The new General Medical Services (GMS) contract is helping to improve primary care services in Wales and is integrating General Practitioner (GP) services more effectively. But changes are needed to the way the contract is run, according to Auditor General Jeremy Colman. His report “Review of the new General Medical Services Contract in Wales” identifies a need to monitor more closely the money given out to GP Practices.
The new contract, introduced from April 2003 has helped to allay the widespread concerns that existed amongst GPs about their workload and the sustainability of services. The contract has provided GP practices with more funding for services, and gives more control over the services their practices offer. GPs’ working conditions have improved, working hours have reduced, and GPs’ incomes have increased by around 25 per cent on average. Patients continue to have access to GPs and some primary care and chronic disease management services are now more readily available to patients via their GPs. Services to patients are being improved after being asked by their GPs for their opinions about the quality of services they are getting.
A new points system, the Quality and Outcomes Framework, has been introduced to help measure GP practice performance and distribute funding. This measures steps in the process of care, some interim patient outcomes and other aspects of services. This has improved the baseline activity and quality of care in many areas. The new points system has also increased GP practices’ income. Practices achieved much higher scores earlier than anticipated and received payments more quickly than expected, drawing on money originally intended for drugs. These drugs savings could have been used for other health care developments.
The Report finds some problems with the way the new contract is managed. There is ambiguity about defining what core services the contract provides, and some GP practices have been able to claim additional income for services which they provided under the old contract. There also appears to be a variance in the depth and rigour applied to checking the points awarded to each GP practice. Local Health Boards are not making random checks to ensure that the new system is working properly in Wales, in contrast to the position in England.
The contract provides a framework for GPs to provide new and enhanced services to patients. The report finds the number of these services provided has been limited, apart from some services directed nationally.
The changes introduced by the contract mean that general practice is now a more attractive option for young doctors and, for the first time in many years, trainee schemes are oversubscribed and vacancy levels are falling.
This report makes recommendations for improvement, including:
- NHS Employers (who are the negotiating body for the GMS contract on behalf of the four UK Health Departments) must clarify what are the core services provided by the GMS contract;
- Local Health Boards must introduce routine, detailed checks;
- GPs’ targets as expressed by the new points system must continue to reflect continual improvements in services and in outcomes for patients; and
- NHS Commissioners must make full use of the new contract’s flexibilities to provide local services based on local needs.
Auditor General for Wales, Jeremy Colman, said today:
“Although the GMS contract has clearly helped to generate some improvements to primary care services, my recommendations aim to guide how further improvements can be made to the way it is managed, to ensure the GMS contract fulfils its potential”
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