Monitor to review fairness of GP contracts

Health regulator Monitor is investigating whether variations in GP contracts and potential conflicts of interest are acting against the best interests of patients.

Dr Richard Vautrey: variation in GP contracts 'not unfair' (photo: Jason Heath Lancy)
Dr Richard Vautrey: variation in GP contracts 'not unfair' (photo: Jason Heath Lancy)

The regulator will also consider whether patients have enough choice over which GP practice they attend, and the extent to which GPs offer patients choice at the point of referral.

A long-awaited report by the regulator, A fair playing field for the benefit of NHS patients, called for more evidence to help it determine 'the extent to which the commissioning and provision of general practice and associated services is operating in the best interests of patients'.

It said: 'A number of stakeholders suggested that different contractual arrangements for new and existing providers are unfair on new entrants.

‘One contributor to the review pointed out that the different contracts make it difficult for commissioners to get value for money as they each provide for different base levels of remuneration and different payments for additional services or quality improvements. They also create different powers for commissioners to adjust or end contracts.’

The report found that while ‘most GPs report that they offer choice, they also admit to not offering choice all of the time’. It said: ‘Their most common on explanation for this is that there is insufficient time, or that patients are not interested.’

GPC deputy chairman Dr Richard Vautrey said variation in contracts was not unfair. ‘I don’t think contracts are the issue here,' he said. 'If the government wants practices to provide more services and develop, then they need the resources to do that. General practice is still the most cost effective model for providing primary care.

‘The reality is that every patient in an urban area has significant choice over which practice they can register with.’

The review makes 30 recommendations including making all providers of NHS services subject to ‘freedom of information requirements’ on a ‘consistent basis’.

It said the government should ‘rapidly extend access to the NHS pension scheme’ for all staff moving from a public provider to other NHS-funded 'clinical' providers. VAT refunds should also be applied to some charitable NHS-funded health care providers, the report recommended.

Health minister Lord Howe said: ‘We are committed to making sure that patients can access services delivered by the best possible providers.

‘Many of these recommendations are for other key organisations who will have to consider how they take them forward. Some of the recommendations will require further work before decisions about changes are made.

‘That is why we are asking Monitor to establish a high-level group that will review progress in creating a fairer playing field for the benefit of patients.’

A Monitor spokeswoman said the regulator could make further recommendations on primary care at a later date depending on evidence it received. It has set a June deadline for more evidence to be submitted.

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