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GPs should be paid on proportion of appointments they provide, says Conservative health group

GP practices could be paid for the proportion of appointments they provide per patient, in plans that will be put to Jeremy Hunt by a Conservative health policy forum.

The ideas – developed by senior members of Conservative Health and to be put to the health secretary ‘soon’ – are designed to incentivise practices who offer better access to patients.

Practices who provide additional services such as ECGs and phlebotomy for patients would also be paid more under the proposals.

Dr Paul Charlson, vice-chairman of Conservative Health, and a GP in Yorkshire, revealed the ideas when speaking to Pulse at the Conservative party conference in Manchester.

He told Pulse: Practices who provide good care provide more face to face time with patients. We could pay practices who have higher numbers of appointments for the number of patients on their list.

He added that the system should be reconfigured so that the practices that offer the most services to patients are paid the most.

He said: To earn a lot of money as a GP you can have very few partners and refer all your patients to urgent care centres. What we want is to pay the practices who are doing the work, not the ones that aren’t.

‘For example, if you have a ECG machine and do phlebotomy, you are providing a better service for patients, but it costs you money.

‘No ECG machine and not doing phlebotomy is less convenient for patients, but the practice doesn’t have to pay for it. So incentivising is a solution for gaming. Whatever system you create there’ll be another way to game, but at least this will reward work.’

But Dr Richard Vautrey, deputy chair of the GPC said incentivising higher numbers of appointments would be rejected by GPs as ‘micromanagement’.

He said: ‘I don’t think any more micromanagement of general practice would be welcome- when you start telling practices what they can and can’t do. Saying how many appointments they should offer will not be welcome- they should be trusted to get on with it and be judged by outcomes. There will be differences between practices that will be largely down to historic differences in funding.’

He welcomed the idea of more outpatient work being carried out in primary care, but said it was problematic that ‘the resource isn’t flowing to support that work.’

At the conference yesterday, health secretary Jeremy Hunt also laid out plans for GPs to pilot extended access in the evenings and at weekendssaying that the move would restore the ‘family doctor’.

Dr Charlson said he supported this move as the absence of continuity of care led some patients who could have attended their GP practice to attend A&E.

He said: ‘Hunt also wants to move back to the towards the family GP. The move to practice lists rather than a named GP has made patients anxious. They thought “Who is looking after me?” This and lack of access has made some patients attend A&E inappropriately.’

But one prominent Conservative MP, the GP Dr Sarah Wollaston, disagreed, telling Pulse yesterday that the Government risks ‘over-promising and under-delivering’ with its £50m pilots of extended and weekend GP opening.