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GP contract to be rewritten to promote integrated care

The GMS contract is set to be overhauled to incentivise GPs to provide integrated care, the Department of Health has revealed.

In its official response to the NHS Future Forum's ‘second phase' report, published today, the DH said it accepted all of the forum's recommendations including a call for integrated care to be incentivised in the GMS contract.

The DH said it would charge the NHS Commissioning Board with exploring ways of incentivising integrated care in future GMS negotiations as GPs have an ‘increasingly important role' to play in treating patients with complex needs as the NHS shifts more care to community settings.

The DH report states: ‘We welcome the recommendation that the board should promote integrative approaches to out-of-hospital care and that the board should explore how to incentivise integrated care in General Medical Services contract negotiations.'

The DH response acknowledged the NHS Future Forum's view, reported by Pulse this morning, that handing CCGs ‘multi-year' settlement budgets would allow GP commissioners the stability to commission integrated care but stopped short of giving full-backing for the move. Instead the DH argued that the level of upheaval in the NHS means ‘multi-year settlements' need to be considered once ‘new organisational structures have settled in'.

The DH report states: ‘One option the board may wish to consider in due course would be indicative multi-year settlements that could be confirmed (and altered if needs be) year-on-year. This is the current approach for local government.'

NHS Future Forum chair Professor Steve Field said: 'We are making robust and ambitious recommendations to the NHS and to Government. We have heard an enormous amount of support for the shift to patient-centred care but also frustration that this has not yet been achieved. This must now become a reality for patients across England and health and social care professionals must lead the way.'

Health secretary Andrew Lansley said: 'We are taking forward modernisation within the NHS in partnership with professional leaders from the service. I'm pleased to accept all their recommendations.'

Jo Webber, director of the NHS Confederation welcomed the focus on integration of care, but pointed out that ‘people have been talking about this for a long time'.

She said: ‘We need to be honest that, so far, integration has only been successful as a result of the efforts of unusually determined local leaders who have been prepared to take a lot of risks and swim against the tide.'

In other key developments, the DH said that CCGs will have to prove they have the ‘will and capability' to commission integrated care before being granted full statutory powers. The Department also agreed with the forum's call for PCT clusters to delegate decision-making responsibilities to local CCGs ‘as soon as possible' and said NHS managers will need to demonstrate that they are giving GP commissioners appropriate financial and staff support to run CCGs.

The DH also lent its backing to the forum's call for there to be ‘a clear presumption in favour' of hospital discharge summaries being made available to the GP and patient at the point of discharge. The DH also acknowledged the NHS Future Forum's call for GPs to be given support for the ‘financial and time burden' placed on practices by the drive to give all patients access to their records online, and said more detailed plans will be set out in their forthcoming information strategy.

The DH gave qualified support to the forum's controversial call for GPs and health professionals to ‘make every contact count' by talking to patients about their general health and lifestyle risk factors at every appointment, whatever its purpose.The report states: ‘The Government agrees that it should be the role of all healthcare workers in the NHS to make use of those contacts wherever appropriate, with the aim of improving the public's health and wellbeing and reducing health inequalities.'

When trailed in the national press, the policy was met with heavy criticism. RCGP chair Dr Clare Gerada told the Guardian the policy was ‘muddled' and warned patients would be put off if ‘lectured' by GPs, while the Patients Association claimed it could lead clinicians to ‘inappropriately badger and lecture patients each time that they see them'.


Watch Professor Steve Field discuss the recommendations in the NHS Future Forum report