The proposed GP contract will lead to GPs delivering at least twice the efficiency savings of other parts of the NHS, the NHS Alliance has warned.
NHS Alliance GP Network lead Dr David Jenner urged the Government to consider the impact the contract proposals will have on GP workload. He argued in a blog post that practices are being asked to do much more for the same or less than other parts of the NHS, with GP services already cash-limited while hospitals continue to be paid by results.
In the NHS Alliance’s response to the Government’s consultation on its proposals for the 2013/14 GP contract, Dr Jenner also urged the Government to hold off imposing QOF changes until all read codes, business rules and guidance are in place. They said this should be done by April or, since this is unlikely, be deferred to later in the year.
The GPC has said the average practice stands to lose £31,000 from QOF changes alone.
NHS Alliance further raised concerns over Government plans to change the allocation formula by removing the MPIG over seven years from 2014/15 and rejigging the Carr-Hill formula to take into account deprivation. The Alliance said any changes to the formula should be widely consulted on before being imposed.
Dr Jenner wrote: ‘Yes, the country is facing challenging times, but the threatened imposed contract would appearto set general practices a much stiffer efficiency target than the 4% the rest of the NHS is facing - indeed the secretary of state admitted GP practices were seeing 3.7% more activity at last year’s NHS Alliance Conference.’
‘With 15% of QOF also becoming core contract policed by the CQC, and having to be re-earnt through a series of DESs that are weakly evidenced at best, I estimate general practice is being asked to deliver at least twice the efficiency savings of other parts of the NHS, whilst being asked to do more and more, including commissioning the vast majority of health services through CCGs.’
Dr Jenner added that medical accountants were warning of a 10% reduction in drawings, increased pension contributions and ever dwindling limits on tax free pension contributions. This led to a ‘perfect storm brewing for GP recruitment and retention’, especially when taking into account the introduction of the CQC, revalidation going live and enforced membership of CCGs. ‘Add in a move to four year training for GPs, and very soon I fear we will face a pre-2003 scenario again of a crisis in the GP workforce,’ he said.
He said: ‘General practice is at capacity now, much more will break it. Could this be the plan? Or is it just the unforeseen consequences of a series of policies that have not really been thought through? I’m really not sure!’’