The
GP contract could be set for a radical overhaul, with payment to
be potentially based on activity rather than on capitation basis, after
LMC leaders voted in favour of such a move.
Despite GPC setting
out its concerns for such a move, LMCs voted 53% in favour of a motion
that said the ‘current formula based core contract is unfit for
purpose’, and should be ‘replaced by a payment by activity contract
which directly links workload to resource’.
This proved a departure from last year, when a similar vote was lost.
Dr Jim Kelly from Kent LMC, who lost the vote last year,
said: ‘The Government wants us to do more. They want to move more work
our way and the way to incentivise activity is by paying for activity.
‘The
problem with the NHS is that we are the most efficient part of it and
we’re all on block contracts, effectively. Capitation [payment] is a
block contract which means that no matter how hard you work you don’t
get any more money.’
He said this was a ‘radical’ motion, adding:
‘It is something that is designed to shake things up. But radical
problems need radical solutions.’
Speaking against, Dr Rob Bailey from Cambridgeshire LMC warned that
it would lead to increased bureaucracy for
GPs who would need to
report their activity in order to get paid, similar to reporting QOF.
He
said: ‘It would be lovely if we were paid for every item of service we
provide, but wouldn’t we risk breaking the link between our patient list
and the freedom to do the right thing by introducing target-driven,
bean-counting incentives, and who is going to do the counting?’
Speaking
ahead of the vote, GPC chair Dr Chaand Nagpaul said: ‘I think there are
some real issues here, which conference needs to decide on. I just want
say though, that we have seen many problems with payment by result in
hospitals.
‘We have seen many perverse effects and NHS England is
minded to replace payment by result in hospitals with a capitated
approach, simply because they believe that that system is driving
activity at the expense of quality.
‘So we have a climate where I
don’t believe we are going to see a promotion of payment by activity in
hospital. I just want you to consider that.’
Earlier in the same
session on funding, LMC representatives also voted for a halt to the
demise of seniority payments, which the Government started phasing out
last year.
Source: Pulse Today
