DH 'mythbuster' hits back at critics of GP contract change

A 'mythbuster' document published by the DH seeks to justify GMS contract changes it plans to impose. Read it in full here, and tell us what you think below.

DH: mythbuster published

Myth: There is no evidence for making these changes to the QOF

This is not true, NICE developed indicators and have piloted them for six months. There is evidence that improving performance against QOF indicators will improve health and save lives.

Myth: These changes will mean significant financial losses for GPs

This is untrue. The proposals do not involve removing any money from the contract and in fact include proposals for new investment in new vaccinations.

As in 2004, when the QOF was first introduced, we believe practices can and will rise to meet the new reward thresholds and this will therefore lead to further benefits to patients in terms of improved health outcomes.

Myth: The government is ignoring the concerns of GPs and pushing these contract changes through – isn’t this just bully boy tactics?

Improving care for patients is our number one priority. Our population is living longer and more people have long-term conditions. Changes need to be made to the GP contract to make sure we reflect our changing population. We highly value the work of GPs and want them to lead the change.

The department continues to be prepared to offer a further period of discussions on the changes proposed.  We would hope, however, that negotiations between NHS Employers and the GPC might continue to see if an acceptable agreement can still be reached. If not, the department will consider any representation made during the consultation period.

Myth: Patient care will suffer as more strain is put on GPs

Improving patient care is at the heart of these proposed changes. We recognise this is a challenging time for GPs as it is right across the NHS.

Myth: IT systems to support online access to services will only increase business processes and workload for GP practices.

GP practices who are already providing access to some services online recognise the benefits and increased efficiencies for practice workflows and business processes. Online access to services as the norm for general practice has huge potential for reducing administrative workload on practices.

Myth: These measures are really all about saving money not patient care

The GP contract needs to change so that it further improves care for patients. Our population is living longer and an increasing number of people have long-term conditions. By 2018 those with one or more long-term condition is set to rise to 2.9 million. Our proposals will help ensure that we provide the very best care and support possible for those at most risk of life threatening conditions. We want to drive up standards and our contract will reflect the most up-to-date expert guidance and excellent standards of care. We want the BMA to work with us but we will not back away from making changes that will deliver better care for patients.

Myth: Losing the MPIG will cause practices to close

Income is generated through GP practices retaining patients. If a patient chooses to move to another practice – the original provider will lose income regardless of whether MPIG remains in place.  The challenge is for practices to provide the best services for local patients.

It is unacceptable that two practices next door to each other that care for the same type and number of patients could potentially have huge variations in their funding. In some cases, one practice can receive £65 per patient through its global sum payments and the other, £95.  We are committed to introducing a fairer system of funding for GP practices. The plan to remove MPIG is about driving out inequality. This is scheduled to happen over a number of years so practices can plan and adjust to the changes in income. Resources freed up from removing the MPIG will be redistributed between practices so money is shared more equally based on need.

Myth: The new Quality and Outcome Framework is unworkable

Improving patient care is our priority - GPs should only get additional funding for the quality of services they offer.

The QOF framework is a voluntary incentive scheme and all the new indicators were discussed during negotiations. It is not true to say the proposals for new indicators are unworkable. All of them were piloted by NICE for at least six months and their independent Advisory Committee considered the question of practical implementation before they made their recommendations. In addition, we are actually removing some QOF indicators which relate to bureaucracy.

Independent research shows little advancements have been made in improving care since 2006. This has also recently been noted by the public accounts committee in their report on the management of adult diabetes services in the NHS published 6 November. So increasing thresholds is necessary to incentivise practices to raise standards. Average practice achievement is already higher than all the upper thresholds. We are proposing to raise thresholds to a level which is achievable for the majority of practices and to continue to incentivise those at the lower end to improve.

Myth: GPs will be penalised for not offering services under the QOF which are not actually available in their areas

From April, clinical commissioning groups of GP practices will be responsible for making sure services recommended by NICE are available for patients. If these services are not immediately available in 2013/14, practices can except patients from a QOF indicator so that they are not penalised.

Myth: Raising thresholds will lead to bullying of patients

On the contrary. Raising thresholds will lead to more patients being offered and receiving the care they need, which could be life-saving. The QOF exception rules mean that practices can remove patients from an indicator for various reasons, including if they refuse a treatment or if it is not clinically appropriate and GP practices will not be penalised. Similarly if a service is not immediately available, practices will not be penalised for not offering it.

Myth: GPs are only going to have a short consultation length

We are committed to being open and transparent with GPs and the GPC and want to make sure they are given sufficient time to consider the proposals for the 2013/14 contract.

NHS Employers has consulted with the GPC recently or in the past on each of the changes proposed in line with the mandate given by the department.  
There is no statutory requirement for consultations to be three months long. New guidance issued by the Cabinet Office says the time frame should be 'proportionate to the nature and impact of the proposal'.

Myth: The government is set to ignore the advice of the DDRB

The recommendation given by the DDRB will considered as will the outcomes of our consultation before the final decision is made.

Myth: Plans to give more weight to deprived areas through the Carr Hill formula will destabilise general practice

We are committed to improving the Carr Hill Formula to make sure it takes better account of patient needs. Discussions have been going on with the BMA over implementing recommendations made by a joint group including the GPC, DH and NHSEs . The proposal will include deprivation weighting factors. There is clear national and international evidence that patients with the highest health needs are clearly associated with those living in areas of greatest social deprivation. Funding practices with greatest need is best for patients, the practices seeking to meet those needs as well as fairer for everyone."

Myth: The DH backed out of negotiations to force through a number of undesirable changes like phasing out MPIG in a seven year timeframe and changing locum payment terms.

This is not true, the GPC backed out of negotiations with NHS Employers. They later cancelled planned meetings with NHSE and the department, we remain willing to negotiate and would welcome an agreed settlement.

We are committed to introducing a fairer system of funding for GP practices. This has been known to the GPC for some time. The issue of getting rid of the anomaly in locum payments has been raised in negotiations several times and the seven year plan to phase out MPIG was agreed in principle with GPC before they walked away from the negotiating table.

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