Government threatens to force through GMS changes for 2013-14

The Department of Health has warned that it may impose its suggested changes to the terms and conditions of next year’s general practitioners’ general medical services (GMS) contract if agreement with the BMA cannot be reached.

Its intention, announced in a letter formally setting out the government’s proposals, comes after five months of negotiations with the BMA.

The move has infuriated the association, which has called into question the evidence on which some of the government’s proposals were based and the feasibility of their implementation.

Barbara Hakin, national managing director of commissioning development at the Department of Health, said that the decision had been prompted by the failure to reach an agreement with the BMA.

“This means that the Department of Health may need to vary the contract without agreement from the BMA. Should this be the case, we would need to have undertaken a consultation process with them. This letter signals the beginning of this process and identifies the range of changes which may be made,” she wrote.

The proposals, which are for the GMS contract but could include personal medical services (PMS) contracts, include an uplift in practice income of 1.5%.

The government estimated that this would allow for an average pay increase of 1% for GPs and practice staff and a “wide margin” for increases in non-staff expenses.

If the BMA did not agree, the Doctors’ and Dentists’ Review Body (DDRB) would be invited to make recommendations on an overall uplift. NHS Employers has instructed the DDRB to consider no pay increases for doctors, including GPs.1

The proposals also suggest phasing out the minimum practice income guarantee over a period of seven years to even out the variation in “core” funding between general practices.

Several changes to the Quality and Outcomes Framework (QOF) have been put forward, including incorporating all of the new or replacement indicators recommended by the National Institute for Health and Clinical Excellence (NICE); raising QOF thresholds for blood pressure and cholesterol concentration, in a bid to target people in most need or hardest to reach; and discontinuing QOF indicators for organisational tasks, such as good record keeping.

“The implications of the government’s new proposals for general practice are likely to be huge,” said Laurence Buckman, chairman of the BMA’s General Practitioners Committee. “There are serious question marks over whether some of the intended changes are based on sound clinical evidence or are practical or feasible,” he added.

He said that GPs would be “stunned and angered” that the government was riding roughshod over negotiations that were in their final stages and called on it to “urgently rethink its approach.”

He emphasised, “Many practices are already stretched to breaking point, which the government appears to be ignoring. For all practices the changes would place an enormous strain on GPs at a time when they are struggling under the weight of a wholesale NHS reorganisation.”

But in her letter to NHS chiefs Hakin said that the government was aware of concerns about practice workload and intended “to design potential new enhanced services in ways that will support general practice to make most effective and efficient use of resources to improve quality of care.”

She continued: “Given the significant efficiency savings that will continue to be expected of all other NHS healthcare providers, the Department [of Health] regards it as essential to secure improvements in the GMS contract that will help support continuous improvements in quality of care and health outcomes.”

The health secretary, Jeremy Hunt, said, “We want to drive up standards for all and want the contract to reflect the most up to date expert guidance and excellent standards of care.” But he warned, “We want the BMA to work with us on making this happen but will not back away from making changes that will deliver better care for patients.”

• Read Barbara Hakin’s letter and the full proposals for the GMS contract 2013-14 at http://bit.ly/P2aStP.