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LMC writes to GMC with concerns over £95 per patient co-commissioning plans



GP and commissioning leaders have sought advice from the GMC about whether a pioneering local quality scheme would breach the regulator’s standards by financially incentivising GPs to modify their prescribing and referrals.

This week Pulse revealed how Bolton CCG had developed a ‘Bolton Quality Contract’ as part of its plans to co-commission primary care, which will top practice income up to £95 per patient for meeting key ‘quality standards’.

But Bolton LMC has told Pulse they supported the plans, but did have concerns that linking payments to changes in GPs’ practise could bring them into conflict with regulations.

The ‘Bolton Quality Contract’ will see practices’ core funding brought up to £95 per patient in return for meeting a number of ‘quality standards’, including practices agreeing to a transfer of work into general practice where this is ‘clinically appropriate’ and working proactively to anticipate and prevent emergency admissions, NHS Bolton CCG board papers revealed.

Before Christmas, the LMC and CCG wrote to the GMC asking them to evaluate any potential conflicts involved in incentivising practices to cut emergency admissions and manage prescribing.

The GMC had not produced a formal reply as of 2 February, though the CCG said it had had verbal assurance that the conflict was avoided.

But despite this the LMC told Pulse that they could not fully support the scheme without a formal written assurance from the GMC, and had written again asking for a response.

Bolton LMC chair Dr George Ogden told Pulse: ‘The problem we have with the KPIs, particularly on things like A&E attendances and prescribing, the intent of the contract is to reduce inappropriate A&E attendances, and to reduce wasteful prescribing.’

He added: ‘The CCG had quite clearly recognised there was a probity issue there, and had sought advice. They, apparently, had had verbal reassurance that it’s ok. But we haven’t had anything in writing, and standard 80 in the GMC guidance is about not accepting incentives to reduce your prescribing or referral, without clinical evidence. It does kind of sail close to the wind we think.’

‘It’s the unintended consequences issue.’

But Dr Ogden added: ‘It’s that type of issue that we’ve got a concern about. Not the standards themselves… It’s equalising everybody up, instead of levelling down, which is happening nationally. It’s putting £95 per patient in, there are really, really good things, we worked really hard and if we can get this guidance from the GMC through, we think this is a goer.’