Editorial: Yet more change for no more funding

Big changes are afoot in the way general practice is funded. Over recent weeks, GP has reported that MPIG could be gone in five years.

Practices will also see the end of the square root prevalence formula which, for a significant number with low morbidity, such as university practices, will mean a real struggle for survival.

Last week, we reported on the DoH plans to overhaul the quality framework, which would see NICE developing 10 new clinical indicators a year, with indicators that no longer need incentivising being 'retired'. GPs will be expected to work harder and take on new work to receive the same level of funds.

But this could be just the start of changes. At a conference last week, Adrian Jacobs, one of the contract negotiators for NHS Employers, said that quality pay should not make up such a large proportion of GP income, that the QOF should be mandatory for all practices and that those practices that perform poorly should have their contract terminated.

This is a radically different type of framework to the concept to which GPs originally signed up. Rather than offering practices an incentive to improve care and drive up standards, the framework would become a rod with which to beat GPs.

Is the DoH preparing to dump the carrot in favour of the stick? This would be no surprise. As GP pointed out earlier this month, the contract has changed so much that very little of it resembles the original deal the profession voted for in 2003.

Of course, this vision for the QOF is only one person's view and it may not come to pass. However, this government seems intent on doing everything in its power to make GPs work longer and harder without offering them a penny more.

GPs greatly surpassed ministers' expectations with their QOF achievements and will, of course, continue to excel at any new clinical indicators. But such achievements involve a great deal of work, which the DoH should recognise and acknowledge, rather than constantly shifting the goalposts in an effort to get more for less.

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