GP practices will agree and move to a new standard national contract within “two to three years”, the NHS Commissioning Board is estimating. The timescale has provoked warnings from leading GPs that the plan is “naive”.
The board will take over commissioning of family health services from primary care trusts in April next year.
Currently there are three types of GP contract – general medical services, personal medical services and alternative provider medical services. The latter two deals – which account for nearly half of primary care spending – are negotiated locally. As a result, practice income varies widely, as do the services they provide.
“Converged personal and general medical services in two to three years is unrealistic”
The board has said it will apply a “single operating model” nationally to commissioning GP services and move all practices to a standard contract, with much less local variation. But it has not yet said how that will be achieved.
The board expects the change will mean commissioning and contract management can be carried out with far fewer staff, across a larger area than PCTs and within its strict administration cost limit. The board has said it will carry out its functions with half of the resources used at present.
Design of the NHS Commissioning Board, published last week, said “transitional funding” would be in place “in advance of [a] new contractual arrangement”.
Speaking to HSJ, a spokesman said: “Work is underway to get to a more sustainable and affordable contractual model, which is expected to release significant savings [in commissioning administration costs].” However, the spokesman said it was “likely to take two to three years to implement”.
Several leading GPs told HSJ moving them to a standard contract would be a major change and negotiating it with practices and the British Medical Association GPs committee would be very difficult.
It comes at a time when the GPs committee is in dispute with the government over issues including pensions.
Committee lead negotiator for commissioning Chaand Nagpaul told HSJ the plan was “hugely optimistic”. He said: “There is no way we’re going to be able to have personal medical services and general medical services converged [within two to three years]. That is naive and unrealistic.”
NHS Alliance national lead Shane Gordon, a GP and chief executive of Colchester Clinical Commissioning Group, said: “This [harmonising the contracts] is going to be one of the most difficult things in the next few years.” Dr Gordon said shifting funds from hospital into primary care could be used to incentivise a move to new contracts.
Meanwhile NHS North Central London medical director Douglas Russell, a GP credited with leading primary care improvement in north east London, said the administration cost limit on the commissioning board could mean it looked at outsourcing management of GP contracts. He warned against this, saying some PCTs had tried it without success and it risked separating contract management from clinical governance and appraisal. These are likely to remain with the commissioning board.