Large-scale GP contracts could be one-way street to salaried service, says GPC chair

GPs should not be seduced into giving up the security of existing practice contracts to join large collaborative deals that could be damaging and irreversible, GPC chair Dr Richard Vautrey has warned.

GPC chair Dr Richard Vautrey (Photo: BMA)

The BMA's GP leader spoke out after Nuffield Trust research published on Tuesday found that one in four GPs were open to ditching their existing contract to join a local collaborative arrangement such as an MCP (multispecialty community provider) or PACS (primary and acute care systems) deal.

Dr Vautrey told GPonline that effective collaboration should not involve practices giving up GMS or PMS contracts - and warned that practices joining collaborations underpinned by new, joint contractual arrangements could find the switch was 'a one-way street to a fully salaried and managed service'. The BMA has warned consistently that moves to large-scale contracts could prove irreversible.

The GPC chair pointed to findings in a CQC report this week that show GP practices are more likely than all other NHS providers to win 'good' or 'outstanding' ratings in the watchdog's Ofsted-style scoring system. Independent contractor status, and the 'foundation of a GMS/PMS contract' was fundamental to this success, he warned.

GP collaboration

'Good collaboration does not depend on giving up a practice's GMS or PMS contract and practices should not be seduced into MCP or accountable care organisation (ACO) contracts that require them to sacrifice the guarantees they have within their current contractual arrangements,' Dr Vautrey said.

'The GMS contract has an indefinite time limit that lasts beyond the working life of GP contractors, whereas an ACO contract would be up for tender every few years and very quickly could be managed by multinational commercial companies.

'A GMS contract provides stability and ensures practices remain connected with their local community for the long term, developing a level of continuity of care that patients still value and is the reason why general practice remains the most popular public service.'

He added: 'This is completely different from the days when practices took on fundholding responsibilities or moved to PMS. This time it is likely to be a one-way street to a fully salaried and managed service.'

GP contracts

Despite commitments that GPs that join collaborative deals will be offered a 'return ticket', Dr Vautrey warned that 'the reality is that it would be very hard if not impossible to enact in any meaningful way'. The GPC chair has warned previously that untangling shared budgets and sources of income could prove near impossible.

He warned that even if existing GPs joining ACOs were offered good terms and conditions, it was 'very likely' these would change over time. 'There are currently no national terms and conditions for doctors working in ACOs, unlike doctors in hospitals,' he said. 'There is also significant uncertainty what would happen to GP owned premises in these new arrangements.'

He added: 'The CQC has just demonstrated that practices operating through an independent contractor arrangement are performing far better than any other health or social care sector. We need to learn the lessons of this and recognise that the foundation of a GMS/PMS contract is fundamental to this success. What's needed is proper investment and genuine collaboration within the community, developing robust teams working with practices, not another organisational change.'

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