04 July 2008
General medical services in Scotland cost £160m more than planned after the new contract for doctors was introduced, according to an Audit Scotland survey.
A report published on July 3 says the 2004 GMS contract, which reduced doctors' workload and increased their pay, should have been better planned and would take time to improve patient care.
The survey found that the cost of implementing the contract in Scotland was underestimated. In the first three years it was £160.4m more than the amount allocated to NHS boards to pay for GMS.
Most of the extra expenditure was due to the higher than expected costs of introducing an incentive payment system to ensure quality of care and that no practice was financially disadvantaged by the contract.
Review of the new general medical services contract shows that the total cost of general medical services increased from £503.9m in 2003/04 – the year before the new contract was implemented – to £706.1m in 2006/07. The 40% increase compared with a 2.76% rise in the net operating expenditure on the NHS in Scotland over the same period. The survey also found that the average net income of GPs on the new contract increased by 38% – from £65,180 in 2003/04 to £90,127 in 2005/06.
The report highlighted a lack of basic management information about general practice in Scotland. It said the NHS did not know how many of Scotland's GPs worked full- or part-time.
There was also a lack of comprehensive data on staff numbers, workload and activity in practices. 'This makes it difficult for the NHS to plan effectively,' Audit Scotland stated.
Auditor general Bob Black said there were early signs that the contract had addressed GP concerns about pay and work-life balance and had improved services for some patients.
But he added: 'There was insufficient planning for implementing this contract, partly due to a lack of available data on primary care and an underestimation of the costs of the contract.
'The challenge for the Scottish government, the NHS and GPs is to build on the early signs of improvement and to deliver better outcomes for patients.'