The New GMS Contract
The new GMS contract (nGMS) came into force in April 2004, abolished the "Red Book" and led to a significant but temporary increase in some practices' income. Every practice gets a share of a total amount of money allocated towards primary care in GMS practices (the "Global Sum"). This share is determined by the practice's list size, adjusted for age and sex of the patients (children, women and the elderly have higher weights than young men because they cause a greater workload). Furthermore, the practice gets an adjustment for rurality (greater rurality causes greater expenses), for the cost of employing staff (the "Market Forces Factor" (MFF), which captures differences in pay rates between areas, (e.g., it is more expensive to hire a nurse in London than in Perth), the rate of "churn" of the patient list and for morbidity as measured by the Health Survey for England.
The application of the formula to this reduced "Global Sum" would have resulted in great changes in GP income and income loss for many GPs and through their representative organisations the GPs were able to extract a concession. They received a "Minimum Practice Income Guarantee" (MPIG), which temporarlily protected the previous income levels of those who would otherwise have lost out - that guarantee being withdrawn over time by a combination of inflation and the clawback of pay rises.
At the same time the Government introduced the Quality and Outcomes Framework (QOF) which was designed to give GPs the incentive to do more work and fulfil government-set requirements (146 indicators) to earn points (varying amounts per indicator) which translate into greater income. The money for the QOF was taken out of the "Global Sum", so is not really new extra money.
Participation in the QOF is voluntary but since the standards change each year, practically all practices participating have to do more work each year for the same income. However, the substantial additional workload of QOF has led to substantial improvements in the screening for risk factors in the community by primary care, particularly for older patients with cardiovascular disease.
The new contract forced almost all GPs to opt out of weekend and night (Out-of-Hours) service provision - largely because the cost of providing a good quality service was roughly double the funding allocated to it by the patient, but also because the government set standards (all calls to be answered within 60 seconds etc.) that cannot be met by individuals. The inevitable consequences of systematic underfunding of primary care OOH services and their provision by the cheapest bidder came to a head with the Dr Ubani case, although there have been many others. It should perhaps stand as a warning of the risks inherent in the "lowest bid cheapest provider" model of medical care.
A series of amendments have followed each year - each time reducing income for the current workload, and tying existing pay to new targets (adding new QoF indicators, making them harder to meet, extending working hours). This combined with the other workload factors (increasing consultation length, increasing consultation frequency, ageing population (see Office of National Statistics) increasing medical complexity, and transfer of work from hospital means that GP workload is rising 5% year on year as GP income falls - concealed largely by the rise of "half-time GPs" working 40 hours a week which makes pay look artificially high.
Read more about this topic: General Medical Services
Famous quotes containing the word contract:
“The way in which men cling to old institutions after the life has departed out of them, and out of themselves, reminds me of those monkeys which cling by their tails—aye, whose tails contract about the limbs, even the dead limbs, of the forest, and they hang suspended beyond the hunter’s reach long after they are dead. It is of no use to argue with such men. They have not an apprehensive intellect, but merely, as it were a prehensile tail.”
—Henry David Thoreau (1817–1862)