BMA response to the Health Secretary's letter to all GPs - 04 Feb '08
- Extract from : http://tinyurl.com/2nqoe2
- “GPs are not against working extended hours - the BMA's proposals included this as well as significant improvements in clinical care. Indeed the charities which represent older people have said publicly how disappointed they are that the government chose not to accept this offer saying it “would have constituted one of the most beneficial and cost effective reforms in preventative patient care for older people in recent years.1” Instead the QOF (Quality and Outcomes Framework) points2 we wanted to reinvest to improve clinical care are being used to fund extended opening hours – something the government’s own patient survey has shown is wanted by only a minority of patients.3
- “The 1.5% increase in investment talked about by Mr Johnson refers to a future, as yet undecided pay award from the body that recommends doctors’ pay awards. There have been two years of 0% increases in practice funding and the government’s imposition would see practices lose an average of £36,000 in resources. This is money, taken from the QOF, and given to Primary Care Trusts to use to fund extended hours – yet in some areas there is little demand for this.
- “Despite what the government claims, their plans and the resulting loss in practice resources will destabilise many well-established GP surgeries and this could have a knock-on effect on daytime services, the time when our highest users - mothers with young children, older patients and those with chronic conditions - need and want to see their GP. GPs want to provide the best possible care they can because what is good for their patient is invariably good for the practice.
- “GPs are worried about the future for their practices and their patients. We are being contacted all the time by GPs who are angry and upset about the bullying behaviour of the government and who fear that the government’s plans will damage general practice in this country. How else can one interpret the threat to take money away from GPs when we know Primary Care Trusts have been told to spend money on private general practice provision by big companies?
- “It is because of that strength of feeling that we decided to conduct an opinion poll of the nation’s family doctors. The BMA never rejected the government’s offer, but we couldn’t accept it on behalf of the profession without making certain that we are representing what they think.”
Notes:
- Letter to The Times, 14th January 2008, signed by the President of the British Society for Rheumatology, the President of the Royal College of Nursing, the President of the British Orthopaedic Association, the Director General of Help the Aged, the Chief Executive of the British Geriatrics Society, the President of the Royal College of Surgeons of England and the Chief Executive of the National Osteoporosis Society.
- The Quality and Outcomes Framework was introduced in April 2004 as part of the new national GP contract. It rewards GPs for implementing good practice in their surgeries. There are currently up to 1000 points available, which can make up a total of 40% of practice income. Every year an expert panel, the BMA’s GP Committee and NHS Employers negotiators seek to define where points may be moved or recycled and what new clinical work or adjustments should be made to ensure patients continue to receive the best and most up-to-date evidence-based care.
- The government’s GP Patient Survey showed 84% of patients are happy with current opening hours. Only four in every hundred patients wanted extended opening hours in the evening and seven out of every hundred patients wanted Saturday surgeries. Over two million people were surveyed by the government at a cost to the taxpayer of more than £11 million.
Copy of letter from Alan Johnson, Health Secretary
Dear Doctor
Improving access to GP services
I wanted to write to you to set out why the Government is seeking to improve patient access to GP services.
General satisfaction with GP services is high, and the quality of our primary care is admired across the world. However, significant numbers of patients consistently tell us that improving access to GP services should be a priority for the NHS. This includes not just greater choice of appointment times, but continuing improvements in ability to book advance appointments and fast access to GP appointments.
We want to work with all GPs to achieve this aim. Last year we asked NHS Employers to work with the General Practitioners Committee (GPC) of the BMA to develop a package that would increase access to meet the needs of patients.
Extended opening hours
The proposal put to the GPC is that practices should provide 30 minutes of extended opening per week for every 1,000 of their registered patients - or three hours for an average-sized practice. This would be achieved by reinvesting £158 million from access incentive schemes (the Access and Choice 'Directed Enhanced Services') that come to an end this year, not from the Quality and Outcomes Framework.
In return for this, we have offered a 1.5% increase in investment for primary care, worth around £12,000 of new money for an average-sized practice or just over £100 million nationally. The first call on this investment would be any inflationary uplift agreed through the annual Pay Review Body process.
We believe that a guaranteed 1.5% increase in practice income, combined with an additional 30 minutes opening per week for every 1,000 patients, represents a balanced offer that both increases investment in primary care and provides a better service for patients.
Quality and Outcomes Framework
We and the GPC also had to consider how to re-invest a number of indicators in the Quality and Outcomes Framework (38.5 QOF points) that negotiators had agreed were no longer needed and could be reinvested in other areas. After careful consideration, the Government took the view that these resources (together with 20 QOF points which the negotiators had already agreed could be released from local patient surveys) should be used to strengthen the focus on patient experience. We regard patient experience as an important indicator of the overall quality of care.
This would mean beginning to move away from incentives for carrying out patient surveys and instead rewarding practices that have high levels of patient satisfaction as measured through surveys. The two areas of patient satisfaction on which we propose focusing for 2008/09 are the ability to book advance appointments and the ability to make a GP appointment within two working days.
We are disappointed by any suggestion that this proposal to strengthen rewards for patient experience would damage care for older people and for heart disease. The QOF already rewards GPs for high quality care for heart disease and other vascular illnesses, as well as other illnesses that affect older people, such as dementia. Our proposals do not in any way reduce the substantial existing investment in these areas, and this sort of care is at the very heart of general practice.
The QOF clearly cannot cover every aspect of care for all diseases. There have been some suggestions that GPs would need to wait for additional pay incentives before following best practice and guidelines on the care of people with osteoporosis and peripheral arterial disease. We do not believe this is the case: indeed, we know that many GPs are already adopting this best practice.
We fully support, however, the case for developing the QOF to meet emerging challenges, and we have signalled that this is one of the areas we wish to review with the profession and other stakeholders as part of our wider strategy for primary and community care in the future.
Next steps
We were disappointed that the GPC was not able before Christmas to agree the proposed contract changes for 2008/09, but we still hope that front line GPs will back the proposals. However, to avoid reaching an impasse and being unable to make any changes for 2008/09. We are consulting the GPC on an alternative set of proposals, and we began this process before Christmas to allow 12 weeks for consultation as we are legally obliged to do. In the meantime, if there is agreement on the negotiated offer, we would not of course need to complete this consultation.
Our alternative proposals are based on the same underlying principle of improving access to services and patient experience. The main difference is that they would give greater flexibility to Primary Care Trusts to work locally with GP practices and patients to decide how best to improve services. The proposals would maintain current levels of investment in GP practices, but would enable the NHS to work locally with GP practices to make better use of some of the resources in the contract (around £35,000 for an average sized practice). These resources would come from the current access incentive schemes (the Access and Choice
DESs), the QOF resources associated with local patient surveys, and a number of out-of-date or duplicative QOF indicators.
Conclusion
While we await the BMA poll, we would encourage GP practices to discuss with their PCT how to take forward improvements in extended hours, either under the proposed national framework or under locally agreed arrangements. Whichever route you choose, it will clearly require careful discussion between GP practices and PCTs to ensure that new arrangements reflect the needs and wishes of local patients and deliver tangible improvements for patients. We want to continue to work with the profession and wider stakeholders, not only to improve access to GP services but also to support wider improvements in primary care. We are
developing a wide-ranging strategy for primary and community care that is looking at how to develop services in ways that focus ever more strongly on promoting health, preventing illness and managing long term conditions.
Once again, thank you very much for all you are doing to improve health care in this country. I hope that you will feel able to support these proposals to improve services for patients
Alan Johnson
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