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Next GP contract should be ‘less target-driven’, says NHSE primary care chief

Next GP contract should be ‘less target-driven’, says NHSE primary care chief

NHS England’s primary care chief has said that general practice should move to a less target-based contract.

Speaking at the Best Practice conference in Birmingham this week, NHS England national director for primary care Dr Amanda Doyle also said that NHS England is trying to be ‘less micromanaging’.

Meanwhile, BMA GP negotiators also speaking at the conference proposed a new payment-per-contact model as part of the new GP contract starting in 2024.

Dr Doyle told delegates: ‘Can we effectively use funding if we chop it up into little bits, with £1.50 per patient for this and 25p for that? No, I don’t think we can.

‘I think we need to move to a less target-driven approach to how we contract for primary care.’

She added: ‘We’re looking at how do we move in the direction of being less micromanaging, taking a more trust-based approach to the contract so that people can prioritise the patients who are most at risk and see if they can make a difference.’

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’.

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Dr Doyle further stressed that NHS England is ‘absolutely committed’ to reducing workload dumping on GPs by hospitals.

She said: ‘It probably surprises this audience to hear that all that stuff is already in the hospital contract – we put into the hospital contract that you shouldn’t do these things. No one takes any notice. 

‘It’s not in anybody’s interest to have this system, we have to reset it.’

She added: ‘The trouble is that in a system that’s under so much pressure – we can’t kid ourselves that hospitals aren’t just as pressured as general practice is – everybody’s instinct is to protect their own workload. And so it just gets passed back. 

‘Absolutely, we are committed to doing something about that.’ 

Dr Doyle said that the Government is ‘being really quite supportive’ and has ‘written out to all the other departments about things they shouldn’t be asking GPs to do’.

And she reiterated that NHS England has commissioned the Academy of Medical Royal Colleges to ‘jointly come up with a reset’ of the primary/secondary care interface.

NHS England’s board last week issued a stark warning that demand for GP appointments is at record levels and ‘outstrips’ capacity.



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

Bonglim Bong 14 October, 2022 1:45 pm

We are going to be less micromanaging……
Also you can use you AARS funds for a very specific role involving data management and digital integration with the use of a very specific amount of funding for that role with no variations. And you must get exactly the number of those roles as we specify. They must then be used in exactly the way we say, so we can have more access to data to micromanage you further.

But after that less micromanaging.

Turn out The Lights 14 October, 2022 3:01 pm

Do you trust them!

Turn out The Lights 14 October, 2022 4:51 pm

NHSE and the BMA.

David Jarvis 14 October, 2022 6:22 pm

I feel out of step. Much of QOF did put resources into managing chronic diseases. I look at how disease registers changed. Pre QOF we were out of step with our rate of diabetics. Post Qof the difference reduced suggesting to me a lo of undiagnosed un managed illness. I would love to see an analysis of the impact of this funding on management of these diseases. Has hypertension improved. I know some room for gaming but most GP’s I know have expanded workforce with the funds and improved genuinely the measured markers. I may be wrong believing this is beneficial health wise. But it may actually have made a difference and the key is because money followed workload.

Dylan Summers 15 December, 2022 2:25 pm


The excellent Des Spence wrote a memorable column about QOF in the BMJ in 2013. I have to say his views are similar to mine.