72% of GPs back call for fewer contracts

Almost three quarters of GPs think the range of contracts for general practice should be cut, an exclusive GP survey reveals.

Most of the 72 per cent said fewer options would make contract negotiations easier and increase fairness.

GMS is the most popular contract option with 99 per cent of those who want fewer options saying it should be retained.

More than 35 per cent said APMS should continue, but only 26 per cent wanted to keep PMS.

A fifth said PCTMS — the contract option for PCT-run practices — should remain, and only 9 per cent backed specialist PMS (SPMS). SPMS is a form of PMS contract under which the practice is not expected to deliver a full range of essential services.

More than 80 per cent of GPs said that PMS practices should be entitled to MPIG top-ups to core pay if they returned to GMS.

GPs who wanted to keep the existing range of contract options cited flexibility and stability as the key reasons.

GPs overwhelmingly supported retaining a UK-wide GP contract, with more than 79 per cent favouring this option. A total of 86 GPs took part in the survey.

Support for reducing contract options echoes the view of GPC chairman Dr Hamish Meldrum, who said last year that practices should only be offered GMS or APMS contracts (GP, 1 December 2006).

GP revealed last year that current inequities mean that some practices receive up to £50 more core pay per patient than others, and PMS practices earn more on average than their GMS counterparts (GP, 24 November 2006).

Dr Meldrum said: ‘GPs feel the situation is not ideal. A large majority of doctors want the security of a national contract.

‘The basic concept is that we should have a national contract that covers services every patient should receive everywhere, but there may be areas where you want to develop services over and above that.

‘You can do this through enhanced services, but in some cases you may need even more flexibility, which could come from something like APMS.’

Cleveland LMC chairman Dr John Canning said: ‘It is logical to have one contract document, with one set of rules. GMS enhanced services allow for a lot of flexibility,’ he said.

He believed that as many as 99 per cent of practices had no need to vary from the standard GMS contract.

He said the variety of contracts created performance management problems for PCTs and could cause unnecessary variations in care.

Dr Canning predicted the majority of PCT-run practices would be switched to PMS or APMS deals in the future as PCTs ditched their provider functions.

He said APMS and GMS would cover all needs as long as a fair means of returning PMS practices to GMS could be agreed.

However, NHS Alliance chairman Dr Michael Dixon said: ‘It suits the DoH to have a range of options to boost competition.’
He argued that PMS brought greater flexibility for local commissioners.

Dr Meldrum warned that because of devolved governments and differing national priorities, contractual differences between the four UK countries were likely to grow.

‘There is divergence, and if there are different political parties in government they may want to be seen to be different.’

Scotland GPC chairman Dr Dean Marshall agreed. But he said: ‘I think there is support among GPs for a UK contract. Wherever you are in the UK, if you have diabetes for example, you should be treated in the same way.’

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