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GP contract too inflexible for ICSs says Hewitt review

GP contract too inflexible for ICSs says Hewitt review
By Anna Colivicchi
6 April 2023



‘National contracts’ present a ‘significant barrier’ to local innovation, according to a major Government review which recommends ‘a new framework’ for GP contracts.

It also recommends that centrally held buyout funds are set up, to take over GP contracts or premises where practices are ‘not delivering to a high enough standard’.

Former health secretary and chair of Norfolk and Waveney integrated care board (ICB) Patricia Hewitt was commissioned to produce an independent review of England’s new integrated care systems (ICSs) in November.

In her report, which was published on Tuesday, she recommends that NHS England and the Department of Health should ‘as soon as possible’ convene a national partnership group to develop a new framework for GP primary care contracts.

It also said that QOF points were ‘an important and useful innovation twenty years ago’ but are now ‘out of date’, and are seen by GPs as well as ICBs as ‘an inflexible and bureaucratic framework’.

The review found that national contracts present ‘a significant barrier to local leaders wanting to work in innovative and transformational ways.’

‘ICBs also lack effective levers to support and secure the services in practices where practices are facing difficulties in providing a good quality of service in their area,’ the report said.

‘I therefore recommend NHS England and DHSC should, as soon as possible, convene a national partnership group to develop together a new framework for GP primary care contracts,’ Ms Hewitt said.

She added: ‘As the GP contract is now entering its fifth year of a five-year agreement, and the Government will be shortly considering its intentions for the next iteration of the contract, radical reform is needed, and this is the right time to make it happen.’

The contract reform group should include ‘a diverse range of GP partnership leaders’ delivering ‘excellence across a range of different regions and demographics,’ as well as ICB primary care leaders, local government and ‘crucially’ a number of patient and public advocates.

NHS England and DHSC should also engage with ‘key stakeholders,’ including the BMA and the RCGP.

According to Ms Hewitt, the GMS contract provides ‘far too little flexibility’ for ICSs to work with primary care to achieve ‘consistent quality and the best possible outcomes for local people.’

However, she did express support for the GP partnership model.

The report said: ‘I would suggest that [the new] framework should enable systems to find the right solutions to fit their circumstances, including building on the partnership model, rather than sweeping it away entirely.’

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Meanwhile with regards to incentive frameworks, she said QOF ‘needs to be updated with a more holistic approach that allows for variation’.

‘The new approach must also recognise that, in order to allow primary care to refocus resources on prevention, outcomes rather than just activity need to be measured.’

Dr Kieran Sharrock, BMA England GP committee acting chair, said the committee welcomed some of the principles in the review, which are not far removed from what the union has been saying for some time.

He said: ‘Even before the recent imposition, GPC England has been clear that the contract needs a complete overhaul, so that what comes next properly supports practices to look after patients in a way that recognises changing demographics, increased demand, plummeting workforce numbers and rising costs. 

‘We know practices are struggling to meet patients’ needs and the emphasis now must be on supporting practices, rather than penalising them.’

However, Dr Sharrock said that there is ‘worryingly little detail’ within the report about how success is defined and by whom.

He added: ‘A central fund to buy out ‘failing’ partnerships may be seen as appealing for those left with no other way out, but it’s not clear who decides when a practice is failing, and what powers they might have.

‘Rather than improving community-based, holistic care, we’d worry that this would open the door to private companies strong-arming smaller practices into selling – destroying the continuity of care that they have built over many years.’

A DHSC spokesperson said: ‘Integrated care systems are an important part of the Government’s plan to deliver more joined up and effective health and care services and to cut waiting times for patients, one of the Prime Minister’s key priorities for 2023.

‘Ministers will review recommendations of this report in due course.’

Meanwhile, two long-awaited documents which will influence the future of general practice are expected to be released in the coming weeks.

Key recommendations from The Hewitt Review

  • National contracts present a significant barrier to local leaders wanting to work in innovative and transformational ways. I have recommended that work should be undertaken to design a new framework for General Practice (GP) primary care contracts, as well as a review into other primary care contracts. 
  • Practices that are not delivering at a high enough standard need to be supported to improve and, where necessary, to be replaced so that residents in every community receive the support from primary care they need. This should include creating a centrally-held fund to buy out contracts or premises, or both, where that is essential to improve access, care and outcomes in a particularly disadvantaged community.

This article was first published by Healthcare Leader’s sister title Pulse.

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