The practice-PCO relationship will change under the new contract, and this should result in more flexibility in the services GPs provide, says Dr Gerard Panting
Look up the word ‘contract’ in any law dictionary and you will find a definition along the following lines: An agreement, intended to be legally binding, with consideration on both sides.
We are all familiar with the notion of contracts and enter into one or more on most days. These range from regular purchases of goods and services to more formal written contracts connected with house purchase and employment.
In all contracts the main principles are the same. One person agrees with another to do something in return for something else - the ‘something’ here being the consideration set out in the definition, typically money on one side and goods or services on the other.
Contracts can only be between two parties - perhaps two individuals or an individual and a company, which for legal purposes is a body corporate, a single legal entity which can sue and be sued in the event of negligence, defamation, breach of contract or other civil wrongs.
Failing to live up to your side of the bargain may amount to a breach of contract and may result in a claim by the disappointed party for damages, or a requirement that you do what you said you would do in the first place. It may even lead to the contract being terminated.
In the context of both the existing and new GP contracts, this is a rare - and rarely worthwhile - event, involving lawyers, expense, stress and distraction, as well as the considerable delays in resolution associated with any legal action. These are all good reasons to consider the alternative, which involves becoming a health service body (see below).
Exactly what is expected of each party is set out in the terms of the contract. As far as GPs are concerned, under the current system this is set out in the doctor’s terms of service and associated regulations. These will be scrapped under the new GP contract.
Details of the new contract, published and sent to all GPs last year, set out the national terms, which had been negotiated between the BMA and the NHS Confederation and agreed with all four home countries. That documentation also set out the national terms that have to be incorporated in local contracts, for example those for enhanced services.
Changes under the new contract
The major difference between the old contract and the new is that the new one will be between the practice and the primary care organisation, not between each independent contractor within the practice and the PCO.
The idea behind this change, as the BMA explains on its website, is to allow the global sum to be allocated to practices so that they have the flexibility to configure services to meet the needs of their patients.This could result in a retiring medical partner being replaced by other healthcare professionals including, for example, practice nurses or physiotherapists. Importantly, practices will no longer be required to seek the PCO’s permission when advertising for or appointing GPs.
Providers and performers
In the jargon of the new contract, GMS practices are to be termed ‘providers’. Although they can be made up of health professionals from a variety of disciplines, the provider must always include at least one general medical practitioner with a JCPTGP certificate or a GP with a certificate of equivalent experience.
Individual healthcare professionals will be termed ‘performers’. The current medical list and supplementary lists are to be merged into a single primary care performers list, which allows for exclusion of individuals on the grounds of unsuitability, inefficiency or fraud.
The contract between the practice and the PCO is to be a rolling contract, so that changes in personnel will not bring the contract to an end. So, in most circumstances, the contract would remain the same including the provision of the global sum, even if the number of doctors is reduced. However, the global sum would change if the services provided by the practice altered.
If, for example, a practice were to split into two, the contract would come to an end, and each new practice would become a separate entity, contracting with the PCO to provide services.
Health service bodies
After April 2004, practices will be able to decide whether they wish to become a health service body. This will have a considerable impact on how contractual disputes between the practice and the PCO will be resolved. If the practice opts to become a health service body, the contract will become an NHS contract and disputes between the parties will be resolved, not in the courts but under the provision of the NHS Contracts (Dispute Resolution) Regulations 1996.
According to the BMA, it is anticipated that most practices will become health service bodies so that they can take advantage of these regulations. For those that do not, it is anticipated that a more informal dispute resolution procedure will be applied, as exists currently in the case of Personal Medical Services contracts.
Under the dispute resolution regulations, there are two main procedures. The first, dispute resolution, is for dealing with alleged contract breaches, and the second, an appeals procedure for disputes which arise outside the contract.
The example given by the BMA is where there is a dispute about whether an individual GP would have access to the primary care performers list.
In both situations, procedures will be available to resolve disputes locally in the first instance, including a conciliation meeting between the PCO and the provider.