Last week's NHS Future Forum report suggested overhauling the contract to incentivise integration between practices (GP, 11 January).
As GP reports this week, Future Forum chairman Professor Steve Field has said he supports the idea of driving integration between practices by encouraging them to move off GMS and PMS deals in favour of APMS contracts covering whole federations or even clinical commissioning group areas. 'It's pointless spending years negotiating on GMS,' he said.
Some sort of contract change was always likely following enactment of the Health Bill. Speculation has been that this would involve introducing a time-limited, APMS-style deal. It now seems increasingly likely the government would want to push integration as part of any change. And deals that would allow collective local contract negotiations may be an option it would favour.
Local deals are not new. Around 40% of practices are on PMS contracts and last year GP reported that funding inequalities and fears over cuts had forced LMCs in Derbyshire and Liverpool to negotiate local deals to supplement GMS income. So can a UK-wide (or even England-wide) contract survive in the new NHS?
The GPC would say 'yes', and from the profession's point of view it would have greater strength if it sticks together under one UK-wide deal. But, with PMS reviews hitting practices hard and the government chipping away at the 2004 GMS deal with successive pay freezes at the same time as expecting GPs to do more, many practices are facing worrying financial times.
If GMS funding continues to be eroded, some practices could be persuaded to switch to new local deals if the terms and incentives were right.