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GPs set for central contracts in deal to take over from PCOs

By Ian Quinn

Exclusive: Ministers want to scrap GMS and PMS contracts and replace them with a radical new system of GP pay, under which practices report not to primary care organisations but directly to the new national NHS Board, senior managers have been told.

Health secretary Andrew Lansley is believed to want centrally held contracts to underpin plans for GPs to take on as much as 95% of the commissioning functions of PCOs, including responsibility for organising out-of-hours care.

GPs could opt out of responsibility for commissioning under the plans, but might have to accept a pay cut if they were to do so, Pulse understands.

The overhaul of the GP contract would massively reduce the power of PCOs and could see practices granted funding directly from the NHS Board for management and back-office functions. But it could also see GPs come under tough new performance management directly from a national level.

Nigel Edwards, acting chief executive of the NHS Confederation, said health service leaders had been told to prepare for the shake-up, which could happen within months.

He said: ‘This is what I have heard from very senior, very well-placed sources. There are clearly huge areas involved legally to negotiate – this is a fast-moving situation.'

Highly placed sources have suggested basic practice funding under the new system would amount to less than the existing global sum and QOF combined, with extra payments for GPs who threw themselves into commissioning.

Dr David Jenner, practice-based commissioning lead for the NHS Alliance and a GP in Cullompton, Devon, said: ‘We're pretty sure GMS and PMS contracts will replaced by a contract between the heath board and the practice and that PCOs will no longer hold the contract. I have been told by one source the value of the contract would be less than GMS plus QOF combined, but I understand the Government is looking at additional incentives.'

GPC negotiators insisted they had been promised the GP contract would not be radically reshaped and vowed to oppose a two-tier system.

There remains uncertainty over the extent to which commissioning responsibility will be written into new contracts and whether GPs will be expected to manage real budgets – with their accompanying risks.

But Mr Edwards said: ‘Andrew Lansley has made it quite clear GPs will have to take on commissioning. If they don't want to do it they will have to partner with other practices or a private company. Not doing it is not going to be an option.'

The Government's dramatic boost to GP commissioning follows its new health bill unveiled last week, which set out plans to cut NHS administration by a third, with SHAs to be scrapped by 2012.

GPC negotiator Dr Peter Holden said he believed the Government would ‘do away with the GMS/PMS split' but would stop short of a more fundamental overhaul.

‘I don't think they are going to have a fundamental renegotiation of the contract. That's not what we've been told,' he said.

Dr Agnelo Fernandes, chair of the Croydon Federation of General Practices, said it was vital the new independent board did not become another management-heavy quango.

But he said groups of GPs could benefit by having a contract directly with the NHS Board, through better communication with senior management and improved support for back-office functions. ‘I don't think anything could be worse than the set-up we've got now,' he said.

Health bill

• GPs to take on 95% of PCO commissioning role
• New independent NHS Board, which will merge commissioning roles of DH and SHAs
• SHAs to be scrapped as part of drive to reduce NHS administration costs by a third
• Care Quality Commission role to be strengthened and Monitor to become economic regulator to oversee access and competition

Dr Agnelo Fernandes