The new general practice (GP) contract for England has cost £1.8 billion more than expected in its first three years, and general practitioners are not only paid “an eye-watering” 58% more now than they were in 2003 but they are working shorter hours, Parliament’s Committee of Public Accounts (PAC), has reported.

The £1.8 billion overspend was due to the Department of Health underestimating the cost of delivering services such as out-of-hours (OOH) care, it says, while the level of GP performance, as measured by the Quality and Outcomes Framework (QOF), also exceeded estimates and led to extra spending. However, the Department has said that the contract’s cost is now under closer control and it will have recovered any overspend by year-end.

The Department’s goal of increasing the number of GPs working in the National Health Service (NHS) has been more than met; since March 2003, their numbers have risen by 4,098 (15.3%). However, their productivity has decreased an average 2.5% a year, against the 1.5% year-on-year productivity gains which the contract was expected to deliver, says the CPA.

The Members of Parliament (MPs) also point out that GPs’ pay had been expected go up only around 15% and that, in contrast, salaried GPs and practice nurses have received small inflationary pay rises, despite their having taken on a larger share of the GP workload. QOF concentrates largely on indicators that are easy to measure and it seems to have “made it too easy for GP practices to achieved high scores,” said the PAC’s chairman, Edward Leigh, Conservative MP for Gainsborough.

“Partners in GP practices are now putting in less time and their productivity has decreased. Only their pay is burgeoning, having increased on average by an eye-watering 58% since 2003,” said Mr Leigh. The Committee report states that the Department needs to: - develop the QOF so that it is better aligned to national health priorities; - give more weight to achieving health outcomes rather than clinical practices which are easy to measure; and – allow Primary Care Trusts (PCTs) some discretion to agree the content of the Framework to reflect local priorities.

Moreover, access to GP services has not improved significantly since the new contract was implemented in April 2004, say the MPs, who point out that having to arrange to visit a GP in normal working hours is a significant cost to the economy in terms of lost output. In future Directed Enhanced Services, the Department has included the requirement that GPs open for longer hours but, the MPs say that, in order for this to be effective, PCTs need to commission services that are more clearly linked to local needs, underpinned by a performance management framework that enables them to monitor how well GP practices meet this and other requirements. PCTs must also tackle poor performance as necessary, they add.

Discussing other areas in which the new GP contract has failed to live up to expectations so far, Mr Leigh noted that services for deprived areas have not improved and that, while the PCTs are now able to negotiate with GPs the provision of enhanced services to meet the local population’s needs, as yet very few have done so.

- The PAC based its investigation on the Comptroller and Auditor General’s report: NHS pay modernisation: New contracts for General Practice Services in England.