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BMA warns contract changes will damage care

GPs fear staff redundancies, reduced access to patients and cuts in service

Mark Gould

Friday, 22 February 2013

Proposed changes to the GP contract in England risk putting targets before patients and destabilising patient services, the BMA has warned.

The warning came in the BMA’s response to the Government’s consultation on proposals to make sweeping changes to the English GP contract from April 2013. As well as an analysis of the workload and funding implications for GP practices, the BMA’s submission contains interim findings from a survey of GPs with nearly 8,000 responses.

The BMA says the Government’s proposals will see GPs facing new targets and additional workload responsibilities in a number of clinical areas. At the same time, changes will be made to how resources are allocated, including higher targets for GPs to reach in order to retain funding through the Quality and Outcomes Framework (QoF) and reductions in the central funding many practices receive.

In response to the Government’s proposals, the BMA’s survey found that:

  • Almost six out of ten (58%) GPs said they expected to have to make changes to the services in their practice to compensate for the impact of the Government’s proposals.
  • Of this group, just over half (54%) said their practice would have to reduce access to patients. Of these respondents nine out of ten (91%) said they would not be able to see patients for routine appointments as quickly as they currently do, while seven out of ten (72%) thought they would have to reduce the number of consultations offered to free up time for the new workload. A similar number (75%) expected to reduce the range of services offered to patients.
  • In addition, out of this group eight out of ten (82%) expected to make changes to staff working hours or employment. Of these roughly one in five (22%) expect to make clinical staff redundant and over a third (35%) would have to lay off administrative staff.

Findings from the BMA’s analysis include:

  • Practices will be faced with a raft of new targets that will divert time and resources towards box ticking and administrative work. This will include targets asking GPs to complete activity questionnaires every year for patients with some conditions even though there is limited evidence they produce clinical value.
  • A number of the Government’s proposals are likely to lead to unnecessary increases in workload that could restrict access for other patients. For example, GPs will be required to conduct blood pressure tests on every 35-40 year old instead of the current practice where GPs identify at risk patients for this treatment. The workload involved in carrying out blanket tests for this usually healthy age group could reduce appointments for ill patients.
  • A number of the Government’s proposals are not feasible. They include asking GPs to refer patients to certain education programmes which do not exist everywhere in England.
  • An average practice will lose at least £31,100 a year in funding from 2014/15 owing to changes that make it more difficult for practices to achieve funding through the QoF and other budgetary changes. Some practices will see their budget cut even more as alterations are made to other funding streams designed to fund GP practices with complex patient populations.

Dr Laurence Buckman (pictured), Chair of the BMA’s GP Committee said: “This huge package of changes fails to consider the cumulative impact… and includes suggestions which are simply not feasible in practice or would lead to unintended consequences. The changes would make it difficult for practices to maintain the level of care they currently offer while introducing an even greater focus on targets and box ticking at the expense of holistic, patient-centred primary care.

“GP’s will also struggle to reconcile the Government’s desire to increase workload and introduce new priorities with the significant constriction of resources and capacity heralded by these proposals.

But a spokesperson for the NHS Employers organisation, which is representing managers, says it will need time to consider the BMA submission.

"After the GP contract consultation ends on 26th February, Ministers will take into account the representations that have been made during the consultation and then decide how to proceed.

"We have consistently and publically stated that the package of proposals on which the Department of Health are now consulting is consistent with where NHS Employers tried to take negotiations with the GPC last year. In those negotiations we sought to reach agreement on changes that significantly improve patient care and in particular, get more practices to deliver what the better practices already achieve."

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