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For most people their General Practitioner (GP) is the first point of contact with the National Health Service (NHS). Around 33,000 GPs hold some 290 million consultations each year, with GP services costing some £7.7 billion, almost 10% of all NHS expenditure. In 2000, the Department of Health (the Department) determined that many of its planned improvements in primary care were unlikely to be achieved without a new contract for general practice. Fully implemented in April 2004, the new contract is intended to attract more doctors into general practice through better pay and improved conditions. The NHS is expected to benefit by linking GPs' pay to their clinical performance and by improved accessibility to services through more flexible working.[1]
The NHS has realised some but not of all the benefits from the new contract. Over the first three years, the contract cost £1.8 billion more than originally expected because the Department underestimated the cost of delivering services such as out-of-hours care. The level of GP performance, as measured by the Quality and Outcomes Framework, also exceeded estimates and led to additional expenditure. The Department believes the cost of the contract is now under closer control and that by the end of 2008 it will have recovered any overspend.
The Department has succeeded in increasing the number of GPs working in the NHS above the target it set itself: more than 4,000 additional GPs from March 2003, an increase of 15%. It has also been successful in introducing a pay for performance system which has increased the consistency of care for long term conditions. The new contract has helped increase the breadth of services provided in primary care, but has had less success in improving access to primary care, particularly in more deprived areas.
GP partners have benefited most from the new contract, with an average pay increase of 58% and decreased working hours. Other staff, such as practice nurses and salaried GPs, have had only small pay rises despite taking on a larger proportion of the workload in general practice. GP productivity has actually decreased, on average, by 2.5% per year in the first two years of the contract.
Primary Care Trusts have lacked the capacity and capability to commission local services effectively and have not used the contract in a way that fully realises its benefits. They have spent more than they were allocated, but failed to use the contract to provide more convenient opening hours and more general practice services in deprived areas. The Department has now issued central directions to Primary Care Trusts to tackle these issues.
On the basis of a Report by the Comptroller and Auditor General,[2] we examined the contract negotiation, the cost implications, and the extent to which the expected benefits for patients and the NHS are being realised. We took evidence from witnesses from the Department and the NHS.
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