GP contract faces radical reform as opposition to seven-day NHS grows

The GP contract could face radical reform after the LMCs conference voted for a series of policies including dumping formula funding in favour of payment by activity, while GP leaders hardened their rhetoric over government plans to increase evening and weekend access.

LMC representatives voted to abolish the CQC
LMC representatives voted to abolish the CQC

Opening the conference GPC chairman Dr Chaand Nagpaul called on the prime minister to abandon manifesto plans for extended access across England. ‘Jettison the political pipe dreams of tomorrow’, said Dr Nagpaul, ‘and get real about how we resource, resuscitate and rebuild general practice’. The appeal was apparently ignored by government, as days later the Queen confirmed ministers would go ahead expanding access this year.

GPC executive members lined up to assure LMC leaders they would not accept an imposition of seven-day working. Dr Nagpaul told GPonline it would be foolish and counterproductive for ministers to do so, but that he’d had ‘no inkling’ of a contract imposition.

The government has suggested it will expand the prime minister's Challenge Fund access pilots which are due to reach 18 million patients by the end of the year to roll out 8 till 8, 7 day access.

Payment by activity

Dr Nagpaul said the NHS needed to learn for the experience of the existing pilots, many of which reported a lack of demand for Sunday appointments. A motion passed by LMCs said the pilots were undermining GP out-of-hours services and were unsustainable. All urgent and unscheduled care services should be integrated, said Dr Nagpaul.

LMC representatives voted by a narrow majority to replace the current GP contract with a payment by activity arrangement linking workload directly to resource. Kent LMC representative Dr Jim Kelly said general practice was 'on its knees' partly because the capitated contract meant GPs were not paid for the work they do and were disincentivised to take on more work which the NHS wants shifted into the community.

'We need to take a radical approach to GP funding', he said. 'We need to be paid for every item of service we provide.'

Dr Nagpaul said while the issue was complex and government was moving away from tariff payment elsewhere in the service, GPC would take the demand forward. The motion, he added, showed that GPs ‘taking on limitless work with no recognition’ was unsustainable, while other parts of the system are paid on activity. Elsewhere LMCs called for urgent action to limit workload and for practices to be enabled to declare major incidents and capacity shutdowns at times of system stress.

Tower Hamlets LMC chairwoman Dr Jackie Applebee called for GPs to refuse to take part in work which had no impact on patient care, such as CQC inspections, appraisals and 8am to 8pm opening hours. ‘Just calling for urgent action is not enough to make governments see reason’, she said.

LMC representatives voted to abolish the CQC, and reinvest its funding in core services. Proposing the motion, GPC’s Dr Grant Ingrams blasted the CQC as an ‘incompetent, bullying, bureaucratic waste of time’ that was damaging the profession.

Dr Nagpaul said GPs were not opposed to quality assurance. Welsh LMCs, he said, had voted to support the health inspectorate’s approach to practice inspections. ‘It's not that GPs are just against the idea of quality assurance, but against a flawed system.’

Dr Nagpaul called on ministers to look at the ‘significant’ changes called for by LMCs and recognise that if they want the service to change they must start from GPs’ perspective. ‘The government shouldn't be looking at any of these motions as something to battle with’, he said. ‘They should be looking at these motions as the voice of the profession that can't be ignored if they want change.’

*Full LMCs conference coverage including videos

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