DH to block distribution of quality premium payments

Successful clinical commissioning groups (CCGs) may be barred from distributing bonus payments among member practices, a DH report suggests.

It also calls for a rethink of funding for GP training programmes and highlights changes in the GP workforce over the last decade.

Evidence on GP pay submitted last week to the Doctors and Dentists Review Body (DDRB) makes clear the government will press ahead with ‘quality premium’ bonus payments.

The payments will reward CCGs for the quality of services they commission, improving health outcomes and cutting inequalities.

But the evidence adds: ‘Regulations made under the Bill will make provision for how CCGs can use any quality payment awarded to them, including how far they can use it to make payments to GP practices.’

The BMA has warned the quality premium could undermine the doctor-patient relationship by creating perverse incentives for doctors to cut NHS costs.

GPC deputy chairman Dr Richard Vautrey said that the DH was likely to rule that CCGs would have to reinvest quality premium payments in patient services, rather than distributing them to practices.

He said this was a ‘step in the right direction’, triggered by suggestions in the NHS Future Forum report in June.

But he said the BMA remained opposed to the premium payments. ‘We think it would be much simpler if it gave CCGs the money from the start,’ Dr Vautrey said.

The DH evidence also reveals major changes to the GP workforce over the last decade. Although there were 6,527 more GPs in headcount terms in 2010 than in 2000, the number of partners fell by 755 over that period.

The workforce is ageing fast, with 22.2% of GPs aged over 55 in 2010 compared with 17.5% 10 years earlier.

Average list sizes have increased rapidly too, with single handed practices being phased out. In 2010 England had just 1,203 single handers – less than half the 2,662 total in 2000.

Data submitted by the DH also reflect the rise in practice staff numbers as GPs adapted to the requirements of the QOF. Practice staff numbers rose 16.9% between 2000 and 2010, and numbers of practice nurses by 22.9%.

The DH evidence says that training funding arrangements ‘lack transparency and are not fit for purpose’. It says some deaneries are supplementing GP trainers’ grants with additional funding to reflect trainers’ wider remit since Modernising Medical Careers reforms in 2007.

The DH evidence said a review of funding was ongoing and GP trainers grants could be affected by changes that will take effect from April 2012.

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