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New QOF points on admissions and prescribing are last throw of dice for UK-wide contract

Dr Laurence Buckman has made good on his plan for the contract to support commissioning in England without casting the rest of the UK adrift, writes Pulse editor Richard Hoey

GP contract deals over the last few years have provided perfect snapshots of the political obsessions of the day.

The 2004 nGMS contract was classic Blair – reflecting both his obsession with targets, and his penchant for the grandiose.

Gordon Brown's big contractual change - the extended hours DES – was a typically crude piece of popularism and one that, equally typically, ultimately didn't pay off.

This new contract is centred around David Cameron's big legacy to the NHS – GP commissioning – but in true emollient fashion, throws in concessions to both the GPC, and to his coalition partners.

The contract deal reallocates 96.5 QOF points to new ‘quality and productivity' indicators, designed to ‘reduce hospital outpatient referrals and emergency hospital admissions by providing care to patients through the use of alternative care pathways and through more effective prescribing'.

That sounds like two things to me. It sounds an awful lot like Sir John Oldham's QIPP efficiency targets, which he revealed exclusively to Pulse before Christmas.

But it also sounds an awful lot like providing QOF points for many of the core activities underlying GP commissioning. It doesn't say so, because it can't – commissioning only exists in England, whereas these QOF points are for the whole of the UK.

GPC Dr Laurence Buckman has pulled off a bit of a coup on this one. He has managed to agree to what must undoubtedly have been robust demands from the Department of Health to support commissioning, while finding a form of words that just about preserves the UK-wide contract. For now.

Preserving the UK-wide contract was one of the key aims in these negotiations for the GPC. But health secretary Andrew Lansley was facing two sets of talks in agreeing this deal – one with GPs, and another with his coalition partners in Government.

The Liberal Democrats have been mighty upset behind the scenes at the failure of the health bill to provide guarantees of the democratic accountability that they had wanted – and the new patient participation DES is surely a sop to them.

Those are the two stand-out points from the deal, although there's plenty else to discuss – some good, plenty bad.

The end of QOF points for the patient survey, predicted by Pulse a month ago, will be hugely welcome to GPs. The lack of any sort of pay rise, apart from a 2.53% uplift to QOF points, will not be. And the cut to extended hours funding rubs salt in a wound among the profession that has still not properly healed.

An interesting mixed bag then – a bit like the Government that negotiated it.

Richard Hoey is the editor of Pulse.

Click here for more from the Editor's Blog Editor's Blog Full coverage of the contract deal

Contract headlines:

More work, no more pay: Government reveals GP contract deal

Extended hours funding cut by a third

QOF funding shifted to efficiency savings drive

£60m for Patient Participation DES to be launched next month

Northern Irish GPs left in limbo over contract deal

Buckman: GPC 'pleased' with Government concessions on GP contract deal