The government and GP representatives have agreed to pilot methods of increasing choice of general practice.
The plan is announced in an agreement between employers and the British Medical Association GP committee on the 2012-13 general medical services contract published today.
Two methods of providing choice will be trialled in two or three yet-to-be-announced cities, in one-year pilots. One method - that preferred by the BMA - involves the patient still being registered at their local practice, but allowed to use services elsewhere under an extension of the current “temporary residence scheme”.
The other, which has been preferred by the government, allows patients to fully register with a practice away from where they live, and hold no registration near their home.
BMA deputy chair Richard Vaultrey said the pilots would test the approaches and how patients make use of them. The abolition of practice boundaries - which would enable free choice of GP - has been strongly resisted by the BMA and Royal College of GPs.
Further details are being developed by the Department of Health, but a letter from the GMC to members says practice participation will be voluntary, and payments for seeing non-registered out-of-area patients will be capped at £2m.
The contract will also change to allow patients who move short distances to remain with their current GP practice, even if they are outside its boundary, for the first time.
Meanwhile, a change to the quality and outcomes framework pay-for-performance scheme will link practice income to taking part in reviews of the accident and emergency attendances of their patients. It follows similar schemes in 2011-12 for prescribing and referrals. The prescribing scheme will be dropped in 2012-13.
It has also been agreed to extend national payments for extended hours access by a year, to 31 March. The changed contract also includes a requirement on GP practices to be a member of a clinical commissioning group, as planned by the government from April 2013.
There will be a general uplift to practice income of 0.5 per cent. The DH said this, along with changes to the QOF, would “deliver an estimated efficiency improvement of around 3.5 per cent”. That compares with the 4.5 per cent a year efficiency increase which the DH has said is required from the NHS as a whole.
Dr Vaultrey told HSJ the agreement reflected it was “a difficult negotiating environment, both in the NHS and in wider society”. He said, “GPs and practices are working harder than ever and seeing more patients than ever”.
In August the National Institute of Health and Clinical Excellence recommended that QOF indicators for assessing and reassessing people diagnosed with depression and assessing diabetic patients for depression be retired.
But following concerns from campaigners the indicators have been left in the framework. A statement from 10 mental health organisations including Centre for Mental Health, the Mental Health Foundation and Mind welcomed the move.
It said: “Mental health problems – primarily depressive and anxiety disorders - account for almost one GP consultation in four and 23 per cent of the burden of illness in the UK. Many people with mental health problems already struggle to get the treatment they need and this decision retains an important incentive for family doctors to manage the care of millions of patients with common mental health problems.”