The GP pay for performance framework has been significantly pared back, with some of the proceeds used to pay practices to provide more comprehensive care for those at risk of admission to hospital.
Requirements worth around £400m will be removed from the quality and outcomes framework under the deal from April next year, as will funding for several existing enhanced schemes. Those dropped include rewards for specific interventions to monitor and manage long-term conditions, and productivity related requirements such as taking part in peer review of emergency admissions with other practices.
Three enhanced services introduced in April this year and worth about £78m – for identification and management of those at risk of admission, remote monitoring of patients, and electronic access and prescriptions – will also be scrapped.
Most of the proceeds from dropping the QoF indicators and additional services will go to GPs’ core, non-performance related, income. The British Medical Association said the deal “reverses most of the changes imposed [to the QoF] in 2013-2014”.
However, around £160m of the money released will be used to pay for an enhanced service requiring practices to use risk stratification to identify patients at risk of admission to hospital. They will have a named GP accountable for their care, preferential phone and appointment access, and individual care plans. The accountable GP will be able to identify a “care co-coordinator who would be the most appropriate person within the multi-disciplinary team” to be responsible for their care plan and a point of contact. All patients 75 or older will have similar arrangements.
The contract agreement also includes:
- Removing practice boundaries from October next year, allowing free choice of provider, where practices participate.
- Requiring GPs to publish their earnings from the NHS from 2015.
- Reviewing the quality of, and collaborating with, out of hours services, and reporting any concerns to commissioners.
The deal was heavily promoted in national media, and health secretary Jeremy Hunt described it as a “return to the old-fashioned values of family doctors”.
“I think this is what GPs really want,” Mr Hunt told BBC Breakfast.
“They became GPs because they want to deliver personal care that really looks after their patients. They didn’t want to do all this box-ticking and bureaucracy and target-chasing. I think this is a return to the old-fashioned values of family doctors and I think both patients and doctors will see this as a big step forward.”
Dean Royles, chief executive of the NHS Employers organisation, said: “Almost all healthcare workers, including GPs, nurses, support staff and cleaners, have now changed their national contracts. We now need to press on with agreeing changes to hospital doctors’ contracts.
“Those negotiations are happening right now and it’s essential for patients that we get a good result. That means real changes to improve seven-day working by removing the barriers in consultant employment terms and conditions that can get in the way of it. These aren’t complex changes but they are now urgent, given the changes other staff have agreed.”
Chaand Nagpaul, chair of the BMA’s GP committee, said: “We recognise that GPs are facing unprecedented pressures on workload with rising demand and limited resources.
“From the outset of this year’s contract talks, the BMA has sought to positively engage with the government to address the difficult financial and workload pressures facing general practice, in order to find new ways of improving patient care, while at the same time freeing up GPs and practice nurses from pointless bureaucracy.”