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Major government review suggests an end to a national GP contract

Major government review suggests an end to a national GP contract

‘National contracts’ present a ‘significant barrier’ to local innovation, according to a major Government review which recommends ‘a new framework’ for GP contracts.

It also recommends that centrally held buyout funds are set up, to take over GP contracts or premises where practices are ‘not delivering to a high enough standard’.

Former health secretary and Government adviser Patricia Hewitt was commissioned to produce an independent review of England’s new integrated care systems (ICSs) in November.

In her report, which was published today, she recommends that NHS England and the Department of Health should ‘as soon as possible’ convene a national partnership group to develop together a new framework for GP primary care contracts.

It also said that QOF points were ‘an important and useful innovation twenty years ago’ but are now ‘out of date’, and are seen by GPs as well as ICBs as ‘an inflexible and bureaucratic framework’.

The review found that national contracts present ‘a significant barrier to local leaders wanting to work in innovative and transformational ways.’

‘ICBs also lack effective levers to support and secure the services in practices where practices are facing difficulties in providing a good quality of service in their area,’ the report said.

‘I therefore recommend NHS England and DHSC should, as soon as possible, convene a national partnership group to develop together a new framework for GP primary care contracts,’ Ms Hewitt said.

She added: ‘As the GP contract is now entering its fifth year of a five-year agreement, and the Government will be shortly considering its intentions for the next iteration of the contract, radical reform is needed, and this is the right time to make it happen.’

The contract reform group should include ‘a diverse range of GP partnership leaders’ delivering ‘excellence across a range of different regions and demographics,’ as well as ICB primary care leaders, local government and ‘crucially’ a number of patient and public advocates.

NHS England and DHSC should also engage with ‘key stakeholders,’ including the BMA and the RCGP.

According to Ms Hewitt, the GMS contract provides ‘far too little flexibility’ for ICSs to work with primary care to achieve ‘consistent quality and the best possible outcomes for local people.’

However, she did express support for the GP partnership model.

The report said: ‘I would suggest that [the new] framework should enable systems to find the right solutions to fit their circumstances, including building on the partnership model, rather than sweeping it away entirely.’

Meanwhile with regards to incentive frameworks, she said QOF ‘needs to be updated with a more holistic approach that allows for variation’.

‘The new approach must also recognize that, in order to allow primary care to refocus resources on prevention, outcomes rather than just activity need to be measured.’

Dr Kieran Sharrock, BMA England GP committee acting chair, said the committee welcomed some of the principles in the review, which are not far removed from what the union has been saying for some time.

He said: ‘Even before the recent imposition, GPC England has been clear that the contract needs a complete overhaul, so that what comes next properly supports practices to look after patients in a way that recognises changing demographics, increased demand, plummeting workforce numbers and rising costs. 

‘We know practices are struggling to meet patients’ needs and the emphasis now must be on supporting practices, rather than penalising them.’

However, Dr Sharrock said that there is ‘worryingly little detail’ within the report about how success is defined and by whom.

He added: ‘A central fund to buy out ‘failing’ partnerships may be seen as appealing for those left with no other way out, but it’s not clear who decides when a practice is failing, and what powers they might have.

‘Rather than improving community-based, holistic care, we’d worry that this would open the door to private companies strong-arming smaller practices into selling – destroying the continuity of care that they have built over many years.’

A DHSC spokesperson said: ‘Integrated care systems are an important part of the Government’s plan to deliver more joined up and effective health and care services and to cut waiting times for patients, one of the Prime Minister’s key priorities for 2023.

‘Ministers will review recommendations of this report in due course.’

Meanwhile, two long-awaited documents which will influence the future of general practice are expected to be released in the coming weeks.

Key recommendations from the Hewitt report

  • National contracts present a significant barrier to local leaders wanting to work in innovative and transformational ways. I have recommended that work should be undertaken to design a new framework for General Practice (GP) primary care contracts, as well as a review into other primary care contracts. 
  • Practices that are not delivering at a high enough standard need to be supported to improve and, where necessary, to be replaced so that residents in every community receive the support from primary care they need. This should include creating a centrally-held fund to buy out contracts or premises, or both, where that is essential to improve access, care and outcomes in a particularly disadvantaged community.



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

Finola ONeill 4 April, 2023 11:17 am

Looks to me like divide and conquer.
GPs are not suitably controlled by the government.
Won’t share the data. Won’t do as told.
90% of consultations for 8% of funding. Extremely efficient.
But too independent for the government and their quango’s liking.
I’m sure being controlled and micromanaged by local managers is bound to make us more ‘innovative’ and effective.
Got my alternative career teed up.
Hope you all have.

John Ribchester 4 April, 2023 11:43 am

With respect this review is chasing the wrong suspect. It is not the national GP contract which is the significant barrier to innovation. It is a complex combination of:
– inadequate training and retaining of GPs, practice nurses ANPs and others.
– inadequate investment in premises and diagnostics suitable for community integrated healthcare.
– a lack of power or interest in NHS commissioners in redirecting resources away from secondary care and into innovative GP led models which will reduce the burden on, and cost of, secondary care.
– a lack of prioritising Lifestyle (as) Medicine. The NHS remains a service mainly for illness, and not for self directed health improvement.

Stephen Savory 4 April, 2023 11:53 am

Suspect my local ‘system’ will continue to bail out secondary care to the detriment of investment / innovation in the GP independent contractor model.

Turn out The Lights 4 April, 2023 12:19 pm

Aprils fool is lasting a long time this year.Does this no mean now that the BMA as a union dissapears in a puff of beaurocratic flatus.

Giles Elrlngton 4 April, 2023 12:19 pm

Please can we also end the national contract for MPs some of whom haven’t delivered much of value.

David Church 4 April, 2023 12:29 pm

Leaving aside questions of ‘independence’ of the ‘previous’ Health Minister, does
“The review found that national contracts present ‘a significant barrier to local leaders wanting to work in innovative and transformational ways.” actually mean :
“government is annoyed ‘that national contracts present a significant barrier to local leaders’ being offered bribes to switch established Partnership GMS contracts to private american multinationals (in which they have financial interests) so that they can exploit the British population even more” ?
And how did they miss the existing opportunities for ICBs to fund local innovations, and even to fund existing GP practices well enough that they could recruit enough GPs to develop more innovations, like GPs did in the 70s?
‘Buy out’ would be a much better solution than ‘hand back’ to Partnerships struggling to recruit, but that does NOT appear to be the intention here, and I think this is somewhat more dangerous.

Some" Bloke 4 April, 2023 12:42 pm

Surprisingly fresh common sense approach, at least as reported. Let’s hope this has any influence on Gov position and let’s watch how negotiating new contract goes. Worried about division that already is present on our side. It’s very hard to represent practices with such variety of needs and priorities. If they are talking about some bespoke deals for each surgery, or be it PCN or region, that might just give little more boyancy to the sinking ship that is our general practice.

Finola ONeill 4 April, 2023 12:49 pm

barrier to privatising general practice, privatising the NHS and exploiting NHS data.
The latter is worth £10 billion per year by their own accountants assessment.
These are interesting times we live in.
Simon Stevens worked for years in private US healthcare companies.
Came back here and worked their theory into NHS long term plan.
They developed the “population health” framework in US where healthcare is private thinking preventing ill health would be cheaper.
Actually preventing ill health is not achieved by healthcare.
It is achieved by public health; ie primary prevention.
All the stuff Dimbleby wanted doing for food industry and obesity/diabetes the main preventable health issue in developed countries.
He’s just walked out as govt adviser due to their insane inaction in tax and advertising on fast food/processed food etc.
It is the same as smoking really.
You don’t tackle obesity by telling people they are fat and telling them about diet.
Central govt makes changes to support healthy eating; ie tax/advertising.
Now in the US, healthcare is private, public health is govt; so for them “population health”, ie secondary prevention; wait till people are obese/+/-have type 2 diabetes and then plough money into weight management schemes.
I actually don’t think it’ll be particularly effective; but don’t worry they have lots of nice pharmaceutical options to sell us like liraglutide.
But for the UK “population health” is a nonsense.
Healthcare and public health are both publicly funded.
Public health measures are clear. It’s all in the Dimbleby report the government won’t do.
No. They want the data, the pharmaceutical industry, the genome tech industry, medical tech industry and Big data. And probably private healthcare.
And for that my friends GP partners are standing in the way.
Interesting times.

Darren Tymens 4 April, 2023 2:19 pm

A national contract is not the problem. A national contract is a good thing. It sets minimum standards for funding and care, and prevents there being a wide disparity of offerings dependent on the whims and biases of commissioners. It prevents a literal postcode lottery of standards. There was never any barrier to investing further in general practice services – LCSs were an entirely reasonable mechanism for his – and a national contract simply prevented local commissioners from raiding the general practice budget to pay for the spendthrifts in secondary care. Patricia Hewitt and the ICS leaders that directed her know this, of course. This is just more command-and-control dressed up as an opportunity. Prepare for PCN-based contracts, and takeovers by hospitals and big american mulitnationals.

Centreground Centreground 4 April, 2023 2:42 pm

Attend a meeting of Clinical Directors to see the stark face of failure and this is an efficient way of seeing collections of self serving board hoppers who have now become overpaid CDs and you can easily see why the NHS has been led towards disaster

Nathaniel Dixon 4 April, 2023 5:13 pm

Interesting to get Patricia Hewitt involved – she was responsible for one of the large exodus of junior doctors as Health secretary and seems keen to help other countries recruit GPs now as well.

Dr No 4 April, 2023 10:38 pm

Ahh FFS more managerialist bullshit from bullshit managerialists. The traditional GP model is just fine, efficient, provides continuity of care, and would work just fine if properly funded, and the micromanagement backed-off. But this would involve trusting professionals and making their working lives better. Anathema to the Tory scum we have in government. They see themselves in us, and treat us accordingly. The classic transference.

Bonglim Bong 5 April, 2023 12:26 am

2016 – PMS contracts must end – they provide too much variation between different areas and therefore an unfair, inconsistent playing field.

2023 more local contracts needed so that local services can respond to the needs of local health ecosystems.

David Jenner 5 April, 2023 7:48 am

Colleagues , so
Much good sense written here , especially Bonglim , Darren and Finola.
The report completely misses the point about workforce which is the major threat to NHS.
That needs central investment in training places for doctors, nurses and paramedics etc , not local solutions.

And central government hates devolving power to
Local systems, which can actually help GPs because they realise how vital they are to their local system .
In Devon they have guaranteed income
On 2022/2023 QOF whereas government would not .
Current government have ended PMS and brought in PCN DES to give national standards.
I suspect this report will get as much attention as the Health Select Committee report which said GPs were in crisis and scrap the QOF and IIF and put money into core ( and was actually a really good report )
But Hewitt was a Labour MP though and could Labour adopt this as their manifesto , after all Wes Streeting wants to “ rip up the contract” and salary us all.
My call, this government will just bury this , as they love central control but Labour might look at it for their manifesto ( but then ignore it as they will need central control of NHS too) before it vaporises into thin air.
Of note also, not many private providers making a profit from GP services and we all know how well private companies run GP support services !

A Non 5 April, 2023 10:54 am

So I’ve been gradually moving away from General Practice over a number of years. For me it went- GP Registrar, GP locum, salaried GP, Salaried GP plus GPWSi, then GP Locum again, now research Dr with a bit of GP locum on the side. Maybe I’ll drop the GP all together? Trying to keep an open mind, retaining the possibility of return if things improve. They haven’t and life as a GP has become more distant as each month passes. So here we are in 2023, another report, Patricia Hewitt ..who is? A career politician, started off in Labour party, was health secretary once, now she’s old and ‘wise’ She’s a politician of a generation that has overseen and managed what has turned out to be the virtual collapse of general practice. Here she is with her vision for the future. We need ‘radical reform’ apparently. What a novel idea. It’s depressing to watch. I’m glad i did what I did, moving out of General Practice was the right thing to do. Maintaining some connection was right too, but I’m tired of maintaining the GP title tbh. It has become embarrassing. Think I’ll call myself a research Dr from now on. Maybe drop the performers list pretence and try and get out if this habit of reading pulse. The stuff I used to get so outraged about, like ‘this can not really be happening? Why are they doing this? Don’t they know GPs will just get more more over loaded and collapse under the weight of it all?!” ..well its all kind of happened now and yeah leaving was the right call.

Dave Haddock 5 April, 2023 6:55 pm

Letter In The Times today, Wednesday 05 April.

“The causes of GP disillusionment are multifactorial and include an increasing proportion of elderly patients with complex medical and social conditions, a merry-go-round of hospital referrals and communications, Care Quality Commission inspections, annual appraisals and compliance with ever-changing edicts from innumerable external agencies. However, the greatest burden has arisen from increased regulation, scrutiny and fear of litigation, leading to the need to record every patient-doctor interaction in time-consuming detail. It is the loss of GPs’ autonomy over how to manage their patients that has led to disillusionment, low morale and an increased outflow of doctors. It is these latter, unquantifiable issues that need to be addressed, otherwise primary care will continue to haemorrhage doctors.
Dr James Sherifi”