GPs win 50 per cent pay rise in return for extra services

Family doctors could see their pay rise by 50 per cent over the next three years under a deal announced yesterday to switch the care of millions of chronically ill patients from hospital to local surgeries.

Patients were promised a big expansion in the services provided by Britain's 36,000 GPs and marked improvements in the quality of care.

The deal involves an extra £1.9bn funding for general practice by 2006, a 33 per cent increase. The size of the award is bound to irritate nurses and allied professions who are currently considering a pay offer worth 16 per cent over three years under the Agenda for Change proposals.

Doctors' leaders and NHS managers said the contract was the first in the world to link pay to patients' needs. GPs who provide the widest range of services and hit all their quality targets could earn more than £100,000 a year while those who ignore the quality targets and do the bare minimum could their pay cut. It currently averages £61,218.

But the deal marks the end of round-the-clock responsibility for GPs, which has been the hallmark of the service since the foundation of the NHS in 1948. For the first time GPs will be allowed to opt out of responsibility for organising night and weekend working in return for a deduction of an average £6,000 from their pay.

The British Medical Association expects more than half of GPs to take the pay cut in return for an easier life. Responsibility for organising out-of- hours cover will then fall to Primary Care Trusts but, because most night cover is already provided by GP co-operatives or commercial deputising services, patients will see little change. GPs will continue to make daytime home visits.

The size of the pay rise is intended to boost recruitment to general practice, which the BMA says is facing a crisis with 1,000 unfilled vacancies nationwide. The extra investment, rising from £6.1bn to £8bn by 2006, means primary care will expand faster than the hospital service with extra staff, buildings and IT equipment.

GPs will be offered a choice of three contracts ranging from the basic, providing essential care, to the "enhanced", providing extra treatments such as minor surgery. Their performance will be assessed on a range of 80 measures, which will attract extra payments.

Under the current contract, GPs receive a per capita payment for each patient on their list but there is no financial incentive to do more than the minimum and some GPs have built up large lists and refer all but the simplest cases to hospital. Under the new contract, they will receive extra payments for monitoring and treating patients with 11 chronic conditions including heart disease, diabetes and epilepsy. Extra payments will also be triggered for offering all patients routine appointments within 48 hours.

Dr John Chisholm, chairman of the BMA's GPs committee, said the contract, which had taken 18 months to negotiate, offered "light at the end of the tunnel" for GPs who had been struggling to cope with increasing workloads and inadequate resources.

"This is a historic step change in the level of funding for general practice. For years extra funds have been directed at the hospital service. There will be very substantial rewards for practices delivering the highest standards of care."

Gill Morgan, chief executive of the NHS Confederation, which negotiated the deal for the Department of Health, said: "If GPs can manage chronic diseases effectively it will cut hospital waiting lists."

THE CONTRACTS For the first time GPs will be rewarded on the basis of the quality of their care. They will get extra pay for achieving targets in 11 disease areas. They will also be able to choose from three contracts with varying workloads: Essential: Necessary care to the sick and terminally ill. Patients will be guaranteed other services locally. Pay rise: 10 per cent over three years (or pay cut if quality targets missed). Additional: Necessary care but also contraception, vaccinations, etc. Most GPs currently provide these services. Pay rise: More than 10 per cent over three years. Enhanced: All the above but also minor surgery, blood monitoring or provide care for drug and alcohol problems. Pay rise: Up to 50 per cent over three years.

HEALTHY OUTCOME?: 'I WILL BENEFIT BUT SOME DISEASES MAY BE NEGLECTED'

Eugene Hughes, 46, is certain to be a winner under the new GP contract – but he says it could create a new two-tier service in the NHS.

His seven-partner practice is in Ryde on the Isle of Wight. He is in the surgery by 8.30am and leaves at about 6.30pm. In addition to morning and afternoon surgery, he does about four home visits each day and three or four shifts a month with the island's deputising service to cover nights and weekends.

All patients are offered an appointment within 48 hours and four practice nurses are running clinics for heart disease, diabetes and asthma. On that basis, the practice is likely to qualify.

He says: "On first reading I am absolutely delighted. We feel we have provided a good service but we have not felt able to move forward because we are always chasing our tail. We hope the extra money will mean we can employ more nurses."

But he is concerned that the 11 chronic conditions selected for incentive payments could lead to the neglect of conditions not on the list. "We saw this with GP fund-holding and with the clinics GPs were paid to set up in the early Nineties. If you have patients with Parkinson's disease or arthritis, you may find GPs neglecting those conditions while they seek to achieve the targets that attract payment," he says.