The current GP contract has cost the government a whopping £1.76 billion more than expected since its introduction in 2004, and yet productivity has taken a downturn, says a new report by the National Audit Office.

The spending watchdog has found that, on average, GPs now work seven hours less a week than before the new contract was brought in, but still earn nearly 60% more despite pay increases of just 3% over two years, largely because of a change to out-of-hours responsibilities.

Before 2004, GPs were responsible for the provision of care outside normal working hours, but a radical change in the latest contract allowed doctors to opt out of this for a pay cut of just 6%, leaving primary care trusts with the responsibility of dealing with the approximate nine million patients who require such care in England every year.

The move, alongside other incentives to help doctors improve the quality of care, was designed to attract more junior doctors into primary care and help address the declining morale of already practising GPs, but also seems to have created an environment where doctors are working less for more money, according to the report.

But the NHS Alliance says that, while it is right to focus on outcomes, there is a lack of an appropriate definition of what productivity means in practice for the National Health Service, and claims that the report “risks encouraging further anti-doctor prejudice”.

“In fact, the cost to each tax payer of their general practice team – complete with GPs, nurses, receptionists and other staff – is £120 per year. That is less than the cost of a television licence,” it points out, and warns: “Increasing working hours would result in over-tired doctors and risks to clinical care and patient safety”.

And Dr Laurence Buckman, chairman of the British Medical Association’s GP committee, insists that “the number of consultations has gone up, the time spent with the patient has increased and the work GPs do is more complex.”

“In fact,” he explains, “the entire way GPs work has changed so it’s meaningless to talk about productivity in the way the NAO has done. GP productivity should be measured in improvements in health, not the frequency of consultations – and the early evidence is that the contract is leading to improvements in clinical care.”

Numbers misleading
And while conceding that the cost of the new contract has overshot original expectations, Alastair Henderson, acting director of NHS Employers, said some of the figures quoted are misleading.

“The figure of £1.76 billion relates to expenditure above the Gross Investment Guarantee. This was the figure promised by the government during the negotiations as the very minimum they would invest in primary care. Expenditure was in the end £406 million or 2.8% above that actually allocated by the government for spending on the contract over a three-year period,” he explained.

Buckman was also quick to shake off any blame for the reported overspend. “The overspend on the contract is not the fault of GPs – the BMA repeatedly told the government that GPs would exceed the targets they had set them. It was also well known that GPs had been subsidising out-of-hours care out of their own pockets, so the money taken away from them was never going to cover the costs of running the new service. Overspends of PCT budgets are not within their control,” he stressed.

According to the report, the substantial investment in primary care has not generated the expected improvement in service quality, but again Buckman maintains this is not the fault of GPs. “The NAO recognises what GPs have been saying for a long time – that PCTs have not commissioned the extra services practices wanted to provide for their patients,” he concluded.