GP contract work slashed to focus on covid-19

In a letter to practices and primary care networks, Nikki Kanani, primary care medical director, and Ed Waller, director of primary care strategy and NHS contracts, outlined several activities GPs can suspend, including annual health checks for patients over 75 that are required under the GP core contract.

Other routine activities that can be suspended include medication reviews, new patients reviews and the friends and family test. These are activities that GPs are financially incentivised to carry out under their core contract.

GPs can stop these services unless they are considered to be clinically necessary, in which case they should be done remotely. Some could be done face-to-face but only in exceptional circumstances. The requirements may start again from October, the guidance added.

To ensure clinical decisions are not influenced by funding, practices will continue to be paid at rates “that assume they would have continued to perform at the same levels from the beginning of the outbreak as they had done previously”.

Practices are also asked “to consider stopping any private work they are doing to help free up capacity”.

The letter said the default position for clinical commissioning groups should now be to halt or reduce in frequency any local audits and other data collection programmes except where they are “considered to support the national covid-19 response”.

Meanwhile, funding for the controversial “primary care network” contract — which is being introduced in April to encourage GPs to work more closely with other community services — will continue to all networks that have signed up, although practices will be granted more time to decide what additional clinical workforce they want to bring in under the PCN contract.

The letter suspends some of the requirements set to be introduced under the PCN contract, but the most contentious aspect — to offer an enhanced health in care homes service — remains in place.

Networks will continue offering the care home service in line with the timeline set out in the 2020-21 contract, “given the importance of delivering a coordinated service to care homes”.

This will require each PCN by 31 July to decide which care homes it is responsible for with its CCG, and agree on a plan with local community health providers for how the service will operate. The PCN and community provider will need to establish a multidisciplinary team to deliver the care home service by 30 September.

In many areas, CCGs have been commissioning local versions of the care home specification, and the guidance stated they should “ensure a carefully managed transition from local to national requirements”.

The care home specification has previously caused considerable unrest among the GP profession, and a significant number have said they reject the PCN contract.

Another PCN specification around cancer diagnosis was due to start in the coming financial year, but now the NHS wants networks to “make every possible effort to begin work on the early cancer diagnosis specification as planned, unless work to support the covid-19 response intervenes”.

The guidance asserted “people who are concerned about any symptoms related to suspected cancer should still contact their GP and GPs should make sure they continued to refer those for suspected cancer for diagnostic tests as normal”.

The British Medical Association called for the NHS to go further, saying the measures outlined by the centre should be extended to a full year rather than for the first half of the coming financial year.

Richard Vautrey, chair of the union’s general practice committee, said: “A short-term suspension of QOF [payment incentives] and the PCN service specifications is unsustainable… The idea that it will be business as usual by October is not in line with the evidence and projections, not least as this could be the very time a second wave of infections starts to circulate.”