Expert warns out-of-hours primary care tariff price 'undermines integration'

Fixing a tariff price for primary care out-of-hours services could undermine their integration with other NHS services, an expert has warned.

In June, senior GPs backed a motion at the LMCs conference in London calling for the GPC to press the government to agree a ‘realistic minimum contract price to which commissioners must adhere’ for out-of-hours services.

But NHS Alliance urgent and out-of-hours lead and Primary Care Foundation director Rick Stern has said a tariff for out-of-hours could block efforts to develop better links with other NHS services.

‘I think it is best to get the service to work together, not picking on out-of-hours, when commissioners are trying to see how it fits in.

‘People are looking at how you blur the boundaries not separating it out. A separate tariff would not be helpful.’

But GPC member Dr Fay Wilson, who spoke in favour of the tariff at the LMCs conference, said a fixed price could make integration easier.

Dr Wilson said there was little consistency between out-of-hours services in different areas, because the lack of a fixed price created a ‘reverse auction’ in which commissioners picked the cheapest available option.

She said a fixed price would reduce variation because the tariff would be tied to a standard definition of work included in the tariff.

‘If there was a tariff, it would make it much easier to integrate. I think it would make it much more straightforward, because there would be consistency between them.’

Dr Wilson pointed out that the Health Bill had promised that there would be no competition on price in the NHS.

‘But we’ve had it in out-of-hours for years,’ she said.

Mr Stern said he hoped to publish a report within the coming months offering commissioners examples of how to improve integration of urgent and out-of-hours services within the NHS.

‘There are great opportunities for clinical commissioners to take forward urgent care, without some of the restraints that have existed in recent years,’ he said.

Mr Stern added that although there was substantial variation in the standard of out-of-hours services, overall quality was higher than it was in 2004 when the new GMS contract was introduced.

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