GPs could be forgiven for feeling a touch fatigued by the prospect of change, given their newly defined roles as commissioners and looming responsibility for £60bn of NHS budget.
Now, though, they are facing calls from influential quarters for the GP contract to be ripped up and replaced with something radically new.
The natural reaction will be a collective groan, but the argument is worth hearing, because it is made not by Government officials with a remit to save cash, but by policy wonks charged with helping deliver something dear to many GPs’ hearts – integrated care.
Dr Anna Dixon, the King’s Fund’s head of policy, argues the GP contract is a major barrier to delivering integrated care, because its failure to define core services precisely makes it impossible to judge whether work moved into the community should be paid for or not. This part of her argument will find sympathy with some GPs, given the common view that the nGMS contract – although an improvement on its ‘a GP’s gotta do what a GP’s gotta do’ predecessor – still defines essential services too broadly. The King’s Fund is also absolutely right in its criticism of the ridiculous payment by results system, which has long acted against integration by sucking money into hospitals.
Practices paid twice?
But Dr Dixon’s justification of the need for reform will find less ready support among GPs. She claims that without a new contract, practices could be ‘paid twice’ for work moved into primary care that they should have been doing anyway. She is presumably referring to the terms of the nGMS contract, brought in under the promise of no new work without pay. In practice, however, most GPs have seen wave after wave of workload wash their way with little if any new money to support it.
The real reason many GPs might support the idea of a new contract setting out their core responsibilities is not because of the danger they might be paid twice for new work, but to ensure they are paid at all.
But in any case, accepting the principle that the GP contract ought to set out exactly what GPs are – and are not – being contracted for is the easy part. Far more difficult would be to work out what those core services should be, and which should attract extra funding under integrated care arrangements.
There are already signs the Government sees integrated care as the perfect smokescreen for moves to dump ever-greater workload upon GPs without the trouble of having to pay for it. Pulse revealed last month that GPC chair Dr Laurence Buckman had been forced to reject ‘totally unacceptable’ proposals for GPs, which apparently included shifting new responsibilities into the core contract.
And what might ministers do if they failed to reach agreement with the GPC over a list of core services? Dr Dixon provides an uncomfortable hint. She suggests the alternative to a new GP contract would be to scrap the contract altogether and expect GPs to compete for each and every piece of work undertaken in primary care. That of course would shatter any hopes of integration by fragmenting primary care and destroying continuity.
It is also why GPs are so wary of change.