‘Nerdy’ changes needed to GP contract, says former health secretary

‘Nerdy’ changes to the GP contract are needed to give more flexibility to ICSs to work with practices and achieve better care for patients, a former health secretary has said.

Patricia Hewitt was speaking about the future of ICSs during a panel discussion at the King’s Fund annual conference in London last week.

Her major review into ICSs commissioned by the Government and published in April had recommended ‘a new framework’ for GP contracts, with a ‘radical reform’ needed as national contracts present ‘a significant barrier’ to local innovations.

Ms Hewitt, who is chair of Norfolk and Waveney ICS, told the conference that ICSs ‘are here to stay’ and no political party would think of dismantling them, but that ‘significant changes’ are needed around the GP contract and payments systems to allow them to be more effective.

During the discussion, attended by Pulse, she said: ‘Now when I say ICSs are here to stay it’s a statement of fact – no political party, unless it’s one of the fringes, is going to go into the next election promising to abolish ICSs or have another top-down NHS reorganisation. So that is critical.’

She added: ‘But there are really significant things that need to change and the fundamental problem with all these access issues is that every part of the health and social care system is managed as separate – different contract, different funding streams, different targets, different incentives and often different regulators or regulatory requirements […].

‘We are setting ourselves the ambition of no unplanned admission to hospital for an older person, we can see many of the ways to achieve it, that’s the kind of shift we need and that requires real nerdy stuff around GP contract, payment systems and all those other things as well.’

Ms Hewitt’s review earlier this year also said that practices that ‘are not delivering at a high enough standard’ need to be supported to improve and, where necessary, ‘to be replaced’ so that residents in every community receive the support from primary care they need.

This should include creating a centrally-held fund to buy out contracts or premises, or both, where that is essential to improve access, care and outcomes in a particularly disadvantaged community, the report said.

It also expressed support for the GP partnership model and with regards to incentive frameworks, it said that QOF ‘needs to be updated with a more holistic approach that allows for variation’.

A consultation on the future of QOF and incentives in general practice is expected to be launched imminently.

Earlier this month, the NHS Confederation recommended a new pay uplift clause should be included in both the GMS contract and PCN DES, guaranteeing annual funding rises.

It also set out a number of recommendations for reforming QOF, including streamlining the framework with IIF and including incentives for group consultations for long-term conditions.

A new report this week concluded that the Government’s argument that GPs must to stick to the five-year contract has been ‘short-sighted’ in the face of ‘obvious budgetary pressures’.