The return of the 'proper' family doctor?

Many newspapers are heralding the return of “family doctors” after the announcement of a new contract agreed between the government and GPs. The GP contract has been agreed between the NHS and GPs in England.

Among other changes, it stipulates that patients aged 75 and over will have a named GP to co-ordinate their care, as will younger patients with complex health needs such as poorly controlled diabetes. It is hoped this will reduce unplanned admissions to A&E departments. Incentivised GP targets for certain services will also be reduced, hopefully freeing up more time for doctors to spend on patients.

Why has the GP contract changed?

GP practices are commonly run as independent businesses – partnerships owned by the doctors – which have a contract to provide services to the NHS (often employing other doctors as part of the business). The contract under which they work is known as the General Medical Services Contract. The contract is negotiated between NHS employers and the General Practitioners’ Committee (GPC) of the British Medical Association.

The GP contract covers three major areas:

The funds allocated towards the costs of running a general practice and essential GP services.
The Quality and Outcomes Framework (QOF) – a voluntary incentive scheme that rewards GPs financially for fulfilling certain requirements, for example screening patients for risk factors for heart disease.
Other services beyond those agreed to be essential (called enhanced services), usually agreed with local NHS organisations.

The last contract was agreed in 2003 and came into force in 2004, with amendments being agreed each year. A new contract is negotiated every 10 years or so and takes account of how well GP services are working. For example, there has been criticism of the QOF for increasing unnecessary targets and a “tick box” culture – where meeting targets is seen as more important than patient care.

Most of the new changes will come into force from April 2014.

What has changed in the contract?

The contract has been designed to introduce more personalised care, more choice for patients, remove unnecessary targets, improve the transparency of the quality of GP services and reform aspects of GPs’ pay.

Personalised care

GPs will oversee personalised care plans, integrating all services for patients with complex health and care needs. This is in order to reduce unplanned hospital admissions, which should benefit the patients concerned and the NHS.
All patients aged 75 and over will have a named GP, as will those with complex health needs, responsible for co-ordinating their care. They will develop and regularly review personalised care plans for these patients.

GPs will also:

Offer patients same-day telephone consultations.
Provide paramedics, A&E doctors and care homes with a dedicated telephone line so they can advise on treatment.
Co-ordinate care for elderly patients discharged from A&E.
Regularly review emergency admissions from care homes to avoid unnecessary call-outs in future.
Monitor and report on the quality of out-of-hours care.

Reducing "tick box" targets

More than a third of the “points” in the Quality and Outcomes Framework (QOF) will be removed. The QOF incentivises GPs to test and treat patients for specific conditions, such as diabetes and heart disease. The QOF aimed to incentivise best practice, but much of it is now considered standard care, and removing the unnecessary parts is designed to improve patient care by trusting doctors to use their professional judgement and make decisions based on individual patient need.

The money GPs currently earn from meeting these targets will instead be used for improving other services.

Transparency

The Care Quality Commission will develop an easy-to-understand ratings system of GP practices, based on four categories:

outstanding
good
requires improvement
inadequate

GP practices will publish results of this new inspection regime in surgery waiting rooms. You can also use the NHS Choices Find a GP service to see what other people think about GP practices and the services they provide.

GPs will also be obliged to publish details of their earnings, although it is currently unclear whether this will be at an individual or practice level.

Patient Choice

GPs will be able to register patients from outside traditional practice boundaries.
The “friends and family test" will be introduced, which is a service designed to enable patients to give feedback on their views and experiences of GP services.
It will be compulsory for surgeries to offer appointments and repeat prescriptions online.
GPs will also allow patients to access online the data contained in their health record (called the Summary Care Record).

Pay

Automatic pay rises for older doctors, called “seniority payments”, will be phased out. The £80 million cost of these payments will be re-invested in general funding for practices, based on the amount and types of patients they serve.

What changes will I notice at my GP practice?

The changes will be introduced gradually from April 2014. If successful, they should reduce pressure on GPs, freeing up their time to allow them to provide better care for patients.

For example, if you are over 75 you will have the name of a doctor who is accountable for your care at all times.

You should have better access to telephone consultations and online bookings. You will also have access to more information from other patients about GP services and to inspection results. Out-of-hours services are also expected to improve as a result of the GP contract.

What do GPs and the government have to say about the contract?

The changes have generally been welcomed on all sides. The chair of the BMA’s General Practitioners’ Committee, Dr Chaand Nagpaul, said the contractual changes aimed to provide GPs with more time to spend on improving patient care. He said that reducing the number of QOF targets, “will not only free up GPs to spend more time focusing on treating patients, but will also mean that valuable resources will be reinvested in general practice to improve frontline care”.

The chair of the Royal College of General Practitioners, Dr Clare Gerada, said the changes were welcome news which, “will help us to get back to our real job of providing care where it is most needed, rather than more box-ticking”.

Health Secretary Jeremy Hunt said: “We are bringing back named GPs for the vulnerable elderly. This means proper family doctors, able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital. Rigorous new inspections of GP surgeries will mean every local person will know whether they are getting the care they deserve.

“This is about fixing the long-term pressures on our A&E services, empowering hard-working doctors and improving care for those with the greatest need.”