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Costly GP contracts must be changed to deliver value for money, warns Auditor General.

Byline: By Madeleine Brindley Western Mail

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.": Wales' maternity services 'generally safe':Maternity services in Wales are "generally safe", a review has found. But the investigation by Healthcare Inspectorate Wales has recommended that women and their families should have a greater role in the planning and delivery of maternity services.

The review was carried out after concerns were raised about the state of maternity services in England.

The Healthcare Commission's earlier review in England found problems with the safety of care and the clinical governance arrangements at maternity units.

HIW carried out its own investigation in 2006/07 to ensure that quality and safety were not an issue in Welsh maternity services.

The review looked at issues such as clinical leadership, management of maternity services and teamwork and communication in the 13 NHS

organisations - 12 NHS trusts and Powys Local Health Board - which are responsible for providing maternity services in Wales.

It found that maternity services are "generally being delivered in a safe and effective way" and that there is good team working and communication across different teams and professions.: Students master the art of a quick response as university plays host to simulation of the devastating effects of bio-terrorist smallpox attack:This is the scene as healthcare professionals treat a "patient" with smallpox contracted as a result of a bio-terrorism attack. A group of students on the University of Glamorgan's masters course in disaster healthcare have become the first in the UK to experience such a simulation.

State-of-the-art technology at the university created the scenario which the qualified nurses - who have no first-hand experience of smallpox - were expected to deal with.

The disease, which kills one in three people it infects, has been eradicated throughout the world.

The last cases in Wales were almost half a century ago. But experts have long considered it possible that bio-terrorists could use the virus. Although the simulation is part of the University of Glamorgan's masters course, it will also give the students valuable experience of treating patients under strict bio-hazard conditions.
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Publication:Western Mail (Cardiff, Wales)
Date:Aug 23, 2007
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