Updating the GP contract

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

The Government is making slight updates to the GP contract, the system that pays GPs partly depending on their performance on various indicators. The changes came into force on April 1st 2006, and incorporate seven additional long-term care conditions in the quality and outcomes incentive scheme. Moreover, GP incomes will ultimately be determined by surveys that aim to measure patients? views and experiences of access to their GP and the level of choice (of, e.g., hospitals) their GP offers.

Neue Entwicklungen

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

On balance, the policy seems reasonably sensible, and seems to be moving primary care in the NHS in a generally favourable direction. Moreover, the Government is seemingly showing encouraging signs of modifying the contract so as to attempt to improve the incentives for GPs to provide appropriate services and care to their patients, and thus the Government does not seem averse to 'learn' from experiences. The effects of the GP contract over forthcoming years will hopefully be reported by the Government, and, if so, will be reported in future Health Policy Monitor reports.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung: The Government is clearly supportive of the changes, otherwise it wouldn?t be implementing them. GPs may be a bit upset that they are being asked to do a little more, but they cannot complain too much: over the last few years, and specifically since the introduction of the GP contract, NHS GPs have become the highest paid primary care physicians in Europe (and possibly the world).

• Leistungserbringer: GPs and PCTs are probably not fundamentally opposed to the updates, particularly as the updates seem to place more emphasis on the better management of long-term care conditions.

Stakeholder positions

As noted above, I am not aware of fundamental stakeholder opposition to the updates to the GP contract. It is very possible that some of the patient advocacy groups that cover the conditions that are being added to the performance contract - which include dementia, depression, chronic kidney disease, atrial fibrillation, obesity, learning disabilities and palliative care - will be supportive of the changes (and may have even had a hand in bringing the changes about), as they should mean that GPs focus more of their attention on these conditions. It is quite interesting that three of the conditions are mental health-related, since mental health does at last seem to be attracting more attention in British health care policy, which given the overall burden of disease accounted for by these problems, is probably long overdue.

Actors and positions

Regierung
Central Government	sehr unterstützend		stark dagegen
Leistungserbringer
GPs and PCTs	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

The legislative process did not change the GP contract. The updates have been implemented, firstly, to attempt to improve performance with respect to the seven stated long-term conditions, and secondly, so that the GPs' pay is linked directly with patients' reported experiences vis-à-vis access and choice.

Legislative outcome

Enactment

Actors and influence

Regierung
Central Government	sehr groß		kein
Leistungserbringer
GPs and PCTs	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

The updates were implemented on April 1st 2006, and GPs and patients (particularly patients with the seven stated long-term conditions) are presumably the most affected parties.

Monitoring and evaluation

The updates were introduced on April 1st 2006, so it is too early to comment on their effects. The Government will, I suspect, monitor the updates to the GP contract (indeed it has to, because the extent to which GPs conform to the performance incentives determines the size of their salaries). If the Government finds results that are favourable to its general policy direction, it will no doubt report them. Regarding access, for example, the Government has introduced financial incentives for GPs to allow more patients to book appointments in advance, and it has also introduced financial incentives for GPs to deliver more of the services that were traditionally delivered in a hospital setting, such as physiotherapy, ENT services, and diabetes care. Assuming that the Government reports the results of its monitoring exercises, these will be included in future reports of Health Policy Monitor. The Government has reported some effects of the pre-updated GP contract, and these will be reported below.

Expected outcome

The Government has reported what it considers to be key achievements of the GP contract. These include:

• 98% of GP practices now offer patients a range of appointment times that cover a minimum of 5 mornings and 4 afternoons each week;
• 94% of practices now meet the consultation time target, which is not less than 10 minutes per patient for those who have pre-booked appointments, and not less than 8 minutes per patient for those who visit their GP on an open-surgery basis;
• 82% of GP practices now have a receptionist who is contactable via telephone or face-to-face for a minimum of 45 hours per week.

There are potential drawbacks of the GP contract, however. For example, blood pressure targets may give GPs the incentive to prescribe pharmaceuticals that do not offer particularly good value for money to patients with blood pressure levels marginally above the target threshold, and can even offer incentives to GPs to simply lie about the readings of these types of indicators.

Overally, however, the GP contract is, on balance, probably encouraging GPs to improve the services that they offer to patients in exchange for financial rewards, which helps the Government detract somewhat from recent criticisms that it increased hospital consultant salaries without in exchange securing increased and/or improved service NHS commitment from these specialists.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
current    previous

It is still a little early for an assessment of the impact of this policy, but the signs are looking generally favourable.

References

Sources of Information

Department of Health. New GP contract combines better patient care and good value for money. Department of Health, London, March 31st 2006.

Reform formerly reported in

The new GP contract Process Stages: Umsetzung, Strategiepapier, Gesetzgebung, Idee

Author/s and/or contributors to this survey

Adam Oliver

Empfohlene Zitierweise für diesen Online-Artikel:

Adam Oliver. "Updating the GP contract". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/gb/a7/4