This site is intended for health professionals only

GP contract could be set for ‘radical’ overhaul as LMCs back payment by activity

The GP contract could be set for a radical overhaul, with payment to be potentially based on activity rather than on capitation basis, after LMC leaders voted in favour of such a move.

Despite GPC setting out its concerns for such a move, LMCs voted 53% in favour of a motion that said the ‘current formula based core contract is unfit for purpose’, and should be ‘replaced by a payment by activity contract which directly links workload to resource’.

This proved a departure from last year, when a similar vote was lost.

Dr Jim Kelly from Kent LMC, who lost the vote last year, said: ‘The Government wants us to do more. They want to move more work our way and the way to incentivise activity is by paying for activity.

‘The problem with the NHS is that we are the most efficient part of it and we’re all on block contracts, effectively. Capitation [payment] is a block contract which means that no matter how hard you work you don’t get any more money.’

He said this was a ‘radical’ motion, adding: ‘It is something that is designed to shake things up. But radical problems need radical solutions.’

Speaking against, Dr Rob Bailey from Cambridgeshire LMC warned that it would lead to increased bureaucracy for GPs who would need to report their activity in order to get paid, similar to reporting QOF.

He said: ‘It would be lovely if we were paid for every item of service we provide, but wouldn’t we risk breaking the link between our patient list and the freedom to do the right thing by introducing target-driven, bean-counting incentives, And who is going to do the counting?’

Speaking ahead of the vote, GPC chair Dr Chaand Nagpaul said: ‘I think there are some real issues here, which conference needs to decide on. I just want say though, that we have seen many problems with payment by result in hospitals.

‘We have seen many perverse effects and NHS England is minded to replace payment by result in hospitals with a capitated approach, simply because they believe that that system is driving activity at the expense of quality.

‘So we have a climate where I don’t believe we are going to see a promotion of payment by activity in hospital. I just want you to consider that.’

Earlier in the same session on funding, LMC representatives also voted for a halt to the demise of seniority payments, which the Government started phasing out last year.

The motion in full:

KENT: That conference believes that the current formula based core contract is unfit for purpose:

(i) in that it fails to recognise the ever increasing demand for access and complex care associated with model 21st century general practice

(ii) in that it fails to incentivise the expansion of primary care needed to cope with the vision set out in the NHS Five Year Forward View

(iii) and should be replaced by a payment by activity contract which directly links workload to resource.