Public Accounts Committee Report On The GP Contract Is Out Of Date, Says BMA, UK

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 09 Oct 2008 - 3:00 PDT

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Responding to the Public Accounts Committee report on the new contracts for GP services in England, Dr Laurence Buckman, chairman of the BMA's GP Committee, said:

"We are pleased the report recognises that the contract has had benefits for patients and the NHS. However, the GP contract is now quite different to the deal originally agreed in 2003 and much of the criticism in this report is based on an out-of-date understanding of the current situation.

"GP practices have taken on additional work since the original contract was agreed, practice income has been frozen and issues such as the phasing out of MPIG (Minimum Practice Income Guarantee) are already being worked on through negotiation. We want to reduce practices' reliance on MPIG and create a fairer system, but if it's done too quickly it will damage practices and the services they provide for patients."

Commenting on the government 'overspend' and the pay for performance system known as the Quality and Outcomes Framework (QOF), Dr Buckman said:

"The Department of Health grossly underestimated the cost of out-of-hours which was the main reason it exceeded its own budget. It also didn't listen to the doctors who told them GPs would hit the vast majority of the targets. Hitting these targets has been good for patient care. QOF was a radical change brought in to improve health over the long-term. It was never just about measuring what GPs do. It means patients across the country get the same high-quality care wherever they are as all GPs follow the same evidence-based path. Furthermore, the gap between those in the most and least deprived areas is narrowing year on year1. As a result of the QOF more conditions are being diagnosed and controlled earlier, patients' quality of life is improving, hospital admissions are reduced and ultimately deaths are prevented."

The BMA also challenges the suggestion that GP 'productivity' has decreased. Dr Buckman said:

"The measure of productivity quoted is crude and doesn't accurately reflect how GPs' work has changed in recent years. GPs now deal with more complex consultations and the intensity of the work has greatly increased. For example, the care of patients with asthma and diabetes is now routinely managed in general practice. We're happy to work with the government to come up with a productivity measure that is accurate."

The GP contract set core hours for GP services between 8am and 6.30pm and was never intended as a means of making practices open for longer. The recent deal on extended hours saw money taken away from practices if they did not open for longer in the evenings.

For more information on this and a briefing on the health outcomes for patients since the changes to the GP contract, including a case study on how the QOF works in a practice, please go here.

British Medical Association
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http://www.bma.org.uk

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