The new GP contract : incentives for pharma too
pharmafile | October 29, 2003 | Feature | |Â Â GP contract, NHS, healthcareÂ
As the final details of the new GP contract are decided, the pharmaceutical industry is now preparing itself for a revolution in primary care when the new system is introduced in April 2004.
Practices will no longer by assessed on the basis of how many patients they have on their books; instead they will be paid according to the clinical results they deliver.
At the heart of the new General Medical Services contract is the promise that "High achievement against quality standards will bring very substantial rewards" – an incentive system that promises higher prescribing, and a golden opportunity for the industry.
Practices will now have to show improvements in specific areas, defined in the quality framework, agreeing their targets in advance with their PCT.
The quality framework will then provide financial incentives for increased performance in ten key clinical areas, as well as encouraging the raising of organisational standards and better patient experiences.
The framework is the first time any large national healthcare system has tried to systematically reward practices for the quality of care given to patients.
It reverses previous policies introduced in the 1990s to encourage lower prescribing wherever possible, and seems certain to increase prescribing in some areas, such as chronic disease management.
Michael Sobanja, chief executive of the NHS Alliance and HealthGain Solutions Director of NHS Strategy, said: "History tells us that GP behaviour is driven by payment systems. This new contract will pay GPs by results so we should expect to see a dramatic change in policy and prescribing patterns."
But he says the contract demands a strategic response, not "a feeding frenzy of toolkits on how to do the NHS contract".
"The pharma industry needs to develop an integrated solution between PCTs and GP practices, he says. As far as it can, it needs to align itself with the payment by results system, represented by the quality payments and enhanced services section."
"The over-riding principle should be on helping the NHS meet its strategic objectives – not persuading prescribers to spend more money."
A Minimum Practice Income Guarantee backs up the contract to ensure no practice is out of pocket through signing up to the changes, but beyond that GPs will be watching their income – and thus, their clinical performance – with an eagle eye.
Practices will be paid an average of £9,000 per year, for the first three years to collect initial data to work out their position in the quality framework. From 2004/5 they will also receive 'aspiration payments' based on how their scoring in the framework relates to aspirations agreed with their PCO. Also from 2004/5, practices will start to be measured for achievement payments, which will then be paid at the end of each year.
Practices that achieve the relevant national access targets will receive additional payments, to recognise the increased workload required to deliver good access at the same time as higher quality. Practices meeting these targets will be rewarded through the 50 bonus points available through the framework.
All practices will be provided with computer software in 2003/4 that will enable them to calculate at any point in time, what they are achieving.
For 2004/5, the first year the new contract is in force, each point will be worth on average £75 per practice. This is then due to rise to an average of £120 per point in 2005/6.
While many of the practical outcomes for patients and the wider NHS remain unknown, the industry has never had such a well-defined structure for its sales and marketing strategies.
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