Press Release - NHS Pay Modernisation: New contracts for
general practice services in England
28 February 2008
The new contract for general practice has contributed to
improved recruitment and retention of GPs, with numbers increasing
from 26,833 to 30,931 since 2003. However, according to a report
out today by the National Audit Office, the contract has cost the
Department £1.76 billion more than it originally budgeted for.
Today’s report found that, in the first two years of the
contract, productivity has fallen by an average of 2.5 per cent per
year. GPs are working on average seven hours less per week than in
1992, partly because of the removal of the responsibility for out
of hours care. While the number of consultations with patients has
increased, these are not in proportion with the increase in costs.
Primary Care Trusts’ spending on GP services has however now
started to level off.
The largest overspend of the contract was due to an
underestimation of the amount that GPs would earn from the pay for
performance scheme, the Quality Outcomes Framework (QOF). While
there is evidence that the QOF has improved consistency in the
quality of care, it is too early to say if overall patients’ health
has improved as a result.
In 2005-06 the annual average pay of a GP partner was £113,614,
an increase of 58 per cent since 2002-03. GPs report, however, that
over the last year their pay has stayed the same or decreased. GP
partners have taken more profit from the practice as pay while the
average salary for GPs they employ increased by only three per cent
in the first two years.
The report found that nurses are delivering more practice work
leaving GPs to spend more time with more complex cases. The
proportion of consultations undertaken by practice nurses increased
from 21 per cent to 34 per cent between 1995 and 2006. GPs now
spend more time with each patient, an average of around 12 minutes
compared to 8 minutes in 2002-03.
The report concludes that Primary Care Trusts have not made use
of all the levers in the new contract. Money for new local services
has not led to improvements such as increased opening hours and
some of the most deprived areas remain under-doctored. Some 40 per
cent of GPs believed that aspects of the contract had not helped
tackle health inequalities.
The NAO recommends that the Department develop a strategy for
yearly negotiations on the QOF and the QOF should be based more on
health outcomes. Primary Care Trusts should provide more services
based on local need and review the number and skills of staff
employed to commission and performance manage GP services with the
aim of improving local commissioning.
Tim Burr, head of the National Audit Office, said
today:
“There is no doubt that a new GP contract was needed and there are
now 4,000 more GPs than five years ago. But in return for higher
pay, we have yet to see real increases in productivity. The extra
money flowing into practices has largely benefited GP partners
rather than rewarding other important members of the practice team.
Primary Care Trusts now need to deliver to patients the benefits
that were expected in return for GPs increase in
pay.”
Notes for Editors:
- Press notices and reports are available from the date of
publication on the NAO website, which is at http://www.nao.org.uk/.
Hard copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Tim Burr, is the head of
the National Audit Office which employs some 850 staff. He and the
NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources. Mr Burr
took up post on 1 February 2008.
Press Notice 13/08
All enquiries to Donna Watson, NAO Press Office: Tel: 020 7798
7038
Mobile: 07917 555 388