, reduce their funding to the same level per consultation as GPs and let the fight begin.

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  • I'd love to get the payments WICs get for seeing the walking well.
    Monitor sounds like they've been nobbled by the WIC interest groups as they obviously have no clue about the WIC contracts and circumstances in which they were introduced.

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  • Walk in centres get paid per patient that comes in through their door at a much higher rate than GPs, that is a basic fact and the truth of the matter.
    GPs can only compete with walk in centres if they get paid the same, so either we start getting paid the same as walk in centres or walk in centres will have to get paid less and live on a budget like the rest of us.

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  • I have used my local walk in centre and found the service to be very good. I used the service after 7pm rather than the local out of hours service when my GP was closed and rather than A&E which clocks up an even higher price! Maybe patients need to know what each appointment costs them, they need to know what the cost of inappropriate presentation at A&E or A N Other inappropriate service costs and an example of how that cost could be better spent. I think most people are responsible, BUT for those who aren't or don't understand some educational examples may help. We spend a fortune on NHS re-structure, when surely the money would be better spent telling patients what services are available and how best to use them!
    A graphic map of how your local NHS works might help displayed in waiting rooms or on the advertising screens. Put one on the back of every patient information leaflet, every presecription everyfit note, the drip feed method can only help!

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