The new contract for GP practices should have been better planned, will take time to improve care for patients, and has cost more than expected, a new report published today says.
However, the Audit Scotland report, Review of the new General Medical Services contract, outlines that there is evidence of improvement in the care of some patients since the new GP practice contract, introduced in April 2004. The report cites examples including better monitoring of people with certain long-term conditions such as diabetes, increased income for GP practices, and flexibility for NHS boards to plan healthcare based on the needs of the local population.
In the first three years of the new contract, general medical services cost £160m more than was allocated to NHS boards to pay for these services. The majority of the additional costs are due to higher than expected costs of implementing an incentive payment system for the quality of care, and ensuring that no practice is financially disadvantaged by the new contract.
The Auditor General for Scotland, Robert Black, said: “The new contract for GP practices is an opportunity to improve both patient care and the working lives of GPs, and give the NHS greater flexibility. There are early signs that the contract has addressed GP concerns about pay and work life balance, and has improved services for some patients.
“However, there was insufficient planning for implementing this contract, partly due to a lack of available data on primary care and an underestimation of the costs of the contract. The challenge for the Scottish Government, the NHS and GPs is to build on the early signs of improvement and to deliver better outcomes for patients.”
The report also notes that the new contract has the potential to develop care for patients. In particular, it gives NHS boards greater flexibility to move services from hospital to the community and to deliver services tailored to specific local needs, such as drugs misuse services and healthcare for homeless people.
However, it also highlights a lack of basic management information about general practice in Scotland. The NHS does not know how many of Scotland’s GPs work full or part time. There is also a lack of comprehensive data on staff numbers, workload and activity in practices. This makes it difficult for the NHS to plan effectively. Most GPs are independent contractors who provide services to the NHS. Very few are employed directly by an NHS board although this number is increasing.
The new General Medical Services contract was introduced because previous GP contracts were considered to be no longer fit for purpose. The aim of contract is to: reduce GPs’ personal and practice workload to a manageable level; appropriately reward GPs for their work; address problems in recruiting GPs; and deliver more services in primary care, closer to patients’ homes.
Responding to the report, Dr Dean Marshall, chairman of the BMA’s Scottish General Practitioners Committee, welcomed the recognition that the contract would benefit patient care but warned that the ‘boom and bust’ approach to funding general practice was a mistake.
Marshall said: “The report is a timely reminder of the reasons why a new contract was required for general practice. GPs were struggling to manage an ever-growing workload, morale was at an all time low and recruitment and retention was becoming a significant problem as one in four GPs was considering leaving the profession. The new contract sought to resolve these issues which helped to make general practice an attractive career option once again.
“I am pleased that this report has recognised the hard work and commitment of Scotland’s GPs to deliver the new contract. They have adapted quickly to the new ways of working and have achieved high levels of quality achievement within a relatively short period of time. Already patients are reaping the benefits.
“But without better co-operation between government and GPs, these benefits may be short-lived. In the last three years, practices have seen cuts in their core funding which adversely affects the services they can provide to patients. Just as we are beginning to see the beneficial effects on patients’ lives, these cuts in funding could mean that those improvements are less likely to continue.”
Mary Scanlon MSP, the Conservative Shadow Cabinet Secretary for Health and Wellbeing, said: “There are some cost issues to carefully examine, but family doctors across Scotland have risen to the challenge of delivering more health care nearer patients homes resulting in better monitoring and better information on long term conditions such as asthma and diabetes as well as delivering the successful outcomes of lowering blood pressure and cholesterol for many patients across Scotland.”
“Given that 12 out of 14 health boards confirm that the new contract has made it easier to develop services tailored to the needs of the local population - this is a firm vote of confidence in primary care which accounts for 90 per cent of patient contact with the NHS.”
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