Former GP Dr Sarah Wollaston said the seven-day GP plan unveiled by prime minister David Cameron on Sunday could disadvantage practices that are unable to federate and make them less attractive to GPs if badly implemented.
Speaking at a BMA fringe meeting at the Conservative party conference in Manchester, Dr Wollaston said the big question over the new contract was how it would be incentivised.
‘If it's incentivised in a way that hugely disadvantages practices that can't federate and deliver, then again you may have an unintended consequence of driving GPs away from those practices and towards the large federated practices’, she said.
GP workforce crisis
'And then what could happen in those under-doctored areas - because fundamentally we do have a shortage of general practitioners.'
Dr Wollaston, however, backed plans for the new contract to reduce QOF bureaucracy and called for practice federations to be given more control under the new contract over what they want to achieve for their populations.
The voluntary seven-day contract will be launched for April 2017, Mr Cameron announced over the weekend. The new deal is being developed to support NHS England’s new care models vanguards programmes and the integration of wider primary and community care services.
The GPC said it would be wrong to use relief from QOF box-ticking as a carrot only for the benefit of patients of practices able to sign the new contract.
NHS England has said previously that it would develop new contractual options to encourage GPs to join new care models. As well as simplifying the QOF, it has suggested merging GP funding with other providers’ streams.
The government said the new contract would be based on the principles of more money for primary care, more control for GPs over the way they work, and more time to care for patients, and services seven days a week.
A new ‘patient guarantee’ will require CCGs to ensure every patient has seven-day access to services by 2020.
Dr Wollaston has been openly sceptical of her government’s pledge to ensure a seven-day service for all patients in England, suggesting it may not be possible because of the workforce crisis. Speaking at the conference event on Monday evening she said the government should be clear what its objectives are.
‘Our number one priority appears to be to address the variation in weekend mortality at 30 days for those admitted on a Sunday compared to Wednesday,' she said. ‘There is a very strong case for saying we try to reduce avoidable hospital admissions by making it easier for people to be seen in a way where they don't necessarily end up in hospital if that's not the right place for them to be.’
But, she added: ‘What we probably can't deliver, unless we are diverting money from more important priorities, is a convenience seven-day service.’
‘If you try and deliver that,' she added, ‘there is a danger that you undermine existing out-of-hours services.'
Dr Wollaston said ministers had clarified their intentions recently, suggesting services would not be ‘pushed through’ in areas where there is no demand.
Photo: JH Lancy