Under-resourced primary care in poor areas could be improved by tackling practices currently providing a bad service, a senior GP adviser has said.
Sir John Oldham, national clinical lead for the Department of Health’s quality, innovation, productivity and prevention programme, said commissioners should tackle a minority of practices that were not providing good value for money.
Sir John chaired an international review of primary care held for the Global Health Policy Summit held in London last week. The review found GP services in many countries required more investment. Speaking to HSJ after the summit Sir John said in the UK there were not enough good primary care services in many poorer areas.
He acknowledged additional funding was unlikely to be available but said the NHS Commissioning Board – which will contract primary care services from next year – and clinical commissioning groups could improve access and release resources by together identifying and tackling poor providers.
Sir John said: “This doesn’t need additional investment but it needs looking at what return we get on existing investment.
“We need to make sure provision in less well-off areas is as good as in well-off areas. Most of us recognise the minority [of poor GPs] need tackling, not least to make sure patients receive a good level of care, but also to make sure they are contributing to CCGs’ commissioning aims.”
The government previously promised national incentives to attract GPs to poor areas, but this appears to be on hold. A commitment to “develop incentives to improve access to primary care in disadvantaged areas” - which was also in the 2010 coalition Programme for Government - was dropped from the DH’s monthly reform timetable in June 2011.
Sources involved in primary care policy development said increases for poor areas would have to come from reductions elsewhere, which the British Medical Association would not accept.
The DH and commissioning board face calls to overhaul the GP contract from some senior commissioners, who believe it is currently too difficult to change funding and performance manage poor providers. But changes to the GP contract for 2013-14 are expected to be minor and HSJ understands the board has no clear plans for major shifts the following year.
One senior commissioning source close to policy development said: “It is absolutely fundamental we do something about this.” A PCT cluster chief executive said: “If we push this into the long grass because it is politically too difficult, it will be really unhelpful.”