General practices could be forced to provide a more specific and expanded set of services by a renegotiated GP contract, under proposals being considered by senior NHS managers.
A senior source close to discussions said the move, if successful, would address concerns that practices vary too widely in what they provide and the income they receive, regardless of the size of their patient list.
NHS sources said such changes could also address concerns that primary care is not bearing enough of the burden to make efficiency savings.
Currently the “core services” that all practices must provide are only vaguely defined under the contract, requiring “treatment or further investigation as is necessary and appropriate” to be made available to patients.
A wider range of services are provided only by some practices and to varying extents. Some are paid to do so under deals agreed locally for additional and enhanced services, while others do it for free. Common examples are screening, minor injuries, minor surgery, ECGs, phlebotomy, contraception, flu services and extended opening times.
HSJ understands the move, still being considered and not yet the subject of negotiation, would seek to increase the services provided across the board and begin to standardise practice income.
Senior NHS sources said that the changes could be introduced from next April or April 2013, depending on decisions about how and when to renegotiate the contract. The changes will also depend on whether the Department of Health decides elements of primary care commissioning can be delegated to clinical commissioning groups from 2013, as opposed to remaining with the NHS Commissioning Board.
One senior source familiar with discussions said it was acknowledged there was “huge variation”, which national contract changes could help address.
HSU understands that primary care trusts are increasingly attempting to standardise services and payments locally to cut costs and potentially reduce demand for secondary care by extending services.
A review of the financially troubled NHS North Yorkshire and York health system last month proposed that GP practices should sign up to “minimum specifications of service”. This would dictate which services must be provided, opening hours and quality standards.
The review, chaired by NHS Confederation medical director Hugo Mascie-Taylor, called for “a code of practice for primary care to ensure greater clarity and transparency about the minimum delivery expectations”.
However, British Medical Association GPs committee deputy chair Richard Vautrey said making the contract more specific and standardising services had previously failed. He said local variations, such as location in a rural or urban area, meant what was required from practices varied significantly.