By Gareth Iacobucci
Exclusive: The Government has backed calls from senior NHS managers for the GP contract to be torn up and rewritten to include tougher powers for dealing with poor performers, and financial incentives for GPs to work in polysystems.
An NHS Confederation report, Rising To The Challenge, has outlined radical proposals to bring GPs under tighter control. But it also calls for GPs to be offered incentives for taking greater responsibility for out-of-hours care, aligning NHS bosses closely with Conservative plans for health.
Other proposals include removing the MPIG, reviewing seniority payments, allowing greater local flexibility to negotiate GP contracts, and using practice accreditation as a basis to reward disease management expertise.
The Government's public backing for the plans comes after recent leaked discussions between the Department of Health and SHA directors highlighted mounting pressure from NHS managers to be able to ‘hire and fire GPs'.
In the report, the Confederation makes clear its desire for a new GP contract to put greater pressure on poor performers. ‘We believe a new GP contract is needed to support reform, better integration and greater choice of GP.
‘Specifically, it should include strengthening contractual levers to deal with poor or unresponsive services, [and] creating incentives for practices to work federally and rewards for increased scale.'
The report also calls on trusts to make ‘difficult commissioning decisions' to eliminate spending variations as a result of the Government's drive to increase capacity, which it blames for increasing demand from patients.
‘There is much that NHS organisations can do to improve services and make efficiency savings,' it says. ‘Increased capacity at A&E and walk-in centres has led to increased utilisation of services.'
NHS Confederation chief executive Steve Barnett said: ‘Both clinicians and managers need to focus on rooting out inefficiencies in the system, reducing costs and redesigning services.'
A DH spokesperson said the recommendations were in line with the direction of travel in their five-year plan for the NHS: ‘We have signalled the need to drive further improvements in the quality and efficiency of primary care. Annual negotiations between NHS Employers and the BMA will clearly need to consider for 2011/12 onwards how best the GP contract can support these improvements.'
But Dr Elka Elston, a GP in Immingham, Humberside, criticised the top-down approach of the proposals: ‘It's not fair on the majority to change all the contract arrangements just to target the minority of practices that aren't performing well.'
• Allow greater local flexibility
• Removing MPIG
• Reviewing seniority payments and premises funding
• Local QOF indicators
• Contractual levers to deal with poor or unresponsive services
• Aligning general practice and pharmacy contract mechanisms
• Incentivising practices to work in federations, rewarding for increased scale and greater out-of-hours responsibility
Source: Rising to The Challenge, NHS Confederation
• Allowing greater local flexibility to negotiate GP contracts
• Using accreditation as a basis for rewarding disease management expertise
Source: Rising to the challenge, NHS Confederation