GPs can expect major changes to their contract terms by 2014 – including greater responsibility for out-of-hours care and a major reduction in box-ticking targets – after health secretary Jeremy Hunt revealed a list of changes he intends to make within the next few months.
Speaking at a conference on the future of primary care at the King’s Fund think tank in central London, Mr Hunt said: ‘Without a profound reform of out-of-hospital care the NHS will be simply unsustainable, so this is an issue of critical importance.’
‘This is the first time I have pulled together a number of strands of the current Government’s thinking for reforms of primary care.’
The key announcements by Mr Hunt include:
– the GP contract will be rewritten by next April to ensure a ‘dramatic simplification’ in targets and incentives, with the aim of removing the ‘bureaucratic overlay to the work of a GP’
– additional funding will be channelled to general practice to help support GPs’ new responsibilities, and will come from savings made by a reduction in unplanned admissions
– GPs’ new ‘named clinician’ role, which will initially cover vulnerable elderly patients from next April, will involve GPs taking overall responsibility for patients’ care, ensuring they have proper care plans, proactively managing their care and deciding how out-of-hours care should be managed in their area
– further modelling will be carried out to see if current plans to scale up the GP workforce are sufficient, and ministers may aim to recruit even more additional GPs as a result
Mr Hunt said the new ‘named GP’ role represented a return to a traditional model of general practice which had been lost as a result of the additional demands of the 2004 GP contract.
He said: ‘We need to go further than just having a named GP, so from next April I would like to empower those GPs to look after vulnerable older people on their lists, which I think GPs always wanted to when they joined general practice.’
‘To be able to take responsibility for ensuring their patients have proper care plans and for supporting them to look after themselves. To have the time to contact patients proactively, not just when they walk through the surgery door.’
‘To be able to decide how best out-of-hours care should be managed in their local area, including for example choosing to take back responsibility at a practice level for delivering out-of-hours care if they wish. To be able to decide what sort of care their most vulnerable patients get from district nurses.’
‘Not all GP practices will be able to do this on their own, many will choose to do so through federations, or indeed through their CCGs. And nor do I think that GPs will personally administer all these things on their own. I recognise that GPs work hard and need time off. But if they themselves are not able to see a patient out of hours or do a home visit they should make sure another clinician can.’
Mr Hunt acknowledged that in order to take on these additional responsiblities the NHS would have to expand the general practice workforce. While Health Education England had already been asked to recruit an additional 2,000 GPs and increase the proportion of medical students choosing general practice to 50%, he said, further modelling on whether even more GPs were needed was planned.
‘It may be that we need to increase those numbers still further,’ he said.
He added: ‘But we also need to look at the burdens that we place on general practice and give them better support in managing demand.’
‘QOF, DES, LES and a myriad of other targets were all introduced with the best of motives, but they have created a bureaucratic overlay to the work of a GP which means that there is often a conflict between the requirements of a patient and the needs for a practice to generate income. So we need a dramatic simplification of targets and incentives imposed on GPs – to give them back the professional discretion to spend more time with patients who need it the most.’
Mr Hunt also signalled that his planned contract changes would be tied to a rise in overall funding for general practice.
‘We need to recognise that if more proactive general practice is going to save the NHS money by reducing unplanned admissions to hospital, then some of that saving needs to go back into general practice to pay for the higher levels of care,’ he said. ‘Precisely how will be a matter for detailed negotiation later on in the year, but we need to be ready to go with a new approach for how we care for vulnerable older people for 2014.’
Asked by King’s Fund chief executive Professor Chris Ham whether he was confident he would be able to negotiate such far-reaching changes to the GP contract within just a few months, Mr Hunt said: ‘I am, actually.’
Responding to Mr Hunt’s speech, RCGP chair Professor Clare Gerada said: ‘We welcome the health secretary’s intention to shift the focus from hospitals to primary care, which is essential if we are to restore the NHS to a sustainable footing.’
‘We are also pleased that he recognises the urgent need to tackle the shortage of family doctors on the ground, and that he rightly sees the dire need to recruit more GPs in order that safe patient care can continue to be delivered in the community.’
‘However, this speech will not end the crisis in general practice. We urgently need a clear commitment for sufficient funding to enable general practice to deliver more services for their patients.’
‘We urge Mr Hunt to be bolder in recognising the need for a shift in NHS expenditure – so that general practice receives its fair share of NHS funding and GPs can deliver the care that our patients need and deserve.’