Single contract delayed until 2014

Plans to merge all GP contracts into a single deal will be put off for at least two years as the government fights to rescue its NHS reforms, DoH advisers have said.

Dr Jenner: securing support for single contract has been difficult (Photograph: M Alsford)
Dr Jenner: securing support for single contract has been difficult (Photograph: M Alsford)

The White Paper Liberating the NHS set out plans to adopt a 'single contractual and funding model' for general practice that would 'remove unnecessary barriers to new provision' in England.

The plans could see all GP contracts become time-limited APMS-style deals open to private providers.

Conservative Medical Society chairman Dr Paul Charlson said the introduction of time-limited contracts was an 'inevitable' change as PMS, GMS and APMS contract streams were unified.

However, the Health Bill's difficult progress through parliament has now forced the issue onto the back burner.

Dr James Kingsland, England's clinical commissioning network lead at the DoH, said a change to the core of the GMS and PMS contracts was unlikely to happen 'within the lifetime of this government'.

'Will it happen this year or the next? No,' he said. 'I don't think the issue is going to go away, but I don't see it as a major issue during negotiations.'

GPC deputy chairman Dr Richard Vautrey said: 'The government has enough on its plate without having to discuss single GP contracts.'

NHS Alliance GMS/PMS contract lead, Dr David Jenner, said the government had faced difficulty in 'securing widespread support' for a single contract. Such obstacles may mean 'anything too contentious' is left out of this year's contract renegotiations, he said.

In the absence of any change to the core of the GMS and PMS contracts in 2012/13, Dr Kingsland said that he would expect to see a number of changes made to the QOF.

These include adding indicators for extended care for long-term conditions and incentives for GPs to reduce referrals and carry out services currently provided within hospitals.

But he said the most important issue for the government was making GPs financially, as well as clinically, accountable.

'My advice to colleagues would be read the outcomes framework; it is going to be the means by which NHS success is measured,' he said.

An 'inevitable' change

A single contract for GPs is inevitable, according to Dr James Kingsland, England’s clinical commissioning lead at the DoH, and Dr Paul Charlson, Conservative Medical society chairman,

Dr Paul Charlson said single contracts were likely to be available to a wide range of providers.

‘I think there is going to be one contract for any provider of primary care services,’ he said.

Dr Charlson believes GPs can also expect to see an end to timeless contracts.

‘In the real world people have contracts that have to be renewed, and there’s not reason why GPs should be any different,’ he said.

Dr Kingsland said that, over time, GP contracts will focus more on improving outcomes and the QOF will change to incorporate the five domains of the NHS outcomes framework.

‘Contracts will be aligned with encouraging activity such as changing referral patterns, empowering patients and expanding the QOF for next year,’ he said.

However, Dr Kingsland said that the most important issues for the government will be implementing the five domains of the outcomes framework and changing GP behaviour.

‘We need to get every GP consulting in every general practice, to realise that they are financially, as well as clinically accountable,’ he said.

* Editor's blog: The good news about the train crash that the Health Bill has become

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