New GP contract heralds historic new investment for NHS general practice
Press release 21 February 2003
Resources for NHS general practice are set to rise by 33 per cent over the next three years under the terms of a radical new contract to modernise the services provided by family doctors.
If accepted by GPs in a ballot next month, the new UK-wide contract will help to protect patients from the effects of GP shortages, open up a range of new patient services at local level and build rewards for high quality care into GPs’ contracts. The significant additional resources for general practice should boost the incomes of most GPs substantially over the next three years.
Under the contract negotiated between the BMA’s General Practitioners Committee, the NHS Confederation and the four UK health departments, spending on general practice will rise from £6.1 billion per year to £8 billion by April 2006.
General practice recruitment is in crisis, with more than 1,000 unfilled vacancies and many GPs planning to retire or leave practice unless their workload is brought under control. Under the new contract, funding will follow the patient, so if a practice loses a partner, it will retain its funding, and will be able to cover the gap with a salaried GP or with nurses.
Although the contract will be practice-based, patients can still specify which GP they want to see, and the contract has a patient service guarantee to ensure that the full range of patient services will always be available in a locality. A weighted formula, based on a variety of information sources including data from 99 million real patient consultations, will ensure that practices with a higher proportion of sick or elderly patients, or higher costs, will attract extra resources.
The pattern of services is set to change, however, with many GPs likely to give up their responsibility for out-of-hours care. It will cost the average GP £6,000 to shed this responsibility which will be picked up by the local primary care organisation. A lead time of up to 22 months will ensure a smooth transition to the new arrangements.
Modernisation and quality are key features of the new contract. There will be substantial investment in the improvement of GP premises and GPs will receive 100 per cent funding for information technology. Practices will earn more income for delivering better quality services in line with well researched evidence on the best patterns of care and follow up for ten different disease areas including coronary heart disease and mental health. The quality scheme is based on a points system with money attached to the points earned.
All GP practices must deliver essential services to sick patients and to the terminally ill. On top of the essential services there is a range of additional services and also enhanced services which will attract extra funding. Practices which are struggling to control their workload will be able to opt out of some services such as child health surveillance, but the primary care organisation must ensure that the full range is available locally.
A retirement bulge is looming in general practice and better seniority payments have been agreed to encourage GPs to stay in practice. It remains to be seen if this is sufficient to slow down the flood of family doctors leaving general practice prematurely.
The shortage of GPs has meant that many GPs have been forced to close their lists to new patients in order to protect quality and safety. However, currently extra patients can be added to their list by the primary care organisation by forced patient allocation. This has caused huge demoralisation amongst hard-pressed GPs who are struggling to cope with a spiralling workload. Under the new contract, a revised system with an appeal mechanism will make it easier for practices to control their list size.
The GPC has said that the new contract must stand or fall on its own merits and a series of roadshows will be held during March to explain the deal to family doctors. A ballot of all GPs will follow, with the results available in April. If accepted, parts of the contract, particularly preparation for the rewards for quality and the extra funding for new services, would come into force from April this year with full implementation from April 2004.
Commenting on the new contract, Dr John Chisholm, chairman of the BMA’s General Practitioners Committee says:
Primary care has always struggled to get a fair share of NHS resources. This new contract, if accepted by family doctors, promises huge and historic extra resources for patient care and a much needed and major boost to GP earnings through rewards for the delivery of high quality care to patients.
“It modernises primary care by focusing on quality and it offers a light at the end of the tunnel for GPs who are genuinely struggling to cope.
“It also offers a better deal for other practice staff such as nurses and practice managers because the practice will not have to go cap in hand to the Primary Care Organisation to ask for money for an extra nurse. GPs and practices will have flexibility and be much more free to employ a mix of staff that suits local needs.”
The new GP contract: Summary of key points:
Benefits for patients
- 33% increase in resources for general practice over the next three years from April 2003
- Fairer resource allocation, based on the needs of patients
- New contract is designed to encourage good quality care
- GPs will have extra money to expand their services
- Extra investment in information technology will improve care and record keeping
- Better surgery premises
- No services will be cut, although they may be offered by different practices or other providers within a locality
- Greater flexibility should improve recruitment and help fill vacancies
- The practice-based contract means patients register with a practice but can still express their choice of GP.
Benefits for GPs
- 33% increase in resources for general practice over the next three years 2003 –2005
- Fairer resource allocation
- Increased investment in practice infrastructure
- GPs’ own incomes may rise substantially
- All NHS work will be pensionable
- A practice-based contract where money follows the patient and practices have the power to decide their staffing mix
- Extra rewards for improved quality on a points system
- Extra resources available for offering extra services
- Controls over workload
- The right to opt out of 24 hour responsibility
- Improved seniority payments for all GPs
- Salaried option available
What happens when
March 2003 |
Programme of roadshows to explain the detail of the new contract to GPs |
20 March 2003 |
Ballot papers go to all 42,000 UK GPs |
11 April 2003 |
Close of ballot |
Spring 2003 |
If accepted, parts of new contract come on stream. |
2003/4 |
New legislation to support the contract |
April 2004 |
Legislation comes into force |
31 Dec 2004 |
Final deadline for Primary Care Organisations to take on responsibility for out-of-hours care if requested to by local practices |
Click here to access General Practice: Basic Facts document.