GMS contracts could be time limited

GMS contracts could become time limited and practices could be incentivised to integrate with large providers to cut NHS costs, influential policy experts say.

Nick Goodwin: report's co-author
Nick Goodwin: report's co-author

A joint report by The King's Fund and the Nuffield Trust, co-authored by Nick Goodwin, who is leading a review of general practice, suggests GMS is a significant barrier to the integrated care organisations (ICOs) mooted in Lord Darzi's NHS Next Stage Review.

'If ICOs are to become an effective force within the NHS, a new and controversial strategy of GP contract reform may be needed,' the report says.

The proposals ratchet up pressure on the GMS contract in the week after an NHS Confederation report also called for the deal to be overhauled.

The confederation called for the MPIG to be scrapped, strengthened contractual levers to deal with poor or unresponsive services and a combination of incentives for practices to work federally and rewards for 'increased scale'.

It also wants greater flexibility to negotiate GP contracts and a national menu of QOF indicators that can be adapted locally.

The King's Fund/Nuffield Trust report makes it clear that even if plans to impose time limits on contracts were 'forcefully opposed by medical unions', an alternative would be to phase the deals out gradually by ensuring growth and incentives are geared towards integration with ICO-style groups.

'Without powers to direct the transfer of existing GP contracts to ICOs ...

they may remain simply a minority sport for enthusiasts,' the report says.

Deputy GPC chairman Dr Richard Vautrey called the idea 'nonsense', and said the GPC would 'strongly oppose' vertical integration of primary and secondary care.

GPC chairman Dr Laurence Buckman said any such changes would be illegal, and warned that the GMS contract could not be unilaterally changed in that way. 'I don't believe the GMS contract gets in the way,' he said. 'The contract has nothing to do with delivering integrated care. ICOs would virtually destroy general practice in the UK.'

The proposals to reform the GMS contract come after revised PMS regulations implemented this month made clear that a PMS contract can be revoked by a PCT, as long as six months' notice is given.

National Association of Primary Care chairman Dr Johnny Marshall, said he would be 'livid' if this meant a contract could be terminated without grounds.

A DoH spokesman said: 'The amended PMS regulations simply clarify the existing provisions put in place in 1997 when PMS was first made available.'

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