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Single contract will inevitably create winners and losers, GPC warns

By Gareth Iacobucci

The creation of a single GP contract will destabilise general practice and inevitably create a set of winners and losers because of the chronic shortage of funding in primary care, a GP leader has warned.

Speaking in a debate on the future of the GP contract at the NAPC conference in Birmingham, GPC negotiator Dr Chaand Nagpaul said that the 'only logical way' that the Government could move towards a system of greater equity in GP funding would be to take funding out of some practices and give it to others.

The recent NHS White paper states clearly the Government's wish to move to a single contractual mechanism for general practice over time, which is set to spell the end of the GMS/PMS split.

Dr Nagpaul said that the GPC's preferred option would be to 'level upwards' by investing different amounts in GP practices year on year in order to move towards a system of equitable funding. But he acknowledged this would be extremely difficult to achieve in the current financial climate.

He said: 'If you are to move towards equity, the only logical conclusion is you will have to have some winning and some losing. We would prefer leveling upwards and investing more year on year but there isn't the money to do that. The only logical way is to redistribute which would disrupt a lot of practices.'

Dr Nagpaul said the GPC did not anticipate the new contract seeing the light of day immediately, predicting that negotiations over any new deal would be on hold until health secretary Andrew Lansley's GP commissioning reforms were more firmly entrenched.

He said: 'It's not today's priority. I suspect the Secretray of State will want to get GP commissioning off the ground. But it is a stated aim.'

David Stout, head of the PCT Network at the NHS Confederation, also on the debate panel, said it would be increasingly impossible to justify two different contracts when they are all contracted by the national NHS Commissioning board.

'The White paper says the NHS Commissioning Board will commission primary care. At that point, you can't argue that apparently random variation is viable anymore.'

Dr Pauline Brimblecombe, a GP and commissioning consortia lead in Cambridge, suggested that one solution to the disparity in GP funding would be for commissioning and provision budgets to come from the same pot.

But Dr Nagpaul rejected this out of hand, saying there were 'many reasons' why the GPC's strong desire for budgets to be kept separate should be adhered to.

Single contract will inevitably create winners and losers, GPC warns Click here for more live coverage from the NAPC conference More from the NAPC conference