In a recent BMJ article Dr Margaret McCartney proposed that GPs be paid to provide service and move away from the micro-management we have been under from the 2004 GMS contract. This is exactly the proposed direction of travel that RCGP Scotland is proposing and this is my response: –
Thank you for your paper that continues a dialogue contributed to by my predecessor Dr John Gillies et al. in the paper “Distilling the essence of general practice: a learning journey in progress” (1).
I am delighted to say that in Scotland we are close to moving away from the tick box world you describe. Colleagues from the Scottish General Practice Committee are in negotiations on a contract to replace QoF with new proposals that incorporate the Royal College of General Practitioners (RCGP) vision for a “peer-led, values driven” model of quality, leadership and governance. The Cabinet Secretary for Health has recently announced the phasing out of QoF and has endorsed the RCGP approach. Our vision is for the creation of GP “clusters” that will be responsible for quality planning for their locality, be given resource to undertake quality improvement and demonstrate the quality assurance needed of GPs in a modern health and social care system as described in the joint RCGP and Health Care Improvement Scotland document “Developing a Quality Framework for Scottish General Practice”.
We have a long way to go and we do not underestimate the difficulty in delivering the changes that you are suggesting. The obvious barrier is the present climate when general practice is being resourced at record low relative levels and workload and workforce are ever increasing challenges.. Refocusing the agenda to one that has patients and locality needs as central and rebuilding professionalism will be a key to reversing some of the negative view of general practice that is so prevalent. It will also equip the NHS with primary care that will be able to deliver integrated and community delivered care as described in the Scottish Government “2020 Vision”.
1. Br J Gen Pract. 2009 May;59(562):e167-76. doi: 10.3399/bjgp09X420626