Launching a renewed health policy this week, Tory leader David Cameron also promised an effective return to fundholding.
The policy document suggests three main changes to the quality framework, which would see the central concept remain but with changes to how points are allocated.
The party wants to alter the balance of the framework so that improvements in clinical outcomes are more explicitly and more greatly rewarded’.
It suggests adding further outcome indicators ‘in discussion with health professionals’ and a move away from patient registers to more actual treatments.
‘GPs are awarded more than four times as many points for keeping a list of patients with high BP than for ensuring that patients who have had a stroke are immunised against flu,’ says the document.
Another change would be to give more weight to patient feedback.
‘Patient-reported outcomes are a key element in learning how effective services are for patients,’ it says. ‘However, at present, just 70 points are awarded to the GP: 40 points for carrying out a patient experience survey once a year, 15 points for ‘reflecting’ on it, and 15 points for producing evidence that changes have been made as a result of the information gained from the survey.
‘We believe that the system of patient-reported outcome measures can be enhanced, and that patient-reported outcomes should have a much larger impact on GPs’ remuneration.’
It also suggests that GP pay should depend on patients’ experience of secondary care.
The document states: ‘At present, the quality framework makes GPs responsible for the care of their patients for which they are directly responsible. We would ensure that GPs are also paid for the quality of care their patients receive from other healthcare providers, such as local hospitals.’
To achieve this, the Tories suggest a return to fundholding with GPs holding actual rather than indicative budgets ‘because GPs typically know their patients at first hand, and are therefore best placed to know the services which would be of benefit to them’.
Shadow health secretary Andrew Lansley said that fewer targets, ‘the freedom to make clinical decisions’, and ‘enabling GPs to take responsibility for the entire progress of a patient’s treatment’ was at the heart of its suggested reforms.
‘The family doctor is central to the way the NHS should work,’ he said. ‘We need them to have incentives to deliver the best outcomes for patients... by controlling budgets for their patients. Giving the family GP more responsibility, will mean they can combine clinical decisions with accountability to their patients.’