GPC to push for optional commissioning DES to avoid GP contract rewrite

By Gareth Iacobucci

Exclusive: GP negotiators will resist the Government's attempts to make commissioning responsibility part of the core GP contract, and will instead push for it to be offered as an optional enhanced service, Pulse has learned.

GPC leaders revealed this week that they have already begun preliminary dialogue with the Government over its plans, and will look to step up talks when the consultation on the white paper plans closes in October. But the stance appears to put the GPC on a collision course with ministers, who have pledged to write commissioning responsibility into the GP contract.

The Government made clear in its NHS white paper that all GPs will be expected to join commissioning consortiums when PCTs are abolished in 2013, and outlined plans to link ‘a proportion of GP practice income to the outcomes that practices achieve collaboratively through commissioning consortia'. The far-reaching proposals would make all GPs contractually responsible for commissioning, and tie a proportion of their GMS income to the results of the consortia they belong to.

The white paper also contained plans to 'establish a single contractual and funding model' for GPs, and health secretary Andrew Lansley is on record as saying there will be ‘a need for contractual changes with GPs.'

But GP negotiators told Pulse this week they would be pushing hard for commissioning to be offered outside the core contract thorough a DES or locally negotiated LESs, to avoid it becoming compulsory for practices.

Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, said the GPC was adamant that there was no need to ‘tamper with the contract'.

He said: ‘We would support incentivising practices to be involved in commissioning via an enhanced service. That is our position. We don't think there's any need to unpick the contract in order to achieve this.'

‘It's too early to comment on how the detail might work. It could operate as a DES, but there may be local flexibilities.'

‘What we'd want to negotiate is something practices would want to sign up to.'

Dr Nagpaul said the GPC accepted that all GPs would be required to join consortia under the plans, but warned the Government it risked repeating the failures of practice-based commissioning if it forced GPs to accept contractual responsibility for commissioning.

He said: ‘The Government needs to learn the lesson of why PBC failed, it took too much of a stick-like approach. Making it compulsory would seem rather stick-like.'

Dr Brian Dunn, another UK-wide GPC negotiator and chair of GPC Northern Ireland, said developing an enhanced service would make it easier for the devolved nations to start commissioning without breaking up the UK contract.

‘Rather than having commissioning as part of the core contract, it would be much more sensible to have an enhanced service for commissioning which could be used in the other countries if they wanted,' he said.

Dr Julian Hall, a GP in Birmingham, said: ‘The GPC should fight to protect our contract rather than merely accepting dictated change.'

A DH spokesperson said: ‘We will be discussing with the BMA and other NHS partners the changes necessary to empower GPs to achieve improved outcomes for their patients.'

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