GPs put patient care before targets
21 February 2013
GP leaders have told the government that proposed changes to the GP contract will put targets before patient care.
The BMA GPs committee warns that the combined impact of the changes will destabilize GP practices, reduce access for patients, and put GPs and staff under ‘enormous strain’ in terms of workload.
In a letter to Department of Health head of primary medical care Richard Armstrong, GPC chair Laurence Buckman says GP leaders share the government’s aim of promoting the very best quality of care for patients.
However, he adds that the package of changes for England ‘fails to consider the cumulative impact … and includes suggestions which are simply not feasible in practice or will lead to unintended consequences’.
The letter adds: ‘The changes would make it difficult for practices to maintain the level of care they currently offer, while introducing an even greater focus on targets and box-ticking at the expense of holistic, patient-centred primary care.’
Consultation feedback
The GPC response to the DH consultation on the changes, which could be imposed from April 2013, includes findings from an online BMA survey of GPs and feedback from roadshows attended by hundreds of GPs.
Interim results of the BMA survey, which attracted around 7,750 responses, show that almost nine out of ten GPs believe they would be less able to offer patients good-quality care.
Eighty-seven per cent would be less likely to recommend general practice as a career for new doctors.
Six out of every 10 GPs say they would have to do things differently to cope with the imposition. For this group, the survey finds:
- 54 per cent expected their practices to have to reduce access to patients
- 82 per cent would expect to make changes to staff working hours or employment. Of these, 22 per cent would expect to make clinical staff redundant and 35 per cent to lay off administrative staff
- 52 per cent would expect to reduce their use of GP locums.
The GPC response also expresses disappointment at the way the government bypassed the negotiating process and launched the consultation on the changes it wanted.
These include scrapping most of the organisational points in the QOF (quality and outcomes framework), and using the £167m freed up by that to fund new work; a seven-year phase-out of the minimum practice income guarantee; and an increase in QOF thresholds.
What GP leaders want
GP leaders would prefer a negotiated settlement but, as a bare minimum, want the Department of Health to:
- Follow the Scotland government example, and put QOF (quality and outcomes framework) organisational funding into GP practices’ global sum equivalent
- Return to draft proposals for securing equitable funding for GP practices worked out by the BMA GPs committee and NHS Employers, and fully model the impact of funding changes before implementation
- Postpone some changes as there are just five weeks before the complex proposals are due to take effect
- End the encroachment of QOF targets on holistic, patient-centred care
- If funding from QOF is to be used to fund new work, it should be focused on a more limited range of new services.
Locum pension changes
GP leaders want a one-year delay to the implementation of changes to arrangements for locum pensions. As of April, GP practices in England and Wales are due to take over responsibility for the 14 per cent employers’ contributions from primary care organisations.
GP leaders say they understand that general medical services GP practices will be reimbursed for this via extra payments to the global sum, but this would not adequately reimburse GP practices receiving correction factor payments.
They want an alternative system with the funds administered centrally.
Opposition to extra work without new funding
The GPC has expressed its ‘fundamental opposition’ to new DESs (directed enhanced services) being introduced without fresh funding.
GP leaders argue that stripping funds from the QOF (quality and outcomes framework) organisational domain and making GPs earn the money back by doing significant new work will have a ‘major negative impact’ on patient services, staffing and income.
Almost eight out of 10 respondents to the BMA’s online survey of GPs agree with this
The response also sets out the BMA GPs committee’s concerns about specific aspects of the new work. On dementia, for example, GP leaders say plans to screen at-risk groups for dementia contradict policy from the National Screening Committee and the National Institute for Health and Clinical Excellence, and could find a large number of ‘false positives’, causing unnecessary anxiety.
The plans do not consider the lack of services available for people after positive dementia diagnoses, the BMA says.
The story so far