Exclusive: Five-year contract threat for practices

DoH considers using short-term contracts to eliminate under-performers.

Practices could be forced to switch to five-year contracts, giving PCTs greater power to remove them, GP has learned.

Sources close to health minister Lord Ara Darzi say that the plan is one of a number of proposals being considered as a way of tackling under-performing practices. It is believed to be the option favoured by health minister Ben Bradshaw.

Other options under discussion include putting tighter minimum practice standards in contracts and strengthening regulation.

GPC chairman Dr Laurence Buckman said that short-term contracts would destroy continuity of care and discourage GPs from investing in services.

'It's like saying that because two of the ship's suites need new panelling, we're going to scuttle it and put everyone in the lifeboats,' he said.

Fellow GPC negotiator Dr Chaand Nagpaul said: 'The greatest failing in tackling GP performance has been PCT performance.'

PCTs should use existing powers to tackle under- performance, he added.

Speaking at the NHS Confederation's Primary Care Network in London last week, health secretary Alan Johnson said: 'Where there is poor quality we want to see PCTs taking active steps to tackle it, if necessary, by removing contracts.'

He added that the government was not 'punishing' GPs.

Sources said that poor-quality practice would not be defined against a single measure. Instead, PCTs would use a range of indicators, including clinical outcomes, patient satisfaction, quality framework scores and peer opinion.

At present, PCTs can only remove GPs if they are seriously in breach of contract. But the process is long and the pressure is on PCTs to help struggling practices improve, making it difficult to remove contracts unless patients are in danger.

The APMS contract provides a precedent for short-term contracts, giving PCTs new powers to press for improvements in performance.

A less radical option would be to give the Care and Quality Commission powers to enforce standards in primary care. It starts work in April 2009.

Alternatively, the GMS contract could be redrafted, to make it easier to prove breaches.

The DoH was unavailable for comment.


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