New sections 223L(1) and (2) of the 2006 Act state that at the end of each financial year the NHS commissioning board may make “one or more payments” to consortia that it considers have “performed well” or will “perform well”. New section 223L(3) states that is it up to the board to determine the amount of payment, depending on the consortium’s performance. However, new section 223L(7) states:
“A commissioning consortium may distribute any payments received by it under this section among its members in such proportions as it considers appropriate.”
At the end of the financial year the NHS commissioning board can decide whether a commissioning consortium has performed well. However, that vague term is not defined anywhere.
The board can make one, two, three or however many bonus payments it wishes. It will then be up to the commissioning consortium to do whatever it wants with those bonus payments. The board can also determine their size. In other words, the Bill allows for performance-related bonus payments to be made by the national board to GPs, and the money could go into the GPs’ private pockets and not be reinvested in patient care. That is what the Bill says; that is what it allows.
The matter has been raised by Dr Peter Carter, the chief executive of the Royal College of Nursing. In evidence to the Health Committee, he said that
“there should be no question of it”—
“being put back into people’s pay packets or giving people bonuses. This is taxpayers’ money. Any surplus should be ploughed back into patient care, not extra pay and bonuses for those who are already reasonably well paid.”
Dr Clare Gerada, the chair of the Royal College of General Practitioners, has also raised concerns about the ability under the Bill for bonus payments to be made. She said that they would be “unethical”.
On 15 February, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), wrote to The Guardian. She said,
“I want to reassure Dr Peter Carter, Dr Clare Gerada and any concerned MP”—
I assume that she meant Opposition Members—
“that there is no way GPs will be able to pocket any money not used from their allocated budget as a bonus. The budgets of GP consortiums will be used exclusively to fund patient care. High-performing consortiums may be awarded a quality premium by the NHS Commissioning Board, based on the outcomes they deliver for patients and good financial performance. But the consortiums’ commissioning budgets will never be diverted from patient care. Any surplus cannot be used to line GPs’ pockets.”
First, I thought that the hon. Lady had not read the Bill or did not understand it. That would be one explanation. The Bill clearly allows for it. The payment is for performance; it is not about the quality and outcomes framework or the contracts but about commissioning performance, and nothing in the Bill would prevent a bonus payment from the board from going directly to GPs. The measure states that the consortium can distribute the payment
“among its members in such proportion as it considers appropriate.”
I carefully reread that letter to The Guardian, and the Minister’s words seemed quite specific. She said that GPs will not be able to
“pocket any money not used from their allocated budget”.
It is unacceptable to allow taxpayers’ money to go directly into the pay packets of GPs without any scrutiny. The measure leaves it to them to decide whether to put that money back into patient care when the NHS is facing the biggest financial challenge of its life, services are being cut, staff are losing their jobs, and waiting lists and waiting times are rising.