Reports back doctor contract changes
pharmafile | December 18, 2012 | News story | Sales and Marketing | BMA, DDRB, NHS, doctors, reform
The government looks to be heading towards a showdown with clinician groups over proposed changes to doctors’ contracts.
It has published two independent reports – from NHS Employers and the Doctors and Dentists Review Board (DDRB) – on the issue which support the government’s desire for change to make contracts “fit for purpose to support the modern NHS”.
The BMA has already been strident in warning that the government has not considered the impact on GP practices of its proposed contract changes.
The doctors’ body has criticised the “unacceptable way the government has handled these negotiations” although it is at pains to concede that a few proposals have merit.
“The government’s proposals may sound attractive on the face of it and some of their suggestions are good,” said Laurence Buckman, chair of the BMA’s GP committee.
“However they have not fully considered the overall impact on practices of all these changes being implemented together,” he went on.
They could make it difficult for some practices to maintain the level of care they currently offer, let alone increase their capacity to meet the demands of the new proposals, Buckman added.
The BMA says the government intends to implement all changes to the Quality and Outcomes Framework (QOF) recommended by NICE – “including those rejected for good reason by the General Practitioners Committee during negotiations this year”.
It will increase upper thresholds for 20 QOF indicators next year and for remaining indicators from 2014, with upper thresholds continuing to rise with overall achievement from 2015.
The BMA says this means the average practice is likely to lose £11,000 from their QOF income. “This loss alone is very likely to wipe out any increase in contract prices for 2013 recommended by the DDRB,” it insists.
Most of the QOF organisational indicators will also end, requiring GPs to take on new work to retain this funding – a move which the BMA says will cost practices around £19,800 on average.
The new report from NHS Employers covers junior doctors and says they need more flexible working and better training and that there should be a single contract for all trainees, regardless of whether they are a GP or hospital doctor.
The DDRB one looks at consultant contracts and says there should be changes to recognise “current excellence in providing high quality patient care, medical teaching and research”.
Consultants are currently eligible for payments up to £75,000 per year – which are pensionable and continue until they retire – for ‘outstanding clinical excellence’.
The report recommends – and the government agrees – that such payments should be linked to performance (including patient feedback), capped at £40,000 and should be awarded for no more than five years.
Progression through the current consultant grade (£74,000 to £100,000) should also be based on performance rather than time served.
The government says such changes will promote better medical education and research while motivating doctors to achieve results for patients. In a time of austerity, it should also ensure that they remain affordable, the Department of Health says.
Health minister Dr Dan Poulter said the proposed changes were about ensuring that the correct training and rewards are put in place.
“Reviewing the contract will ensure that doctors have the right training and rewards to look after patients from the moment they are newly qualified until the day they retire as an experienced consultant,” he concluded.
The government says it will now begin ‘active engagement’ with doctors and NHS employers about how to take things forward.
The BMA insists it is “open to real dialogue with the government” about the impact of these changes but warns: “We would be extremely disappointed if this consultative process was a rubber stamping exercise for their existing plans.”
Adam Hill
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