GPs split over contract changes

GPs are unsure on QOF changes but pension reforms could see half take 24-hour retirement or quit. Tom Ireland reports.

Dr McKeown: 'People are divided by the new QOF indicators. Some say we can improve services and save money, others say it is just rationing' (Photograph: Malcolm Case-Green)
Dr McKeown: 'People are divided by the new QOF indicators. Some say we can improve services and save money, others say it is just rationing' (Photograph: Malcolm Case-Green)

A third of GPs would consider retiring early to avoid the impending NHS reforms, this week's GP survey found.

But the poll also revealed GPs' deep anxiety about changes to their contracts and a possible pension overhaul.

As GP leaders at the BMA special representative meeting on 15 March called for the Health Bill to be withdrawn - a call backed by GPs in our poll - measures to support the reforms have been written into the GP contract.

While coping with just a 0.5 per cent funding uplift to cover rising expenses, GPs will now be expected to shift their referring, prescribing and emergency admissions closer to national averages to achieve full QOF points (GP, 18 March).

Opinion is split on whether the new 'productivity' indicators in QOF are welcome or not. Just under half (44 per cent) of GPs feel the new indicators, which account for 10 per cent of all QOF points, are a bad idea. But exactly the same proportion back the plans.


Financial indicators
One GP partner responding to the survey said the indicators were 'blatantly financial' and had 'nothing to do with improving patient care'. But many others wrote that they consider the new indicators to be work they already do.

'We already audit our own referrals to ensure good clinical practice,' said one GP.

Another GP said the indicators were the only way consortia can encourage 'tardy practices' to control secondary care and prescribing budgets.

But one respondent, a GP in Sussex, claimed the indicators contradict messages in the DoH's national cancer strategy, which encourages more diagnostic referring by GPs.

'You cannot have a system whereby GPs are being offered financial inducements not to refer, and then expect malignancies to be diagnosed earlier,' he wrote.

Either way, the DoH will need GPs to engage with the scheme - it is banking on the productivity indicators saving the NHS £800 million a year.

However, concerns about this year's QOF indicators are eclipsed by fears about pensions, the GP survey shows.

Chancellor George Osborne, in last week's Budget, announced he will consult on progressively raising the public sector retirement age as suggested by former Labour health minister Lord Hutton's pension review. GPs' retirement age could rise to 65 by 2015, and to 68 by 2044.

Almost half (45 per cent) of GPs would consider quitting or partially retiring if the public sector retirement age increases, GP's poll found. Just under 20 per cent of GPs would quit general practice if the changes go ahead, while another 25 per cent would take 24-hour retirement.

One respondent, 54 years old, and typical of many, wrote he'd 'just go now'.

As well as threatening to leave en masse as pension changes approach, GPs are also likely to cut services they offer.

Around a third of partners polled said their practice would stop providing extended hours in 2011/12 as a result of contract changes.

Funding for the scheme will fall from £3 to £1.90 per patient, and although not all GPs use this nationally negotiated deal, PCTs are expected to make equivalent changes to local schemes.

Reflective of GPs' mood
GPC member Dr Helena McKeown says GP's poll 'definitely seems to reflect the mood' in Dorset and Wiltshire.

'People are divided by the new indicators - some think we can improve services and save money, others do think it is just rationing,' she says.

The mood in some practices is 'disheartening', due to ongoing funding cuts and the prospect of pension changes and NHS reform, she says.

'GPs already have so much on their plates. We had consortia elections locally recently, and only five GPs stood for six places. That sums it up really.'

Ministers should pay close attention to GP's snapshot of grassroots GP opinion.

The government's NHS reform programme could fail if GP morale is undermined by attacks on pensions and contracts; extended hours, popular with some patients could disappear unless properly funded; and GP commissioning, the government's flagship policy, could be a disaster if GPs feel they are just rationing patients' care.

The profession can make the reforms work, creating the savings and service the government wants - but not if they feel their contracts and pensions are under attack.

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