28 February 2003
A revised GP contract will put patients at the heart of NHS primary care services by ushering in a radical reform of the way practices are funded.
The proposed contract, published late last week, is central to the government's plans to offer more treatment in GP surgeries and other GP-run units such as cottage hospitals.
The contract will overhaul a system largely unchanged since the creation of the health service, and it will increase spending on general practice from £6.1bn now to £8bn in 2005/06, a 31% rise.
Currently, GPs hold individual contracts with the secretary of state for health and are paid largely according to the number of patients on their list. They also receive funding to cover staff, IT and premises costs.
If a GP leaves and is not replaced, their former practice may inherit all their patients but not their funding.
In the proposed contract, however, money will follow the patient. It will introduce practice-based contracts agreed with the local primary care organisation (primary care trusts in England, for example). The funding will be based on the number of patients looked after by each practice and will be adjusted to take account of factors that can increase costs, such as numbers of elderly patients and high levels of deprivation.
If a GP leaves, the funding would remain, allowing the existing partners to decide whether to manage the extra workload by taking on another GP or employing other health care staff, such as extra practice nurses.
British Medical Association GPs' leader Dr John Chisholm said the contract would modernise general practice. 'GPs and practices will have flexibility and be much more free to employ a mix of staff that suits local needs,' he added.
As yet it is unclear how the new contract will affect individual GPs' pay. The BMA believes GPs will lose £6,000 a year if they opt out of out-of-hours care for their patients, as they will be entitled to do under the new contract. They could also gain, however, in a number of ways. The BMA predicts GPs' income may rise 'substantially'.
Health minister John Hutton said it was a 'something for something' deal. 'For the first time, GPs' pay will depend on the quality of the services they provide. The better they do, the more they will get. The contract proposes that the more NHS work GPs do, the higher their rewards will be. This provides a positive incentive for GPs to treat patients in the community rather than referring them to hospital for treatment such as diagnosis or minor operations,' he added.
Practices will receive a 'global sum' to provide essential and additional services based on the new funding formula. This figure will incorporate funding for staff costs, including GPs' salaries, which it is believed will see an above-inflation uplift. Each practice will be able to spend the money as it see fits. Practices will be able to earn more by offering enhanced services, such as treating violent patients.
Income would be increased by meeting prescribed standards of care. Two-thirds of the extra £1.9bn to be poured into primary care over the next three years will be ringfenced for a new quality payments scheme. Each GP could earn an extra £10,000 a year over the next three years if this money were shared equally.
Partners in a GP practice may be able to enhance their personal earnings by dividing up any profits from the practice's income.
Ballot papers go out to all 42,000 GPs on March 20 and the vote will close on April 11. If accepted, the contract will be introduced gradually, with some elements coming into force in 2003/04. Legislation will be needed to cement the new contractual framework, delaying full implementation until April 2004.
Last year, 75% of GPs backed the proposed contract in outline form. But their continued support is not a foregone conclusion. Ministers, managers and medico-politicians will push hard for GPs' support.
Rejection would deliver a body blow to large elements of the government's NHS modernisation plans and postpone much-needed improvements in patient care.
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