Practices that take on new patients to support the government’s drive for greater choice will be rewarded with extra funding, as part of the Department of Health’s (DH) new primary care strategy, published today (3 June 2008).
Changes to the Quality and Outcomes Framework (QOF), “reinvigorating” practice-based commissioning (PBC), health checks in pharmacies and GP consultations by email are some of the other plans contained in Our Vision for Primary and Community Care, a new document published as part of the Next Stage Review of the NHS.
This document sets out the future direction for primary and community care in England, and is designed to help patients and the public make “informed decisions and have greater choice and control” in their primary healthcare.
The DH announced that the strategy will build on the £250m extra investment and recent initiatives in primary care. The new plans include reforming practice funding “to reward GPs who take on new patients to support greater patient choice.”
This announcement follows on from the decision to phase out the minimum practice income guarantee (MPIG), as set out in Lord Darzi’s final Next Stage Review report earlier this week.
The primary care strategy also reiterated the plans for everyone with a long-term condition to have their own “personalised care plan” and those with complex health needs a “care co-ordinator” by 2010.
Other plans include:
- Encouraging patient feedback and greater public accountability for staff working in primary care.
- Patients will be able to register online and will be able to consult with their GP by telephone or email.
- A new online system called “myhealthspace” will allow people to access and update their personal care record, to share information with their care team, and book appointments and order repeat prescriptions.
- Faster and simpler access community-based services such as health checks in high-street pharmacies, walk-in services, and self-referral to physiotherapy or podiatry services.
- Working with GPs to amend the QOF to help manage the health of high-risk patients and providing stronger incentives for early intervention.
- Reinvigorating PBC by enabling “high-performing GPs to have greater freedoms to develop new services for their patients, working with other primary and community clinicians”.
Health Services Minister Ben Bradshaw (pictured) said: “Our vision for primary care will protect the highly popular and effective system of registering with a local GP, but give family doctors a stronger role in working with other clinicians, local authorities and other organisations to provide the right services, in the right place and at the right time to meet individual needs.
“All of this will only happen by unlocking the talents and professionalism of NHS staff working in primary care, giving them greater freedoms to provide the services their patients want and more control over how they do it, while equipping them with the necessary skills.”
Professor Michael Dixon, NHS Alliance Chairman, welcomed the “laudable aspirations” of the new document. “The primary care strategy is a big thumbs up for general practice,” he said.
“The NHS Alliance looks forward to working closely with the DH and the local NHS across the country to make those aspirations reality for patients and professionals,” he added.
Dr Laurence Buckman, Chairman of the BMA’s GP Committee, said: “There is much within this vision for primary care that is positive. Many of the ideas, such as personal plans for all patients, faster and simpler access to a wider range of community based services and early intervention to improve the long-term outcomes for patients, are good and welcome.
“We particularly welcome the statement that “changes will be driven not through top-down targets but by giving responsibility to the staff at local level.”
However, he added: “Some of the ideas are not new – patients have always been able to consult by phone and practices have always been funded on the basis of the number of patients who are registered with them.”
Referring to recent comments from Health Minister Ben Bradshaw accusing GPs of operating “gentlemen’s agreements” to ensure they do not take each other’s patients, Dr Buckman also said: “Rather than taking petty public swipes at family doctors as Ben Bradshaw has done, the government would be much better off working with us rather than against us.”
“While we welcome the good notions in this report, we are still to be convinced that previous government announcements, and by that I mean the polyclinic agenda, will do anything other than damage general practice and continuity of care for patients.
“Choice of a GP is a good thing for patients, but unnecessary and potentially destructive competition ends up wasting NHS resources. We know every PCT has to build a ‘GP-led health centre’ or ‘polyclinic’ if they want any new money to invest in primary care.
“Lack of investment is the reason why patients in some areas have trouble registering with new surgeries. A practice may be full to bursting, but when they ask the local PCT for money to expand they’re told there is none. We hope the £250m extra investment promised by Lord Darzi, which is very welcome, is spent wisely.”
Your comments: (Terms and conditions apply)
“Critical to this debate is the financial shake up concept. Already PCTs around the country are looking to change the funding processes for general practitioners, often under the veil of losing their contract completely. The example in Northumberland is illustrative of that point. The new strategy will clearly put an increasing burden on practice management and staff, and it should not be a forgone conclusion that general practice will simply accept the way forward unchallenged. A lot of what is said does make complete sense, but my biggest fear from a management perspective is that once again our profession will be reactionary to change rather than being instrumental in making change happen. Now more than ever, there is a requirement for practice managers to be vocal and express their views. There is no doubt that what happens in one area will not be the same as another, but we should learn from what works well and what does not. I urge managers to start looking now about how this future strategy will impact on their surgery. Let’s make this strategy the catalyst for making sure that our views are represented and that changes reflect true local needs” – Steve Williams, London