Halloween may be safely behind us, but GPs are still in the dark about whether the Government’s latest offering is a candy fest or another bag of tricks.
After the poor response to the ‘new deal’ for the profession, the Prime Minister has sought to re-set his relationship with GPs by announcing a new voluntary contract from 2017.
David Cameron vowed to boost funding and banish the spectres of ‘box ticking and form filling’. In return, he said practices would have to ensure patients had access to a seven-day service.
Pulse has already learned that the new contract may not be all that it seems. While practice funding will no longer be linked to the QOF, GPs may still have to record activity under the framework.
The contract will also be restricted to practices or federations with lists of at least 30,000 patients and, although Mr Cameron pledged to ‘work with the profession’, the Department of Health has refused several times to confirm to Pulse whether the new contract would be developed in negotiation with the GPC.
The world is starting to look very different. I welcome the opportunity
Dr Nigel Watson
The PM’s announcement – a complete surprise to the GPC – was made during an interview on the BBC’s Andrew Marr Show before the Conservative party conference in Manchester. In response, GPC chair Dr Chaand Nagpaul said the new contract was a ‘diversion’ and that what was needed were ‘proper levels’ of investment in GP services and thousands more GPs.
But the new contract presents something of a problem for the GPC. It will be voluntary and promises to deliver greater funding for practices at a time when national negotiations have failed to prevent year-on-year pay freezes. And many local leaders have said they will not dismiss the idea just yet.
The break-up of the national GP contract is already happening. The devolved nations have already gone their own ways, with Scotland planning to ditch the QOF entirely by 2017. In England, many CCGs under co-commissioning are taking a more enlightened approach, with one recently offering a completely different local deal to GPs, with the average GMS practice gaining around £200k.
Joint contracts with trusts
The new GP contract fits in neatly with NHS England’s Five Year Forward View, which urges GPs to take on more specialist care. The ‘vanguard’ pilots of the new models of care in many areas are the driver behind the new contract, and it will enable a combined contract between hospitals and large GP practices for the first time.
Some LMC leaders see this as an important move. Dr Nigel Watson, GPC member and chief executive of Wessex LMCs, says: ‘This is driving change and the world is beginning to look very different. I welcome the opportunity to explore a new voluntary contract. It will provide opportunities.
‘Change is always something people will fear; in my view we need to explore the opportunities and also ensure the negative aspects, if there are any, are addressed.’
Dr Mohammed Jiva, chief executive at Rochdale LMC, says practices are already discussing the ‘opportunities and threats’ of the new contract. He tells Pulse: ‘[It was] discussed earlier this week with my LMC, who are supportive of exploring the opportunities of a voluntary contract.
‘Until there is “meat on bone” there is little reason to close the door without exploring the offer.’
Small practices adrift?
But others are less positive. Dr Philip Fielding, chair of Gloucestershire LMCs, warns the Government’s primary care strategy ‘seems to be in freefall’.
He says: ‘The viability of small practices (four partners or fewer) is seriously in question thanks to uncontrollable cost pressures, increasing workload, patient expectation and reduced drawings. A new voluntary contract with strings attached may be the equivalent of changing one set of chains with another as we are thrown back into the sea as too insignificant to matter.’
And GPC deputy chair Dr Richard Vautrey – predictably – is gloomy about the prospects of a good deal for practices.
He says: ‘We have had voluntary contracts for over a decade with PMS and then APMS, but the majority of GPs have remained with the national GMS contract and patients want and expect the high quality and consistency offered by a locally based and nationally funded GP service.
‘Many GPs going through difficult PMS reviews also realise how vulnerable practices can be when subject to local funding pressures.’
Dr Vautrey adds that the new contract was being driven ‘for ideological reasons’, with the Prime Minister looking to marginalise the nationally negotiated contract ‘just because it was the Labour Government at the time that negotiated it’.
But the politics are all pointing in one direction, with the health secretary recently admitting that primary care had been underfunded for years as a ‘penance’ for the initial financial gains under the 2004 GP contract. GPs have suffered cuts in their take-home pay in eight out of the past nine years under the national GP contract, and there is no sign that public sector austerity over the next few years will deliver anything different under the majority Conservative administration.
The GPC is going to have to work hard to persuade GPs to stick with the national contract if they are offered a boost in funding under this new voluntary deal. If large numbers do move over, then it will have a drastic effect on the GPC’s bargaining power. But then, perhaps, that is what the PM is banking on.
What could be in the new contract?
Weekend and evening GP access will be central to the contract. The Prime Minister has said that not all practices in a federation would need to be open, but there would have to be some sort of provision.
Chance of inclusion: 10/10
Removal of the QOF
It is also certain that practices will not need to do QOF in order to get funding. However, health secretary Jeremy Hunt told Pulse they will still need to record their work.
More funding per patient
The contract is likely to retain capitated payments, and the Government has said it would put ‘more money’ into the contract. But quite how much will be made clearer in this autumn’s Spending Review.
Enhanced care home service
Jeremy Hunt told a Conservative party conference fringe event that GP responsibility for care home patients needed to be ‘transformed’. The new contract may include greater requirements for GPs for this group of patients.
There has been greater acknowledgement from the Government and NHS England that GPs’ indemnity costs are becoming a problem. It would make sense for both sides if the Government provided some sort of crown indemnity cover as a sweetener in the new contract.