GPs must be given some form of financial incentive for their performance in commissioning in order to fully engage the profession in the changes to the system, a GP pathfinder leader has warned.
Dr Stephen Shortt, chair of the Principia commisisoning group in Nottinghamshire, said that totally abandoning the principle of a quality premium to reward performance in commisisoning could risk a repeat of the weak incentives that characterised practice-based-commisisoning.
The BMA has been a vocal opponent of plans to introduce a quality premium to link GPs’ income to their commissioning performance, claiming it is unethical and will damage patients’ trust in their GP.
But in a debate at the NHS Confederation conference in Manchester, Dr Shortt said he believed that ‘a meaningful amount of money’ would need to be invested into the system alongside a range of ‘balanced and aligned’ incentives that rewarded the delivery of good qualiy clinical outcomes,
Dr Shortt was speaking in response to a question posed by David Stout, director of the NHS Confederation’s PCT Network, who asked whether financial incentives were necessary to fully galvanise GPs.
Dr Shortt said: ‘The failure of PBC was in part was due to the weak incentives. I’d be very concerned if we don’t acknowledge the fact that for commissioning to be successful, we need a range of balanced and aligned incentives which cover things like professionalism and contracts, competition and maybe regulation. But there will have to be money as well.’
‘If we’re to move people on from being involved in a discretionary way as in PBC, there will need to be a meaningful amount of money. It will encourage those GPs to be collectivised and move beyond some of the slightly weaker incentives.’
But Dr Steve Kell, GP and executive chair of Bassetlaw Commissioning Organisation, also in Nottinghamshire and participating in the debate, warned against placing too much emphasis on financial levers as a mechanism for getting clinical buy-in.
‘If we worry too much about reduced referrals etc we’ll miss the quality part,’ he said.