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GP negotiators hint at payment-per-contact model

GP negotiators hint at payment-per-contact model

The BMA’s GP Committee has proposed a new payment-per-contact model as part of the new GP contract starting in 2024.

GPs in England are currently tied to the five-year deal agreed in 2019, but the GPC is set to negotiate a new contract to replace this from 2024 – with discussions to begin ‘in the next few weeks’.

In a panel discussion on the ‘future of general practice’ at the Best Practice conference in Birmingham yesterday, the GPC England executive committee presented its proposals, including the possibility of negotiating an item of service (IoS) fee for every patient contact.

GPC England deputy chair Dr David Wrigley told delegates: ‘One of the issues is around the volume of work, it’s never-ending. And that hidden work as well – late nights looking at documents, dealing with patients and phoning them.

‘One aspect that we’ve looked towards is an item of service fee. So for each contact – say a face-to-face or a telephone [contact], a home visit, document management or a medication review – how do you feel about an item of service fee for any of those looking forward to the new contract?’

He asked whether this would be ‘attractive’ to GPs, adding that ‘how it would work is for [the GPC] to work out.

GPCE chair Dr Farah Jameel said that alternatives could be ‘an uplift to the global sum or additional guaranteed funding for every single member of the team’.

She said: ‘The current funding model clearly isn’t working. We are not retaining, people are feeling burned out and the workload has expanded.’

The GPC also suggested workload could be reduced by scrapping QOF and the PCN incentive scheme entirely.

A slide presented at the talk suggested that QOF and Investment and Impact Fund (IIF) money could be moved ‘into core’ and practices ‘[trusted] to organise care’.

GPCE deputy chair Dr Richard Van Mellaerts said that the committee is ‘toying with’ this idea, with the aim of achieving a ‘high-trust, low regulation, low bureaucracy environment, [with] less box-ticking [and] more looking after people’.

And deputy chair Dr Kieran Sharrock added that GPs must either be given more resources or ‘give something up’.

He said: ‘At the moment, we are doing a lot of work and everything is thrown at us. 

‘We are trying to do everything for everybody and either we have to have the resources to continue doing that or if the resources don’t come, we have to give something up.’

He asked delegates which key element of general practice out of prevention, chronic disease management and undifferentiated care should be delivered ‘somewhere not in general practice’.

It comes as negotiations for the new contract are due to start, with Dr Jameel telling delegates that the ‘next round’ of contract negotiations’ is ‘imminent in the next few weeks’.

England’s LMCs will next month hold a special conference to discuss the new GP contract for 2024.



Please note, only GPs are permitted to add comments to articles

David jenkins 13 October, 2022 11:53 am

“money could be moved ‘into core’ and practices ‘[trusted] to organise care’.

there is no way anyone in the DoH is going to fall for this. at a stroke it would stop them micromanaging us, most would have nothing to do (and would presumably lose their non-existent jobs), and we would be back in control…………..and we simply can’t have that, can we ?!

come to locumland, where you are actually in charge of your own destiny. ok – it can be a bit hit-and-miss, and there are downsides, but i can promise you it’s preferable to what you’ve got at the moment.

Patrufini Duffy 13 October, 2022 1:22 pm

Why don’t you just stop home visits for a start. Simple and punhcy. Victorian-aged brainwashing in 2022. No professional is doing such a ludicrous activity for free.

John Evans 13 October, 2022 1:28 pm

Good luck.

They know demand is ‘controlled’ a saturated service / finite capacity.

Expectation / demand management is not something that they have any interest or indeed any skill.
Voters bought off with charters of rights without sufficient reciprocal responsibilities.

I do not think that it can be negotiated. Not sure if the negotiators have the backbone to plan for resignation en masse to underpin their case..

Paul Hartley 13 October, 2022 3:06 pm

Payment per contact could create insane perverse incentives to bring patients back for useless follow ups.

Bonglim Bong 13 October, 2022 3:24 pm

PH is correct.

Why see a complex patient with a balancing act between heart and renal failure, severe mental health problems and so on?….
when for the same appointment fee you can bring someone back for their weekly BP check?

Chris Ree 13 October, 2022 3:41 pm

They could not afford it, it would be impossible to manage, it would prejudice any semblance of holism, appointments would be shorter and would lead to gaming and perverse incentives. Non starter.

Slobber Dog 13 October, 2022 4:23 pm

They would find some way to pay less for more work.

Nathaniel Dixon 13 October, 2022 4:29 pm

If the government really do believe GPs are lazy as they keep implying and getting their friends in the press to report lets go with pay per consult, surely this will save government a fortune?
Be interesting if they’ll back up their rhetoric with action.
As a GP partner I’m very happy with moving towards this when it actually starts costing money we may cease to be an endless dumping ground “ideally placed” to do all manner of inappropriate things (such as recently suggesting assessing for help with energy bills!)

brigid joughin 13 October, 2022 6:34 pm

Scrapping QOF would not significantly reduce workload. Good practices should be doing most of this work anyway. Organising a National Public Information Campaign setting out realistic expectations from the NHS/primary care might do something to address workload. But all we see is a government intent on pushing the public to ask more and more from us

Pradeep Bahalkar 14 October, 2022 9:38 am

Way to get around peoples concerns that some GP will exploit the system and call patients again and again is to make system co funded, so if pt pays even small fee eg a pound to see GP. They will question ” Dr why do I have to see you again or is it necessary to see me back in 1 week ” because that one pound is coming of their pocket and they would value that very much.
Current system is unstainable for GP practices. Government wouldn’t mind continuing this forever because they are getting very good deal out of this and they would have no inclination to change to pay per contact model.
DO GPC + BMA & more importantly GP as a collectives have the appetite & unity and spine to push for this.

q b 14 October, 2022 9:50 am

Whilst I dont advocate anyone gaming the system, what the fukc has happened to us- have we not been ‘gamed’ by DoH/NHSE all these years to accept more shit and just take it..?

Its simple – I do work, I get paid. I do special work (home visits), it costs more so you pay more; What work I do, how I bring them back etc will be between me and my patients – if Im shit and dont see the people with complex issues they will vote with their feet – and those that dont need seeing so often wont want to come out of work anyway to see us.

stephen mann 14 October, 2022 11:00 am

It seems odd to me, the entire system except for primary care has for years been pay by contact, this has enabled providers to dream up income generating services, ‘tongue tie cutting in neonate to aid breast feeding ‘ comes to mind. When I did Paeds/ENT and O&G this very rarely happened, now it is endemic with numerous new born babies going to the “Ankyloglossia Clnic” for a barbaric snip, that makes no difference, (papers from Canada and others confirm this). Yet it appears that paying GP’s for what they actually do is a step too far.

Christopher Ives 14 October, 2022 2:00 pm

I think on balance this is an excellent idea. PBR worked brilliantly for the hospital trusts and drove activity upwards without bankrupting them. The commisioners hated it as they paid for more activity that they could not afford. Especially when private providers started seeing NHS patients. Patients I think gained from it a lot. The problem was that CCGs needed to control costs hence there was pressure to try to avoid things being done in secondary care under PBR. Some gaming did go on but overall more patients seemed to be seen and were appropriately funded. The problem is that those few providers who remained on block contracts tended to have more financial pressures as demand inevitably outstripped funding.

Clare King 16 October, 2022 7:13 pm

They do this in Canada so why not here ? It cant come a moment too soon .

Michael Crow 18 October, 2022 7:03 pm

It depends how much they want to pay per contact. If it is only a fiver we might all be worse off. It would also show us what they thought of GPs. Before anyone says yes to pay per contact, there needs to be agreement as to what the fee per contact should be

Matthew Sword 19 October, 2022 5:14 pm