UK reaction to GMS contract changes for England

GP leaders are warning that practices could close if government proposals to change the GMS contract in 2013/14 are imposed.

Dr Peter Swinyard: ‘There are some practices that are on the margins financially that might be forced to shut up shop.’

The DH launched a 12-week consultation today on its proposals for the GP contract, which include GPs having to work harder to retain current pay. It is also proposing that any new funding for practices in 2013/14 will be 'targeted towards those with less current funding per patient'.

Family Doctor Association

Family Doctor Association chairman Dr Peter Swinyard said the proposed contract changes would hugely demoralise GPs and force some practices to close. ‘There are some practices that are on the margins financially that might be forced to shut up shop.’

Dr Swinyard said the transfer of locum superannuation payments from PCTs to practices could have a very damaging effect on small and single-handed practices.
‘GPs in small practices will have to take less holidays and end up burning out. Some won’t be able to take any holidays at all.’

He said that the proposed changes to the QOF were ‘particularly poisonous’. He alleged that plans to retire organisational indicators went against an agreement the GPC made with the government when they negotiated the 2004 contract.

Dr Swinyard added that plans to raise BP targets from 150/90 to 140/90 for patients under 80 years old with hypertension would be particularly hard to meet.

‘That will involve a substantial amount of extra work to persuade patients to take more BP pills to reduce their BP.’

He said that once QOF targets were raised many practices wouldn’t ‘strive too hard to achieve them’.

Rather than reducing ‘box-ticking’ Dr Swinyard said initiatives such as enhanced dementia screening would increase box-ticking and put pressure on already stretched local services.

Dr Swinyard said he hoped that the next steps would be for the government to re-enter negatiations with the GPC. ‘It has got to withdraw the imposition and get the GPC back to the table.’

He said he didn’t support the idea of industrial action over contract changes, but added that there were ‘other ways of making the government’s life unpleasant’.
Dr Swinyard said that practices should look at stopping any work they are no longer being paid to do.

He said: ‘I hope the GPC will provide advice to practices on what was in the QOF and what they can now cease to provide.’

National Association of Primary Care

National Association of Primary Care chairman Dr Charles Alessi said: ‘A lot depends on the implementation. We need to understand what we are trying to achieve.  I am concerned to hear that PMS could be dismantled as that is not helpful. PMS contracts are sensible to the needs of the local population.

‘The way we do things need changing. We need to embrace new technology. QOF will change. The discussion is about the pace of change now. I want to look at the proposals in detail before I comment in detail about them.’

GPC Wales

GPC Wales chairman Dr David Bailey said GPC Wales is still in talks with the Welsh government on contract changes. He said he expected a preliminary imposition letter detailing the changes the Welsh government planned to make to the GMS contract before Christmas.

Although he could not discuss the details of the proposals he said that they were different from those put forward by the DH in England. ‘I don’t think [the contract changes] will be welcomed by Welsh GPs however they will be less unwelcome than those in England,’ he said. ‘I don’t think it’s likely at the moment that we will receive a negotiated settlement like Scotland although it is possible.’

GPC Northern Ireland

GPC Northern Ireland chairman Dr Tom Black said: ‘The letter of imposition for GMS is horrendous. It imposes a huge amount of extra work and will inevitably result in a loss of resources for practices.

‘Northern Ireland GPC is still in talks with the department in Northern Ireland.’

NHS Employers

NHS Employers director Dean Royles said: ‘We note that the consultation letter has now been sent to the GPC, signalling the commencement of the formal consultation process. The proposals outlined in the consultation are consistent with the direction we have tried to take negotiations with the GPC this year, where we sought to reach agreement on changes that improve patient care and in particular, get more practices to deliver what the better practices already achieve.’

*QOF thresholds to rise to 100% in contract changes

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