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GPC given mandate to negotiate GP contract that ‘rewards continuity’

GPs carry out record number of appointments

LMCs have urged the BMA GP Committee negotiators to negotiate a GP contract that incentivises continuity of care.

A motion passed today at the UK LMCs Conference in York demanded that ‘we move away from a target-based GP contract and be rewarded for prioritising continuity’.

Proposing the motion on behalf of Avon LMC, Dr Sam Creavin said continuity ‘acts as an incentive to sort out the problem properly first time’.

He added: ‘Continuity can be measured – there might need to be some debate about how, but it can be done. Placing a modest financial value on continuity would change our behaviour in a way that would improve outcomes for patients and our own job satisfaction. 

‘Ultimately, if we don’t have continuity with our patients, then we are just a less well equipped, less well staffed ad more easily accessible version of A&E.’

Speaking in favour, Dr Gavin Shields of Coventry LMC said that continuity of care is ‘the jewel in the crown of general practice’.

He said: ‘We do not get continuity of care from atomising our workforce, from salarying all of us, we do not get it by stretching me to work longer and longer hours until I fall apart. We get it by core funding into practices.’

However, Dr Christiane Harris from Bedfordshire LMC argued that ‘it’s clear that QOF and its targets have to go ‘ but that a continuity-based contract may be impossible for GPs to deliver.

She said: ‘Sadly – given a declining workforce and the fact that as most of us are ageing we are finding it more difficult to work as many sessions as we did when we were younger – the one thing even the most dedicated advocate of the partnership model quickly realises is that we cannot offer the continuity of care that we would love to do.

Dr Harris added: ‘The use of members of the MDT to fill the workforce gap makes continuity even more difficult. 

‘The danger of passing this motion is we may end up voting for something we’re even less able to fulfil. By all means vote to end the tyranny of QOF, but not to replace it with something we don’t have the means or the workforce to provide.’

GPC England chair Dr Farah Jameel said that despite the evidence of the benefits of continuity, this ‘high-quality, cost-effective and timely care is under-estimated and poorly valued by policymakers’ and ‘in decline’ in the UK.

But she added that there are ‘dangers possibly lurking ahead’.

She told delegates: ‘If continuity of care is to be rewarded and preserved, it will need to be measured and monitored and it will need new payment mechanisms. So we’ll need to spend some time thinking about these matters.

‘[But] we must reward continuity of care and it is right that we ask for it. We’ll need courage – from policymakers, from us [and] from parliamentarians.’

Yesterday, the conference revealed that salaried and locum GP representatives have applied to become their own branch of practice, putting the BMA’s wider GP Committee ‘on notice’ as their negotiating body.

If approved, the plans will see a separate sessional GP negotiating committee formed to represent salaried and locum GPs alongside BMA England’s GP Committee.

Delegates also voted in favour of the BMA GP Committee ‘renegotiat[ing] the GMS contracts with workload limits in order to protect all general practice staff and patients’.

However, they voted against changing core working hours to 9am to 5pm.

Motion in full

AVON: That conference demands that we move away from a target-based GP contract and be rewarded for prioritising continuity. 

Source: BMA


Finola ONeill 11 May, 2022 1:04 pm

Financially incentivise continuity over and above sufficiency of core funding, which currently doesn’t exist. that is key. Then as much as we can provide continuity, we will be financially incentivised to do, and what we can’t manage won’t penalise us. The key is getting that funding for PCN additional roles into core contract. Then when we can staff more GP sessions we will do that with said funding and if not we can fund the additional roles, when and whom we think benefit us. Clue being I suspect the social prescriber and wellbeing roles may go by the wayside for many but that money could be used more fruitfully for GP, reception, admin and nursing team funding. Most of our social prescriber and wellbeing slots are empty and not sure the PCN pharmacist offers much. Physio is top notch however and our own surgery funded pharmacist is awesome. Prescriptive additional roles is a waste of taxpayers money and an NHSE fetish.

Patrufini Duffy 11 May, 2022 2:57 pm

You do realise that “Working at Scale” was their model. It is what the superpractices thrive off, discontinuity. And the permitted Apps. I think all your job now is to do what you can, don’t save this system, and fracture what is already broken. Re-direct everything and anything, let public satisfaction plummet, then you turn up to the negotiations. Only then politicians will listen to your ideas. Create havoc, it is the only card left.

Paul Attwood 12 May, 2022 11:52 am

The whole profession is circling the plughole and the GPC is arguing about ‘continuity’. There is a patent sense of disconnect. A day late and a dollar short. Plan your escape route. Retire, Locum, Emigrate if you can.