GP contract update: Concerns have been raised about plans in the new GP contract for an “as close to real-time as possible” measure of patient experience in general practice, said to have been propelled by Boris Johnson’s number 10.

The new GP contract deal for 2020-21 was published last night, including major concessions by the NHS to ensure doctors sign up to providing additional services as part of primary care networks — having incited considerable dissatisfaction among the profession throughout January. 

It also includes substantially more funding than was included in the five-year contract deal agreed a year ago. Most of this is new money from the government for staff to provide more appointments, as was promised in the Conservatives’ general election manifesto.

‘Near real-time experience’

The new contract agreement states: “A new, as close to real-time as possible and transparent measure of patient experience will be designed and tested in 2020, for nationwide introduction by no later than 1 April 2021. Practices will be required to participate in this.”

HSJ understands that some NHS England officials are concerned about the wisdom and feasibility of developing such a system, especially as quickly as has been planned; while it is supported at the top levels of NHSE and the organisation has supported the measure in contract negotiations.

A senior source close to discussions said the idea of putting “real-time” feedback in the contract had been particularly supported by 10 Downing Street, whose current policy operation, overseen by chief of staff Dominic Cummings, is interested in promoting new rapid measurement methods. Last year, HSJ revealed it wanted a new NHS “morale tracker”, potentially carried out every month.

Dan Wellings, King’s Fund senior fellow and former head of insight and impact at NHSE, said measuring experience in GP practices in close to real-time would be a “significant challenge”.

He said the “challenge will be ensuring data is fit for purpose, ie accurate for comparability between practices and over time and moving to real time”. It would require large enough sample sizes from each practice for them to be compared, and collection of the information through robust processes.

Mr Wellings tweeted: “The more statistically valid it needs to be then the further you need to move away from real time given current availability of sample frames and methods.

“If money is attached to the measure then need to sure it is methodologically robust and that means real time is a significant challenge.”

Last year’s five-year GP contract framework proposed ”a new measure of patient-reported experience of access”, but not that it should be “as close to real-time as possible”.

At present the main measure of experience in general practice is the GP patient survey, which is carried out annually, having been cut from six-monthly in 2017.

The contract does not directly link the measure to performance funding in 2020-21, but says it will form part of the “investment and impact fund” soon. It says: ”Progress against the new patient reported experience metric will be supported by the new PCN [IIF] in 2021-22, when at least £30m of the £150m fund will be directed at improving access.

“However, we intend to introduce the measure as early as possible across all practices in England during 2020-21, and to begin incentivising performance against it at the equivalent rate of £30m/annum pro-rata.”

Meanwhile, in relation to the new flexibility in the contract on how additional services are delivered and staff are deployed, Chartered Society of Physiotherapy strategy director Rob Yeldham said: “Whilst flexibility to address population need is right, there is potential to unwarranted variation in what is delivered. [It’s] not clear how this will be addressed.”

This could mean first-contact physiotherapy services, which are meant to be provided under PCN arrangements, not being properly available in some areas, he indicated.

The contract also included details for how NHSE will improve patient access, increase the recruitment and retention of GPs, and expand the funding for and scale of the PCN additional clinical workforce scheme.

More GPs

From 2021, Health Education England will up the number of GP training places to 4,000 from 3,500, the new contract deal states. The NHS anticipates “a significant proportion” of the extra GP trainees will be “international medical graduates” who will be offered a five-year NHS contract of three years training and a fixed, two-year fellowship programme.

The fellowship programme will offer every newly-qualified GP an opportunity to get mentorship and professional development by 2021. It will also be open to newly-qualified nurses.

Meanwhile, from 2022, GP trainees will spend 24 months in general practice during training, rather than the 18 months they do now. This is expected to account for a large part of the growth in GP numbers the government has committed to in coming years.

The NHS will also target under-doctored areas by expanding the targeted enhanced recruitment scheme, which provides a £20,000 incentive to junior doctors to train in areas with insufficient GPs. It also offers them an incentive to settle in those areas. It currently has 279 places — that will go up to 500 by 2021, and at least 800 by 2022.

RCGP backs contract

The Royal College of GPs chair Martin Marshall — who previously called for a halt to new services in PCNs — has welcomed the new proposals, saying: ”This is an encouraging contract and we thank our colleagues at the General Practitioners Committee of the BMA for their negotiations on our behalf…

“We are pleased that NHS England has responded to many of the recommendations made by the college in our recent workforce roadmap and has listened to the profession by making their proposed specifications for [PCNs], which caused great consternation within the profession, less onerous.

“This should help to ensure that [PCNs] have the time and space to succeed.”

Updated at 2.48pm to clarify some points on the “near real-time” measure.