A report discussed by the NHS England board on Wednesday highlights an array of 'drivers of reform' likely to force a major overhaul of the GMS contract.
NHS leaders are discussing the 'implications and opportunities' of plans to increase the NHS budget by £20.5bn by 2023/24, the report says. The ongoing GP partnership review, plans to scrap up to a quarter of QOF targets, an overhaul of the Carr-Hill formula that dictates practice funding, and a review of premises are likely to combine to drive significant reforms.
GPonline reported earlier on Wednesday on findings from a QOF review published this week by NHS England that could see one in four indicators scrapped, with changes and additions to existing targets and a revamped exception reporting scheme.
NHS England has also set out proposals to reform three GP payment mechanisms that could reduce funding per patient for 'digital first' GP models such as GP at Hand by 20%.
NHS England national director for strategy and innovation Ian Dodge said: '2019 starts the most substantial discussion of the GP contract since 2004 - given the forthcoming long-term NHS plan, current pressures on general practice, the emergence of primary care networks, QOF and indemnity reform, the partnership and premises reviews. This calls for more intensive joint working between NHS England and our partners, particularly the BMA.'
The NHS funding rise, set to deliver an initial 3.6% real-terms increase to the health service budget in 2019/20, will support NHS England 'to take forward our ambitions for sustaining and strengthening general practice as the foundation of NHS care', board papers say. They highlight general practice's 'critical role in improving outcomes, quality, and moderating avoidable utilisation of more expensive hospital-based care as well as over-medication'.
NHS England also plans to continue to support the 'nationwide development of 1,000 to 1,500 primary care networks as an expanding service delivery unit' - the so-called GP superhubs policy that GPonline revealed last year was based in part on a theory extrapolated from the size of groups of apes and monkeys. Larger GP organisations could be funded through a new national ‘network contract’, potentially as an enhanced service to run alongside the existing GMS deal.
These plans will drive the 'full integration of primary care' with the wider urgent care system, including NHS 111, pharmacies, urgent treatment centres and A&E departments; an expansion of 'anticipatory' care for people with long-term conditions; and plans for primary care to 'lead the way in personalised care that empowers patients'.
Health service bosses are also keen to support the 'faster full application of digital technology, for the benefit of patients and practices alike' - despite acknowledging the need to avoid 'unfairly destabilising existing services'.
NHS England board papers also highlight ongoing plans to tackle 'pressures on general practice including workforce recruitment, retention and skill mix'. NHS England says the £40m practice resilience programme, which started in 2016, has delivered 6,000 packages of support to GP practices.
A £30m 'time to care' programme that aims to free up GPs' time to focus on patients with complex needs has been adopted by around four out of five CCGs in England, with 100% expected to be on board by the end of the current financial year. NHS England has also highlighted efforts to boost GP recruitment - despite the ongoing decline in full-time equivalent GP numbers - and measures such as the state-backed indemnity scheme set to go live from April 2019 to support the profession.
GPC chair Dr Richard Vautrey said: 'In the year the health service turns 70, we need to take serious steps to address the fundamental issues facing general practice, from workload and workforce pressures to unsustainable indemnity costs and problems with premises. NHS England’s commitment to work with us to address these and other issues which we have repeatedly highlighted is welcome.'
NHS England has taken on direct responsibility for negotiating changes to the GP contract with the BMA - a role usually carried out by NHS Employers.