Exclusive The GPC and NHS England are moving towards a negotiated deal for next year’s contract which could see a cut in QOF workload in exchange for GPs taking on 24-hour ‘named clinician’ responsibility for vulnerable elderly patients, Pulse has learned.
Dr Paul Charlson, a leading Conservative GP with close links to leading figures within both NHS England and the GPC, told Pulse there were ‘real grounds for optimism for GPs’ in the English contract negotiations and predicted they were likely to conclude ‘within three or four weeks’. Two other senior GPs familiar with the process confirmed they also expected to see a reduction in the QOF and the introduction of ‘named GP’ responsibilites.
However it is understood that a number of sticking points remain, with talks ongoing and discussions over extended hours and the removal of practice boundaries likely to be key.
Last month health secretary Jeremy Hunt set out plans for sweeping reforms to the GP contract in England from next April, which included a ‘dramatic simplification’ in ‘box-ticking’ targets and incentives and pushing for GPs to take on individual responsibility for the care of vulnerable elderly patients.
At the time, the GPC expressed concerns over Mr Hunt’s ‘named clinician’ plans unless further funding was found. But Dr Charlson said he believed negotiators were now ‘likely’ to agree to the move, with talks focusing on freeing up funding through removing some QOF targets and possibly shifting funding into the global sum.
Dr Charlson, a GP in Yorkshire and vice chair of Conservative Health, who was a close adviser to Andrew Lansley and continues to regularly meet with the Department of Health and NHS England, said he believed ministers were also keen to push ahead with changes to practice boundaries from next April. The move, which comes after an interim report into several pilots, could see patients allowed to register with a practice even if they do not live in its catchment area, but with GPs relieved of home-visiting responsibilites for those patients.
In a Big Interview with Pulse and subsequent interview on negotiations, Dr Charlson said: ‘I think GPs need to remain optimistic regarding the new contract. QOF will be simplified and some money will be shifted to global sum. There are likely to be some incentives for care of complex elderly [as part of] a move to family doctor[ing].’
‘[There is also] the likelihood of practices taking on patients out of area without home visiting responsibility.’
‘I think there are real grounds for optimism and many practices will be doing many of the new incentivised things already.’
Speaking about the ‘named clinician’ plans, he said: ‘I think there will be some negotiation around it but I think it is likely that that will be accepted. I get the gist that that is what may happen. If you are going to negotiate you have got to give a bit, and also try to see it from the public’s perspective. Joe Public is looking at “how can I get access to my GP, who is going to look after me if I fall in the middle of the night?”.’
‘The plank of the Government’s idea is to go back to the old-fashioned family doctor so they are trying to shift it back a little that way by reducing beauraucracy and giving GPs more responsibility for coordinating care. I think the percentage of pay linked to QOF will stay largely the same but that there will be fewer targets.’
He said any move to write David Cameron’s recent pledge for seven-day access to GPs into the contract was likely to prove a sticking point, however.
‘Who is going to pay for it, how are you going to fund that extra staff necessary?’ he said. ‘It has got to be viable financially if the contract is to change. So that could be a big sticking point.’
He added: ‘The 8am to 8pm [scheme] is very unlikely to be in the contract, although it is probably seen as aspirational - and 24-hour responsibility may be not as onerous as many fear.’
Dr Charlson’s analysis of negotiations was largely backed by two other senior GPs who are not directly involved in talks but are familiar with the process, and who asked not to be named. Both said they believed the GPC was set to agree to the named clinician role in exchange for a reduction in QOF targets, but that a number of sticking points remain. However they were less certain that funding removed from the QOF would be shifted into the global sum, with one saying only that there were ‘a number of options’.
GPC deputy chair Dr Richard Vautrey said: ‘It is interesting what he says, but Dr Charlson is not involved in negotiations so I think we will have to conclude negotiations and then let GPs know the full package. Negotiations are constructive and we do hope that we can reach a conclusion that GPs feel is fair and reasonable.’
‘We have always said that GPs will provide - and want to provide - good quality personalised care to the most needy members of their practice, particularly those who are vulnerable, those who are older and those with complex problems. But one of the problems that we have had in recent years, and especially in the last year, has been the huge workload and imposed box-ticking bureaucracy, which has made this particularly difficult to do. So we do need to make a significant reduction in that oppressive bureaucracy that every practice experiences. And by doing that, that will free practices and GPs up to a greater extent to be able to do things that they have been trained to do.’
On the removal of practice boundaries, he said: ‘I think our position on practice boundaries has been made very clear, and your reports in recent months showed uptake to the pilot from patients was very poor. But the Government remains committed to continuing that policy and I think we need to look at that and see how it might impact practices if it was to be rolled out on a larger scale.’
Dr Vautrey added: ‘We hope for a good outcome for all sides, but until we have actually signed the document and dotted the i’s and crossed the t’s we won’t know for sure.’
A spokesperson for NHS England said: ‘GP contract negotiations are still ongoing and it would be inappropriate for us to comment until discussions conclude.’