New contract for GPs and primary care to reward quality

Citation

Morris, B. (2001), "New contract for GPs and primary care to reward quality", International Journal of Health Care Quality Assurance, Vol. 14 No. 1. https://doi.org/10.1108/ijhcqa.2001.06214aab.013

New contract for GPs and primary care to reward quality

New contract for GPs and primary care to reward quality

The new core contract for GPs in Personal Medical Services (PMS) pilots starting next year will reward practices for the quality of the services provided to their patients. The standard national contract for GPs essentially links their payments to the numbers of patients and volume of service provided, rather than directly to quality. With a PMS contract the pilot receives a set sum of money from the local NHS based on the services it is contracted to provide. This is worked out on the basis of the health needs of local people, what the practice aims to deliver to meet those needs and specifies targets to be achieved. The pilot itself then decides how to spend that money on staff and delivering the services. Non PMS GPs are paid directly through the existing national contract, not based on local circumstances. Just over 50 percent of their income derives simply from the number of patients they have on their list. This system does not provide the flexibility of PMS to ensure that patients get the services they need, nor does it give financial incentives to GPs to provide such a service tailored to local need.

The new core contract will require GPs and their practices to:

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  provide patient access to a primary care professional within 24 hours and a GP within 48 hours by 2004, though many are expected to achieve this by 2002

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  implement the standards set out in the cancer guidelines, and in the National Service Frameworks for coronary heart disease, mental health and in others to follow

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  keep their skills up to date by committing 30 hours a year to their personal and professional development

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  undertake three clinical audits a year in the pilot, to drive up standards

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  strengthen good employment practice in primary care, including an expectation that nurses in pilots will receive the full Pay Review Body recommendations.

The core contract will be supported by targets tailored to particular local health needs. It will also set out how the performance will be monitored and good performance rewarded. According to the NHS Plan, it is expected that a majority of GPs will work under PMS contracts.

The PMS approach is already making real improvements to health services across the country. Examples are outlined below.

Liverpool PMS pilots

These pilots are working in two of the most deprived areas of Liverpool: Garston and Toxteth. PMS has enabled all of the GPs and staff in the practices to become employees of the local NHS Trust, freeing up the GPs from running a business to concentrate on providing and developing local services. The area has a high number of residents with considerable health needs: the homeless, drug misusers and other socially excluded groups. Under the old system, financial rewards encouraged GPs to have large lists of patients, making it a strain to provide the level of contact and services needed by these groups and also making GP recruitment and retention difficult. The PMS contract being negotiated on the basis of the services provided for local people, not simply the list size, means that the GPs have financial stability and the patients get the services they need.

Maryport Group Practice, Cumbria, PMS pilot

PMS funding mechanisms mean that the pilot's income is used to fund whole services and their staff rather than simply the individual GP paid through the existing national contract. This pilot has been able to use this flexibility so that GPs and nurses have been able to reorganise and run health services in the town. The practice has taken over the running of the town's cottage hospital to create a Primary Care and Minor Injuries Care Service and provides a wide range of services through its PMS contract with the local Health Authority. Benefits have included a Primary Care Emergency Unit with additional GP consultations, reducing waiting times at other GP surgeries, as well as GP and nurse "ward rounds" at local residential and nursing homes, to improve access to primary care services for the elderly.

Pennywell PMS pilot

PMS allows other GPs, and NHS Trusts, to employ GPs. Consequently PMS enables a GP to be employed in an area where an independent contractor GP not in PMS may not find it financially attractive because of a low number of patients on their list or purchasing premises in a particular area is not a sound business investment. How PMS can address this issue is illustrated by the problems in the Pennywell area of Sunderland, which could not attract any GP practices to serve a population of approximately 13,500 on the deprived estate. PMS flexibility has enabled the local NHS Trust to employ two salaried GPs and fully integrated primary health-care team. Access to services has been improved, including drop-in sessions, health promotion, minor operations, asthma control and breast screening. Some services require no appointment. In others, appointments take place on the same day of asking and the average wait for an appointment is just one day.