PAC Report On GP Contract 'ill-judged And Wrong'

Main Category: Primary Care / General Practice
Article Date: 10 Oct 2008 - 4:00 PDT

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Today's report by the Public Accounts Committee is ill-judged and wrong, according to the NHS Alliance. They point to inaccurate statistics and misconceived analysis.

Most worrying is the claim that productivity has decreased since the introduction of the new GP contract. That appears to be based on overly simplistic arithmetic comparing the number of consultations per doctor today with the previous number, but failing to take account of quality or patient need. The Department of Health told the PAC in its evidence that it did not accept this measure.

It takes no account of the complexity of consultations, the number of tasks carried out within the consultation, referral rates, investigations or co-morbidity. All have increased in recent years. Patients who used to be treated in hospital are now treated in primary care. Comparing simple numbers tells us nothing.

Some of the figures quoted in the report differ markedly from the official published statistics. For instance, the Committee claims that the numbers of GPs have increased by 4,000 since 2003, a growth rate of 15%. The official statistics show that GP numbers grew by 3,000 (10% not 15%) between 2003 and 2007, the last year for which figures are available. There are now 66 family doctors per 100,000 population compared with 61 five years ago.

In fact, GP practice - and primary care generally - deliver remarkable value for money. The average GP practice, complete with doctors, nurses and administrative staff, costs just £150 per year per patient. That is less than the cost of most out-patient appointments, or a single patient day in hospital. The report is correct in saying general practice costs around 10% of the NHS budget, but does not say that it also accounts for more than 90% of patient contacts.

NHS Alliance chairman Dr Michael Dixon said:

"The report's analysis of productivity in general practice is naive and ill-judged. Some of its figures appear to be wrong. Everyone concerned with the welfare and safety of patients must find this extremely worrying. Healthcare cannot be measured in the same way you might measure the production of widgets. Nor can patient needs be dismissed as irrelevant to the calculation.

"The new contract has allowed doctors to provide the best possible quality of care and has improved health inequalities. GPs all over the country have welcomed that. For example, I now plan 15 minute instead of 10 minute consultations for around half my patients because I am seeing people with more complex needs. Yet according to the PAC, that means I am not sufficiently productive.

"In the long run good quality care saves money, often by avoiding the need for hospital admissions because the patient's condition has deteriorated. Sadly, the PAC has failed to understand the nature of general practice - and the needs of NHS patients too."

Notes

1. The NHS Alliance is a collaboration of clinicians, managers and board members who put patients first. It is the independent body that represents NHS primary care. Values based, it is the only organisation that brings together PCTs with GP practices, clinicians with managers and Board members, and NHS primary care with its patients. The Alliance membership and its hard working national executive is fully multi-professional.

2. Out of hours care and other issues connected with the GP contract are on the agenda for the NHS Alliance annual conference, to be held at Bournemouth International Conference Centre 16 - 17 October 2008. Journalists wishing to register for the NHS Alliance annual conference should contact Pat Goodall at the address below, or get in touch with the NHS Alliance head office: office@nhsalliance.org

NHS Alliance