C+B incentives to go to extended access

Tags: BMA booking Choice Choose and Book Contract DH Government GP GPs PCTs QoF Quality

04 Jan 2008

GP incentive payments for Choose and Book will be redirected to pay for extended access to GP practices from April next year under controversial proposals put forward by the Department of Health.

In a letter to the BMA’s General Practitioner Committee the DH has told GP representatives that it will impose changes to the GP contract if a package of proposals on extended access is not acceptable to the profession.

The imposed changes, which are now subject to a statutory 13 week consultation period, would take effect from April 1 and give PCTs £158 million from the directed enhanced services’ (DES) for access and choice and booking to spend on extended access as they see fit.

Both DES schemes were due to come to an end on March 31 this year. A total of 60 points would also be removed from the QoF for PCTs to spend on primary care services with a further 75 points in the QoF for its patient survey taken away and used to reward GPs for patient satisfaction using an alternative survey. In addition minimum thresholds for QoF would be raised to 50% and maximum thresholds in line with average achievement in 2005/6.

The BMA has said the imposed changes double the financial penalty to practices from the offer on the table, creating a total potential financial loss of £36,000 for the average practice.

Dr Laurence Buckman, chairman of the GPC, said: “The government seems hell bent on tearing up a quality based contract designed to improve the health of patients and save lives less than four years after Gordon Brown approved it as Chancellor.”

The DH’s package of proposals which the GPC has already rejected but will now consult all GPs on would mean the average practice with 6000 patients would have to open for an extra three hours a week in the evenings or on Saturday mornings in return for redistribution of 58.5 QoF points and DES money plus 1.5% new investment in the contract.

Dr Buckman added: “We believe the government’s method of negotiation is nothing short of a disgrace. They have effectively put a gun to our head and said if we don’t accept their proposal they will impose a more draconian contract.”

The BMA’s proposals that the average practice with 6,000 patients would open for an additional 2 hours a week using funding from the choice and booking and access DESs plus redistributing 38.5 QoF points to new clinical areas was rejected by the DH.

The BMA had proposed that the IM&T DES in England should continue for all practices that had agreed to participate but had yet to complete all its components. The DH’s planned imposed changes include an amendment to extend the completion period for the IM&T DES to the end of March 2009.

Link

BMA’s General Practitioner Committee

Reader's Comments

GMC - Contractual Changes 2008/2009

maria.armstrong@nhs.net

09 Jan 08 14:01

With regards to the IM&T DES. The summary of SFE changes indicate that Direction 9 "Section 7C of the SFE is amended to permit PCTs to continue to make payments under the IM&T DES until 31st March 2008" - isnt this meant to read 2009? This is very important to make clear as a number of PCTs were looking into developing a LES to assist practices achieveing data accreditation after 31st March 2008.

C&B - no choice

18 Jan 08 18:01

GPs will use electonic booking because it is best for the patients. They don;t need to be paid to do what is best.

C & B - A correction

23 Jan 08 11:01

No - SOME GP's will use choose and book. Many will stick with what is familiar (not Choose and Book) and many will follow the money. GP practices are businesses; anyone doubting this and believing it is all about the patient should consider the reduced surgery hours agreed under the new contract (I am not saying this is right or wrong it just is). Bear in mind that the "Choice" aspect of choose and book is limited; for true choice you need to have spare capacity....and we don't in the main.

Choose and Book is a system in development. Not a fait accomli. Until it can be shown to be quick, effective and not cost the GP's in either cash or opportunity costs its popularity will wane when the incentives are removed.