NHS England is planning to make next year what may be “the most substantial changes to the GP contract since 2004”.
It comes as:
- The outcome of a review of the GP pay for performance scheme (the quality and outcomes framework) has been published, with recommendations including retiring “up to a quarter of current indicators” in coming years.
- NHS England is making proposals for how digital primary care affects GP practice funding.
- New details of a review of the GP partnership model have been published, setting out a wide scope for the review and stating that there will be an interim report in the autumn in time to coincide with the NHS long term plan in November.
- NHS England is taking over from NHS Employers direct responsibility for developing and agreeing changes to the GP contract.
Professional leaders and national primary care officials are expecting this work – in addition to reform of GP indemnity, premises, and provisions for digital primary care – to amount to what may be the biggest changes to the national GP contract for more than a decade.
A paper to NHS England’s board today states: “As part of the forthcoming long term NHS plan, 2019 could herald the most substantial changes to the GP contract since 2004.”
It says the drivers include the new NHS funding deal, workforce pressures, the reviews of the contract, and digital technology.
Another is the objective of spreading primary care networks, which could include “a new national ‘network contract’, for example as an enhanced service” to be used in addition to core contracts.
NHS England national director of strategy and innovation Ian Dodge told the board: “The time is right for most significant discussions about the GP contract since 2004… we want to develop and agree what could be wide ranging contract reforms.”
The work will be considered as part of discussions about the NHS long term plan, due to be published in November.
British Medical Association GP committee chair Richard Vautrey said agreed substantial changes were likely and told HSJ: “All of these are major pieces of work and have an interrelationship [with the contract], particularly the partnership review. They could set a series of directions that would have major implications.”
He said it was an “opportunity to resolve many of the issues we’ve been highlighting over recent months and years”, but said policy and contract change would need to be accompanied by additional staffing and funding beyond that proposed in the GP Forward View.
Asked whether it was likely to be the biggest contract change since 2004, Dr Vautrey said the scale of the shift depended on what funding and resources would be made available as part of the changes.
The QoF review could lead to changes as soon as April 2019, which will be decided as part of the annual negotiation process, he said. Some other elements will take more time.
The focus for developing general practice through the NHS long term plan is likely to remain the development and expansion of “primary care networks”, which NHS England said in spring last year should be spread across the country, today’s paper indicates.
This model generally involves GP practices collaborating and developing shared services on a footprint of around 30-50,000 residents, while keeping separate core contracts – unlike under NHS England’s proposed “accountable care contract” which can involve partnerships being given up to become employees of NHS trusts or other organisations.
Nigel Watson, GP and chair of the review of the partnership model, told HSJ that changes to the contract may flow from it, but there were also non-contractual improvements that could be made more quickly.
In the call to evidence document published on Monday, he said: “I strongly believe that the partnership model of general practice has not reached the end of the road… However, it is important to recognise that this model is not the only way to deliver care. We are learning from new models of care, and federations, super partnerships and other models all have a place in primary care.”