GP practices which decide to leave the new ‘voluntary’ contract could be forced to give up their patients, according to guidance published today by NHS England.
NHS England had previously promised that GP practices fully entering into a Multispecialty Community Provider (MCP) contract would have a right to return to their GMS or PMS contract.
But the updated draft guidance said this option would only be made available to practice in two-year intervals, and if the practices were more than two years into the contract their patients would not follow the practices unless the patients themselves specifically requested to.
The document said: ‘If the GP reactivated in the first two years of the [c]ontract the default would be that patients previously on their registered list follow the GP to be re-registered with the practice. If they reactivate after these first two years the patients will remain with the MCP unless they request to follow the GP.’
If a GP practice does decide to leave an MCP contract, commissioners will write to all of their patients to advise them of their right to chose to stay with the MCP or to follow their GP, NHS England added.
The document said: ‘This reflects the need to balance stability and choice to patients, and reflects the ongoing changes to a practice and MCP’s resident population over time.’
Furthermore, the new guidance states that a GMS or PMS contract can only be reactivated once, meaning all the partners originally under the contract will have to agree that it should be reactivated.
The document said: ‘For example, if half a partnership wished to reactivate and half preferred to stay in the MCP, the partners together would have to agree on their preferred course of action.’
NHS England said that GPs ‘have expressed concern that upon reactivation they could find themselves in competition with the MCP’. And it seemed to confirm this was the case, adding that ‘a GP considering a return to GMS/PMS will need to articulate how the care the patient will receive from the new practice will compare to the care provided by the MCP’.
NHS England said that, in response ‘a GP may wish to reactivate GMS/PMS and sign an integration agreement to become partially-integrated with the MCP’.
‘GPs will of course want to carefully consider the options available to them and balance their personal interests with those of their patients,’ the document added.
NHS England further admitted that GPs going back to their original contract ‘will become less practical as time passes’ but said it hoped that ‘by offering regular opportunities throughout the contract, practices and MCPs are able to make informed decisions about the terms under which they are operating’.
NHS England guidance last year said GP practices could hold virtual, partial and fully integrated MCP contracts – only the latter which would see their contracts replaced.
The BMA’s GP Committee has advised practices to not ‘make any hasty decisions’ with regards to MCPs, and to not to feel pressured to give up their GP contracts.
Commenting on the latest guidance, GPC contracts and regulations lead Dr Robert Morley said: ‘The right to return after “suspension” of the GMS/PMS contract is entirely illusory as the default position is that patients stay registered with the MCP/ACO, not the practice.
‘In effect suspending the contract means giving up the practice and is wholly inadvisable.’