Exclusive GP representatives voted in favour of keeping a capitation-based contract from 2024 at a closed session of the England LMCs conference last Friday, Pulse has learned.
Pulse understands that LMC leaders were asked to vote on a number of statements to help inform BMA’s England GP committee of their views ahead of the upcoming contract negotiations.
This included voting on what type of contract they want to see in England, with the capitation-based model ranking the most popular among delegates.
One delegate told Pulse that there was strong support to keep the GMS contract given the advantages it brings to patient care, but there was also consensus that it needs to define activity going forward – and for anything over and above that level of activity a payment by activity model should be considered.
This comes after GPC negotiators hinted earlier this year that they were considering putting forward a payment-per-contact model as part of their proposals for the 2024 contract.
Speaking at the Best Practice conference in October, deputy GPCE chair Dr David Wrigley commented that the volume of GP workload is ‘never-ending’ and asked delegates whether they would support an item of service fee for contacts such as face-to-face or telephone appointments, home visits, document management or a medication review.
GPC England chair Dr Farah Jameel said at the same Best Practice conference that alternatives could be ‘an uplift to the global sum or additional guaranteed for every single member of the team’.
At last year’s England LMCs conference over half (58%) of delegates voted in favour of a motion proposing that GPCE negotiate a ‘fee for service contract, including item of service payments for core general practice work, rather than the current block contract’.
LMC representatives attending this year’s closed session also voted in favour of GP practices being allowed to offer a range of private services to their registered list, Pulse understands.
They also voted to keep vaccination and immunisations in the core contract.
And delegates were asked about opting out of particular areas of care such as same day or urgent care and palliative care, but there was apparently little support for this.
Pulse understands there was however widespread support among LMCs for the requirement that GPs write sick notes to be removed.
BMA England GP committee acting chair Dr Kieran Sharrock said: ‘The discussions on Friday, in which we heard a range of opinions and views, will be useful to ensure that the voice of LMCs are heard and reflected in contract discussions, and that we are able to push for a contract that delivers for both the profession and patients. We want to continue to hear feedback from colleagues about the shape of any future contract.’
Among the motions passed by the conference on the Thursday were the call to end Saturday and evening appointments and repeal the Network DES enhanced access scheme by April next year, and a proposal to reduce core working hours to 9am to 5pm.
This is a huge mistake.
And so the exodus will continue – well done chaps!
As the number of average patient contact,demand has increased.Capitiaiton based contract is a mistake.As said this will not put the plug in the emptying bath.Pathetic, a closed shop as well no open debate.You do worry about the motives in that.Opena and honest???
An unhelpful headline. This wasn’t a conference debate on policy, it was a plenary session after a day of workshops at the additional ‘Special Conference’, seeking to more accurately gauge the spread of views of LMC attendees. Hundreds of wise heads in the room, including non contract holders. Personally, I do believe capitation-based funding (properly weighted) needs to be the bedrock of funding. Its a mistake to assume IoS payment is an all you can eat lunch. Dispensing GPs will atest to the fact that the dispensing fee per item reduces the greater the volume of work done. Attendees agreed that a new 2024-29 Contract needs to define safe workloads.
Huge mistake. There is just no way that a capitation based contract can ever provide a balance between increasing demand ( both necessary and consumerist) and capacity to satisfy.
It may have worked in the past but it is the fundamental cause of ours and our patients dissatisfaction.
It’s impossible to understand why independent contractors would want unlimited liability for a fixed sum!
… but your Practice Manager may want a large % of the practice’s income to be predictable to pay staff, bills and ensure any contract holders can have some drawings. Activity is more variable than population, and as I said earlier, and IoS fee might vary if the total NHS England pot were fixed. LMCE deleagtes (if I recall correctly) advised that GPCE should seek to negotiate a new contract grounded on properly weighted capitation, safe working levels, some IoS payments and some element of true quality.
If I misrecollect, I’m sure another attendee will be along shortly to correct this.
@Stephen Savory
The problem is that capitation based funding IS an all you can eat lunch in the other direction.
Fixed funding, no cap on workload. You can define “safe” if you wish, but this will go out of the window come 3pm when you are fully fully booked and that 4pm sick child comes in – GMC and CQC won’t be on your side when you send them away. At least with IOS income can be proportional to workload if structured properly. It’s more equitable on a basic level.
Good.
Hospitals are paid by activity and are drowning in debt. You want the same?
GP is struggling because the capitation payment is too low, NOT because the model is wrong.
If we go IoS, we’ll have the same problem as we do now, because the payment will still be too low.
Don’t fool yourself that this is a solution, it’s not.
The Whole NHS system is highly dysfunctional.Tinkering around the edges wont work.You have a workforce that is silently quitting.This will not stop that.The GPC need to go in hard and repesent those who it is supposed to.Or else there will be no one to represent.
IOS payment will ruin practices finances. Only a small percentage on practice list consult doctors. . You would never know what your income will be , Probably a lot less than at present. It would be very good for patients as doctor gets paid to see and would want to see them to survive. All this triage business will disappear.. best to keep as it is.