Exclusive: DoH may switch practices to five-year contracts

Practices could be forced to switch to five-year contracts, giving PCTs greater power to remove them, GP has learned.

Lord Darzi
Lord Darzi

Sources close to health minister Lord Ara Darzi say that the plan is one of a number of proposals being considered as a way of tackling under-performing practices. It is believed to be the option favoured by health minister Ben Bradshaw.

Other options under discussion include putting tighter minimum practice standards in contracts and strengthening regulation.

GPC chairman Dr Laurence Buckman said that short-term contracts would destroy continuity of care and discourage GPs from investing in services. ‘It's like saying that, because two of the ship's suites need new wood panelling, we're going to scuttle the ship and put everyone in lifeboats,' he said.

Fellow GPC negotiator Dr Chaand Nagpaul said ‘the greatest failing in tackling GP performance has been PCT performance' and PCTs should use existing powers to tackle underperformance.

Speaking at the NHS Confederation's Primary Care Network in London last week, health secretary Alan Johnson said: ‘Where there is poor quality, we want to see PCTs taking active steps to tackle it, if necessary, by removing contracts.'

Sources say that PCTs would use a range of indicators to define poor quality practice, including clinical outcomes, patient satisfaction, quality framework scores and peer opinion.

At present, PCTs can only remove GPs where they are seriously in breach of contract. But the process for removal is long and the pressure is on PCTs to help struggling practices improve, making it very difficult to remove contracts unless patients are in danger.

The APMS contract provides a precedent for short-term contracts, giving PCTs new powers to press for improvements in performance.

A less radical option would be to give the Care and Quality Commission powers to enforce standards in primary care. The new regulator is due to begin work in April 2009. The GMS contract could be redrafted, to make it easier to prove breaches.

David Stout, director of the PCT Network, stressed that any change would be aimed at ‘a tiny minority of practices'.

The DoH was unavailable for comment.

jonn.elledge@haymarket.com

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