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Monitor calls for greater competition between GPs and walk-in centres

Greater competition for funding with walk-in and Darzi centres could force GPs to ‘raise their game’ and better respond to patient needs, claims a review by Monitor.

The review by the competition regulator found that commissioners were often closing walk-in centres as they believed they were ‘paying twice’ for primary care services when patients were registered with local GPs.

But they said that this was a missed opportunity to stimulate more competition between GP practices and walk-in centres and that ‘stronger incentives’ such as paying GPs only for the activity they undertake could improve quality and efficiency’.

The preliminary findings of the review found 53 walk-in centres have closed since 2010, 25 of which were GP-led (Darzi) health centres, 22 were nurse-led and six were commuter centres, it identified 185 walk-in centres still operating throughout England, 135 were GP led and 50 were nurse led.

But they said that commissioners may not be considering ‘the full range of options’ when deciding not to renew their contracts, and could use them to create ‘payment mechanisms’ that encourage ‘both higher quality and value for money’.

They also revealed that walk-in centre providers have raised concerns with the Monitor about conflicts of interest when their contracts have been terminated in favour of commissioning additional services from local GP practices.

It also suggests that NHS England could be designated the leading body responsible for commissioning walk-in centres – rather than CCGs - when the majority of contracts expire in 2014.

The interim report from Monitor details the preliminary findings of a review into the provision of walk-in centres by the NHS, with a final report due later this year, or early in 2014. A report that is deals explicitly with general practice and funding issues is also expected in early 2014.

It found that current arrangements gave GPs little incentive to improve services, although there was ‘some evidence’ that the introduction of a registered-GP service at Darzi centres had caused some GP practices to ‘raise their game’.

It concludes: ‘GP practices receive the majority of their income through payments that are based on the number of patients registered on their lists; their income is not directly affected when their patients choose to attend a walk-in centre (or other service offering primary care) instead of using their practice.

‘Thus, where their patients have a choice to use a walk-in centre, GP practices have little incentive to improve their services so their patients will choose to see them instead of attending the walk-in centre’.

It adds: ‘If payment mechanisms created stronger incentives for GP practices to encourage their patients to choose their services instead of using a walk-in centre, this competition for patients could drive GP practices and walk-in centres to continually improve their own services.’

It also states some GPs who refer patients to walk-in centres when they’re unable to offer a same-day appointments, are:  ‘using the centres to meet the needs of some patients for whom they are paid to provide primary care, rather than responding to what these patients want, for example, accommodating more same-day or convenient-time appointments.’

Catherine Davies, Monitor’s executive director of co-operation and competition, said: ‘GPs aren’t affected financially if a patient goes to the walk-in centre, so we think that the way the incentives work at the moment, patients aren’t benefitting from the competition between GP practices and walk-in-centres.

‘One option might be to have GP services which reflected patients attending, and consultations that occurred. But at this stage we are looking for people to make suggestions about how that could be improved.’

In a submission to the report, Jill Matthews, head of Public Health and Primary Care for NHS England, said they would welcome changes to the way payments are currently made: ‘The NHS is paying for these patients twice due to the capitated payment to GPs and activity payment to other care settings.

She added: ‘Considering the possibility of rebates on the capitated payment for activity in other settings and more flexibility to commission a mix of access choices for patients would seem a helpful improvement on the current situation.’

GPC chair Dr Chaand Nagpaul said: ‘Patients should have access to the care they need, when they need it.  However at a time of severe financial pressure in the NHS, commissioners need to ensure funding is properly allocated and used responsibly to avoid a duplication of services.

‘Commissioners will need to carefully assess existing service provision and local need when deciding the most efficient and cost effective way of delivering care, and whether or not to keep walk-in centres open.’