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‘Tear up’ GP contract, advisory body urges

Exclusive The GP contract should be ‘torn up' as part of radical reforms to NHS payment systems designed to make integrated care a reality, according to an influential think tank advising the Government on health strategy.

A senior figure at the King's Fund told Pulse a new GP contract was needed which defined core services much more closely so work could be moved into the community to integrate care without the risk of ‘paying GPs twice'.

Dr Anna Dixon, director of policy at the King's Fund, warned the alternative to a new contract was to scrap the GMS contract altogether and ask GPs to compete for separate parts of primary care provision under a fully integrated approach.

The King's Fund, along with the Nuffield Trust, has been tasked by the Government with advising the NHS Future Forum on developing ‘a national strategy for promotion of integrated care'. It told Pulse such a strategy would also require reform of the controversial payment by results system, to prevent money being sucked into hospitals. But it is Dr Dixon's words on the future of the GP contract that will most raise eyebrows.

Speaking at a King's Fund conference on integrated care last week, she said: ‘If we are serious about integrated care, I think we need to tear up the GP contract. People have mentioned integrated care for diabetes for example – where is the GP element of that?'

Dr Dixon said core GP activities were not defined well enough under current arrangements, meaning ‘there is a danger under the new system we will be paying for the same activity twice'. She also said the contractual status of small practices would ‘have to change', with ‘larger federated practices taking on bigger contracts in risk-sharing relationships with other providers'.

‘There are two ways to tackle this,' she added. ‘One would be to define the core of what general practice is so when you buy integrated care you are not paying twice for it. The second is not to contract GP practices any more, but contract for GP care as part of integrated care through the process of more competitive commissioning.'

GPs have long argued a contract defining core services more precisely than the current list of essential services would prevent the Government dumping new work on practices without resourcing it.

But there are concerns ministers may use the suggestion to force through efficiency savings, with GPC chair Dr Laurence Buckman recently forced to reject a package of proposals understood to include movement of some enhanced services into the core contract.

Professor Chris Ham, chief executive of the King's Fund, told Pulse the controversial payment by results system also needed an overhaul to aid integration between primary and secondary care: ‘Payment by results does not work because it pays for widgets rather than continuity of care. We need the right incentives.'

Dr Richard Vautrey, GPC deputy chair, said: ‘The emphasis on an NHS market needs to change, not the GP contract. GPs collaborate with other practices and want to do the same with secondary care. It is not their contract that makes that harder, but payment by results, which sucks activity into secondary care.'

Professor Steve Field, chair of the NHS Future Forum, said the King's Fund was advising on integration, but the forum had yet to start work on its report, due in December: ‘I've heard a lot of people throw ideas around about integration, but we haven't formed an opinion yet.'

EDITORIAL: GPs will be wary of any more reform