General practice and public health: assessing the impact of the new GMS contract

Over the past 30 years, the important role of primary care in public health has

been widely recognised, and in the UK a range of measures to support public

health in general practice have been introduced since the late 1980s. In 2004 a new

general medical services contract was introduced changing the way general

practitioners are reimbursed in the NHS. The new contract shifted the emphasis

from the individual practitioner to the practice and introduced a new performance

incentive framework, the Quality Outcomes Framework, which rewards

performance through targeted financial payments. The performance framework

identifies specific areas of clinical and organisational performance and patient

experience activities – including a number of health promotion activities – and

practices attract points for attaining performance targets. This paper examines

the experience and impact of the new GMS contract on public health activities in

general practice. While the contract has only been operating for three full years,

there is emerging evidence to suggest that it may have a negative impact on public

health activities in general practice. The use of financial incentives appears to be

skewing practice towards areas that are rewarded, which may not be those that

maximise health outcomes, and there is some emerging evidence suggesting that

there is a negative effect on health inequalities. This paper reviews current

evidence on public health incentives in general practice within a wider context of

the impact of incentives for public health.