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Stevens: New GP contract may be unsuitable for rural practices

The Government’s new voluntary GP contract may not be suitable for rural practices, the NHS chief has said, leading to fears that it could create a ‘two-tier service’. 

NHS England chief executive Simon Stevens, taking questions via video link at the National Association of Primary Care’s Best Practice conference in Birmingham, told a practice manager at a rural practice that the new contract was unlikely to benefit all practices.

There are few details about the new contract, but NHS England has said it will be for practices or federations covering at least 30,000 patients, who will have to provide some sort of weekend and evening routine access.

However, there are fears that not all practices may be able to operate at this scale, which will lead to them losing out in the long run as more funding is given to larger organisations.

Kate Davenport, a practice manager in Bath and North East Somerset, said she had ‘a concern that the focus on working at scale potentially creates a new kind of division between urban and rural practices’.

She said: ‘We are as near urban as a rural practice can get, but we have 9,000 patients. The only other practice in our catchment area has 6,000 and we’ve looked and looked at models that make sense on a wider scale, and for us it just doesn’t.’

She added that there was a ‘risk that rural practices will lose out on the kind of opportunities this voluntary contract and all sorts of other working at scale type projects bring to general practice’, because working at that scale ‘doesn’t work for us’.

Mr Stevens responded: ‘No, and therefore it is not the right option for you. However, the mantra here is horses for courses. So if it that is not the right developmental path for expanding and strengthening primary care services where you are, then that’s fine, don’t do it. That is what the voluntary option means.’

In a grassroots GP debate following Mr Stevens’ call in to the conference, Dr Luke Evans, a GP in Birmingham and unsuccessful Conservative MP candidate for Birmingham Edgbaston in the 2015 general election, said he was also concerned some practices could be left behind.

He said: ‘On face value it looks quite good… but my worry is what happens to the people who decide not to take this on. If you’re a trailblazer, you can get 30-50,000 people together, it sounds fantastic. But what happens, as we’ve heard in one of the questions, if you can’t do that? If you’re left behind? Are we going to create a two-tier [general practice].’