Published: 13/11/2003, Volume II3, No. 5881 Page 10 11
The NHS Confederation's chief GP contract negotiator describes the new document as 'incredibly permissive'. But with the new freedoms come a huge burden of responsibility for PCTs to make local implementation work. Graham Clews reports from HSJ's London conference
If the man who lead negotiations on the new GP contract is to be believed, the age of free love could be upon primary care.
NHS Confederation lead negotiator and South Yorkshire strategic health authority chief executive Mike Farrar told last week's HSJ conference that the new general medical services contract would be 'incredibly permissive'.
But in keeping with current mores, this is not complete selfexpression with no strings attached.Mr Farrar says there is a huge responsibility on primary care trusts' shoulders to make sure the new document works.
'You can take the contract and mould it to deliver the strategic objectives you want, ' Mr Farrar told the conference.
He said the combination of the extra resources being pumped into primary care and the permissiveness was a once-in-a-generation opportunity for PCTs to reshape healthcare provision completely in their localities.
Mr Farrar warned delegates that there was a chance that the Commission for Healthcare Audit and Inspection could rate PCTs on how well they have grasped this opportunity, and he put forward nine tests that PCTs should set themselves as they worked towards implementing the contract.
He said the single most important test was whether PCTs would use the new contract simply 'as another way of paying GPs or will you have used it to bring about strategic change across the NHS as a whole'. Similarly, his second test was whether the likely change in out-of-hours responsibilities would lead to PCTs just offering a replacement service, or whether they would look at services across the board to see how GPs could work with ambulance services, accident and emergency and other providers. This, he suggested, could even be brought 'in-hours' offering real choice for patients.
During the contract negotiations, it was estimated that eight out of 10 hospital admissions would be covered by the chronic disease management domains in the quality and outcomes framework written into the contract, which rewards practices for treating patients with high-quality care. As the management of chronic disease rises inexorably up the healthcare agenda, Mr Farrar said the contract would offer PCTs a fantastic 'platform for managing chronic disease'.
Mr Farrar said he was 'slightly disappointed' that a number of PCTs were yet to develop their enhanced services, but accepted that the delay in the contract agreement had meant that local delivery plans had had to be finalised before the contract details were known. But he urged PCTs not to treat enhanced services as a 'cross to bear', but as an opportunity to shift treatment from the acute sector, as they should be able to ensure treatment was cheaper than tariff costs in hospitals.
He said: 'The combination of the quality and outcomes framework and enhanced services will be critical in whether we can deliver the 2004-05 targets'.
Mr Farrar also said PCTs should ask themselves whether PCTs will be using the contract to innovate services, particularly bearing in mind the ongoing discussions around expanding patient choice.
He urged them to look at skill mix and develop partnerships with pharmacists and other health professionals.
He said there will be a new relationship with patients in the future, and although the patient experience survey is a small part of the new GMS contract, it is likely to become more important in the future. 'For instance we know that chronic disease management needs conversations with patients about their lifestyle.'
Other tests that PCTs should consider would be whether the new opportunities in the contract will be used to improve recruitment, retention, and morale of primary care staff, whether the infrastructure will be improved strategically, whether the culture of primary care management will change to become more entrepreneurial and whether the changes in the GMS contract will be used to improve services provided under personal medical services.
So not much for PCTs to do then.
The mood in the hall was unequivocal when asked whether PCTs would face difficulties in implementing the contract on time. Only one delegate disagreed.
During a question and answer session, a panel was asked about the conflict between the pressure to keep management costs down, and some of the work that would be needed to fully implement the contract.
Department of Health national clinical lead on access and choice in primary care Dr David Carson said the word 'from the top' was that the new contract should be prioritised by PCTs.
Poole PCT chief executive Andrew Morris said implementing the new contract was 'a key role for PCTs but not the only one we have to face'. And NHS Alliance GMS contract lead Dr David Jenner said that although the National Primary and Care Development Programme would be announcing support for PCTs soon, it was 'a genuine concern'.
Despite the potential problems, Mr Farrar said the single most important thing for PCTs was that they had a chance to steal a march on the rest of the world in delivering healthcare. He said the most successful healthcare systems will be those dealing effectively with chronic disease management and lifestyles, areas amply catered for in the new contract.
It is unlikely there will ever be a better chance to shape the future of healthcare in this country, he said.
'The limits of our achievement are the limits of our ambition.'
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