THE NHS was forced to raid other budgets to pay for the new GP contract, which cost 44% more than expected in Wales, it is revealed today.
The extra costs – amounting to tens of millions of pounds – drained local health boards of money that should have been used to develop community services in the first few years of the contract.
In the meantime GP salaries have rocketed by 25% over four years, as the contract introduced performance-related pay but reduced workloads.
The Wales Audit Office said the GP contract will not deliver the expected long-term benefits to patients unless it is revised.
A report by Jeremy Colman, Auditor General for Wales, which is published today, has recommended changes to the way the contract is run, including closer monitoring of the money paid out to GP practices.
Mr Colman said, “Is the contract going to deliver value for money? Only if it is changed.
“The barrier for the points system [which measures GP performance and distributes funding] needs to be raised to make sure that the benefits for patients are real and continue to follow.”
The general medical services contract was introduced throughout the UK in April 2003 amid growing concerns among GPs about their workloads and the sustainability of services.
It introduced a new system of funding and performance managing GP practices – the Quality and Outcomes Framework (QOF) points system – and allowed doctors to opt out of providing out-of-hours medical care.
Mr Colman said GPs had essentially been paid up front for anticipated improvements in patients’ health, which have yet to be fully delivered.
And there have been cases where GP practices have been able to claim additional income for services they were already providing under the old contract.
But Mr Colman also said there was evidence that patients have better access to GPs, and some chronic disease management services are now more readily available.
The contract has also helped to arrest the GP recruitment and retention crisis in Wales, making the profession more attractive to young doctors – the 2006 GP vacancy rate was 1.8%, compared to 2.1% a year earlier.
Mr Colman said, “GPs got the money up front and the benefits will come later – it’s too early to see much benefit yet.”
The investigation found that local health boards had not yet developed many local services to meet specific local needs.
It is thought this will only start to happen when more NHS resources are invested in primary, rather than hospital, care – a key aim of the Welsh Assembly Government’s Designed for Life blueprint for the future of the NHS.
The report, Review of the new General Medical Services Contract in Wales, did say that because the contract had cost more than anticipated, local health boards had to use money from other budgets to fully fund it.
This meant that “other important developments in community services have not happened yet, and that budget pressures in other parts of the NHS have not been funded by commissioners”.
Dr David Bailey, chairman of the Welsh GP Committee, and a GP in Trethomas, said he rejected criticism that the contract had not been beneficial for patients.
He said, “The reason the contract was introduced was because British general practice was dying on its feet – the first benefit to patients of the new contract is that there is still a British general practice.
“It is also a huge benefit to patients that the quality of their care is being performance managed and is going up year on year.
“The way heart disease and diabetes is now managed has been shown to improve patients’ lives and improve their life expectancy.”
And Dr Kevin Sullivan, policy and public affairs manager for the Welsh NHS Confederation, said, “The new GP contract is a big leap forward for the NHS in Wales. It means that doctors are rewarded for the quality of the care they provide, not just how many patients they treat.
“Bear in mind that four out of five contacts between patients and the NHS take place in GP practices.
“The Wales Audit Office report highlights that the contract is working well in most parts of Wales, and that patients are already starting to benefit – this is due to local health boards and GPs working together.
“Of course, with a big change like this, as the report points out, there are areas where we can do more. The report’s recommendations will help us identify how we can get maximum benefit from the contract for patients in Wales.”