1990 GP contract incentives for health promotion

Following proposals in the 1987 white paper on 'promoting better health', a new GP contract introduced in 1990 was intended to improve services and incentivise GPs through performance-related payments.

The contract was the product of hard-nosed negotiation. While it embodied public health principles, public health doctors were not the main influencers.

Originally, the Department of Health had planned to introduce performance-related pay, without the prospect of new money to ease its introduction. The package on offer meant more work for the same money, and seniority payments for senior doctors were at risk.

Following negotiations, the secretary of state allowed seniority payments to remain, but rank and file GPs did not welcome the new contractual arrangements. The financial incentives, however, proved to be an effective lever.

GPs received payments for collecting information such as height, weight and blood pressure of patients. Additionally, fixed rate payments were made available to those GPs who ran health promotion clinics. The new contracts were said to have increased GPs' involvement in preventative medicine from 5% to 25%.


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From Alma Ata to Asda-and beyond: A commentary on the transition in health promotion services in primary care from commodity to control.
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