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It was over a year ago when the then Prime Minister, David Cameron, announced that a new ‘voluntary’ contract for GPs in England would be introduced. The result is the publication of the draft Multi-speciality Community Provider (MCP) contract by NHS England.So what does this really mean for GPs? MCP contracts will be aimed at practices who wish to work within an integrated care model, covering populations of at least 30,000-50,000 patients or perhaps larger and who voluntarily want to work separately to the national GMS contract. These will be geographically arranged organisations that integrate General Practice services with relevant community based and appropriate hospital services. Three levels or types are muted; the virtual, the partially and fully integrated. The reasoning behind this change is to more closely integrate GP and community services and move many consultant led services out of a hospital setting.In contemplating this new contractual offer, it is worth remembering though that the key word in amongst the technical jargon is voluntary.While the GPC has been involved in ongoing discussions with NHS England about the development of the contract, it is our view that contractual change is not necessary for practices to collaborate effectively and these quite laudable aims can be achieved with the current contract as the foundation. However, given the very difficult situation that many us find ourselves in, it might be reasonably viewed as their best or possibly only option, or even indeed an opportunity. Quite rightly if they choose to move onto the new contract we will, of course be there to support them in this decision.Nevertheless there are quite clear risks. Abandoning the GMS contract for an MCP contract is a one way street, with busy oncoming traffic. It will be very difficult, if not impossible, for GPs to return to their current contract if for whatever reason working under a fully integrated MCP model does not succeed. There will also be a significant impact on the way that we work. One of our greatest strength is the connection between the individual practice and the community which it serves. A vital link that may well be lost (to the detriment of patients and GPs) if the local list based and perpetual contract is relinquished with the change to a time limited MCP arrangement. Additionally, as the new MCP contract is time limited, it will ultimately be subject to a tender process. This will mean that constituent practices may have to compete against commercial companies to retain it, with as we know, absolutely no guarantee of success. It is also worth noting the implications for a national service, both from a service and negotiating point of view, if a significant number of practices leave the current system. Another area that merits consideration is that of performance related pay. The current QOF system, though not perfect, is largely underpinned by sound clinical rational and guarantees a uniform national approach. This new contract will allow the development of variable and transient incentive schemes, which may impact in a detrimental fashion on our role as an independent advocate for our patient's care.However it is also worth emphasising that GPs are fortunately not faced with a binary choice. There are other routes open to GPs which could allow significantly greater collaboration and integration, but utilising the current GMS contract. The current national contract can act as the foundation on which we can build very successful new models of care, perhaps utilising super-partnerships or very robust federations as a focus for a virtual MCP. As our recent survey highlighted, half of GPs in England support the current independent contractor model, but with the necessary resources needed to successfully collaborate and develop to form a more integrated structure.We recognise and appreciate the enormous pressures that general practice is working under. It is frankly not surprising that 84 per cent of GPs in England believe that excessive workload is preventing the safe delivery of care, while more than a third of partners are considering closing their lists to safely manage workload.While the new MCP contract will be the answer for some facing these pressures, it is vital that GPs are aware that it is certainly not the only means of maintaining and developing General Practice, as the very corner stone of the NHS. In light of NHS England’s announcement we will be updating the GPC’s guidance, including a more detailed analysis of the pros and cons of the MCP proposals alongside further advice and guidance on the alternative options open to GPs. You can read the current version of the guidance here. Gavin Ralston is a GP in Birmingham
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