Sticking it to Whitehall over GP standards

A supertanker is often described as slow to turn, but compared with changing minds in the DoH it corners with the agility of a Formula One car.

But now it seems the minds of some officials are changing when it comes to the quality framework. Discussions are underway over whether the emphasis in funding in the GMS contract should move away from the quality framework in favour of the global sum.

With more funds in the global sum, it would finally be possible to break the shackles of the MPIG which makes it difficult for practices to take on more patients or expand services. At the same time the quality framework would have to be slimmed down and become more focused which could help end the tinkering seen in recent years.

It is clear the government saw the quality framework as a big stick or a trap that it could use to catch GPs out.

Imagine ministers and officials chuckling as they worked out their cunning plan. By putting so much emphasis on the quality framework they would be able to prove how lazy GPs were - and having caught them out it would be able to wield a big stick forcing them to do more for less.

Instead, the DoH found its clever little trap snapping its jaws around the government and the NHS budget, because the architects of the contract deal (on the government side) had failed to comprehend how much work was already being done in general practice and that the quality framework targets, supposedly designed to reward 'special' practices, were generally achievable by most practices.

The shift in emphasis now under discussion could return the balance of GMS contract funding to what was envisaged before the DoH tinkering began.

Professor Roy Carr-Hill, the brain behind the original concept for the global sum, has always maintained that his formula should have distributed a much greater proportion of general practice funding than the 72 per cent, excluding enhanced services, that it makes up.

If the proposed shift in emphasis was to go ahead it could be seen as an acceptance on the part of Whitehall that reducing CHD, treating diabetes and asthma and preventing serious illness is central to general practice, not some kind of add-on only performed when officials wield their cudgel.

Any change would require a radical rethink of the quality framework but it would be an indication that some in the DoH see the value of general practice after all.

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