Speaking at the NHS Alliance annual conference last week Dr Hamish Meldrum said the NHS should operate only two GP con-tracts because the current range of options was too wide and created ‘unfairness and confusion’.
‘The money you get should not depend on the contractual option you choose,’ Dr Meldrum said. ‘We need consistency and fewer contractual options. I think we need two — GMS and APMS.’
GMS would be the ‘nationally based, safe contract’ and APMS a flexible alternative to allow innovative approaches to fit local health needs, he explained.
Dr Meldrum, a PMS GP, told GP after the speech that these were his personal views and not official GPC policy.
He warned that GMS would have to evolve: ‘It doesn’t encourage practices to expand. It is difficult for new practices to set up under current GMS.’
This could be resolved in part by increasing global sum funding to cut the proportion of practices reliant on the MPIG, he said.
But the global sum formula would also have to change, along with the ‘normalisation factor’ applied to practices’ weighted lists to reflect population changes.
Dr Meldrum said: ‘Normalisa-tion is not transparent and we have to do something about it. I think we need to go back to some form of basic practice allowance and capitation on top of that.’
He said PMS practices with growth money might have to hand it back if they were unable to prove they were doing extra work in return. But he said they should be offered a return ticket to GMS, with a full MPIG.
National Association of Primary Care chairman Dr James Kingsland said the comments were ‘premature’ and that further contractual changes now would be ‘a bit of madness’. GPs who took on practice-based commissioning (PBC) would benefit from having a wide range of contract options available to them.
‘We have a diverse population and one-size-fits-all GMS didn’t work in the past and will never work for a significant number,’ he said. ‘If it had, 40 per cent of practices wouldn’t have gone to PMS.’
He added that, if APMS deals took over vacant practices as cur-rent GPs retired, GMS could be-come a minority contract option behind PMS and APMS.
Helen Suddes, acting director of primary care at Durham PCT, which is mainly PMS, said scrap-ping it would be a backwards step: ‘I don’t think primary care is confused by PMS. I think the system works well as it is.’
She said it would be difficult to justify a ‘major bureaucratic change’ just to simplify funding arrangements.
However, Steve Mercer, chief executive of Avon LMC, where almost 90 per cent of practices are PMS, agreed that PMS and GMS should be unified. But he said: ‘PMS practices used growth to employ hundreds of new doctors — to return to GMS they would need a guaranteed retention of growth.’