White Paper cash 'quality premium' for successful GP commissioners

Practices could receive a share of a cash 'quality premium' if their commissioning consortium delivers good patient outcomes and manages finances successfully.

Commissioning for Patients, a DoH consultation on plans for GP commissioning reforms published on Thursday, says this premium will be paid to successful consortia, which would be ‘free to decide how best to apportion it’ between member practices.

The consultation document makes clear that the funds would come from ‘existing resources’, but gives no detail on whether this could be from part of existing GP income or, for example, from funds freed up by the abolition of PCTs.

GP leaders’ reaction was mixed, but most demanded further detail on the plans.

BMA chairman Dr Hamish Meldrum said: ‘This document provides more detail about the government’s plans for GP commissioning, but there are still many questions that need answering. The proposals contain both opportunities and threats and we will be actively engaging with the consultation process to explore this in great detail and to ensure our members’ views are taken on board.

‘We will also be publishing our own proposals for how GP commissioning could be made to work.’

Derbyshire LMC secretary Dr John Grenville told Healthcare Republic that it would be unacceptable if the proposed quality premium was stripped out of existing GP income.

‘If it’s a premium it has to be on top of existing income. If it is out of resources taken out of PCTs or secondary care that would be something we could negotiate around.’

National Association of Primary Care president Dr James Kingsland said the commissioning document was ‘pretty close’ to what he had spent the last 10 years lobbying for.

He said it was reasonable to reflect commissioning outcomes in GP income, because the commissioner and provider functions ‘could not be fully split at registered list level’.

‘It’s very difficult to argue against some of the GP contract being linked to commissioning activity,’ he said.

Cleveland LMC secretary Dr John Canning said linking GP pay to commissioning was ‘quite worrying as a simple statement’.

But he added: ‘It all depends on the detail. I have a concern about [whether the public will be happy] with my income being dependent on my ability to reduce NHS expenditure and me then using that money to reward myself. That is a fundamental problem.’

The commissioning document also contains a damning assessment of the effectiveness of the QOF in its current form.

It says the QOF is ‘failing to deliver any significant degree of continuous quality improvement for patients’.

Dr Grenville demanded details of where the evidence for this statement came from. ‘As far as I am concerned QOF is still driving quality. It pays people for doing things that evidence shows improves outcomes for patients,’ he said.

The commissioning consultation makes clear that although the NHS Commissioning Board will hold GP contracts, it will be able to delegate some responsibilities for managing them to GP consortia, subject to measures to protect against conflicts of interest.

GP consortia will be able to commission services above and beyond standard primary care services from practices that are among their members, too.

The consultation paper makes clear that the DoH will design a system that creates safeguards against conflicts of interest – potentially putting to rest fears that GP consortia could be barred from commissioning enhanced services from GP practices.

Editor's blog: Health White Paper should mean GPs are paid more

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Nick Bostock

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