news analysis - GPs agree a new contract
WORKERS, JULY 2003 ISSUE
Family doctors have voted overwhelmingly to accept the new national GP contract. In a ballot of general practitioners throughout Britain and Northern Ireland, 79.4% said "yes" to the question: Do you wish to see the proposed new GMS (General Medical Services) contract implemented? But that does not mean that everyone is happy about all of the agreement.
The contract includes a pay uplift backdated to April 2003 for GPs averaging 11% in the current financial year and amounting to an average of 26% by year 3. This is the result of two years of negotiation by the British Medical Association's General Practitioners' Committee. The committee also secured from government a "minimum practice income guarantee" to ensure that every general practitioner's remuneration will rise if the profession as a whole backs the contract.
Under the new contract, surgeries are obliged to open between 8:00am and 6:30pm five days a week. Extra, early morning, evening and weekend services can be provided, and will be paid for; but there is no requirement to participate.
GPs are no longer obliged to provide out of hours services to patients in the evening or at weekends - other NHS bodies are intended to take over this responsibility, and will employ trained paramedics and specialist nurses to provide emergency services (also taking pressure off hospital A&E units). The assumption is that shedding this responsibility could save up to £6,000 a year for practices that now pay in to a cooperative arrangement to meet on-call obligations.
There is more money for primary care services, and additional practice staff from the nursing and other healthcare professions could be employed to deal with less urgent cases, allowing GPs to give more time to those patients who actually need the specialist skills of a doctor.
Practices which are demonstrably overstretched would no longer be obliged to provide cervical screening, contraception and immunisation services. They could opt out and devolve responsibility to associated primary care organisations.
Changes
These are big changes, and the level of concern expressed by the 36,000 GPs in the BMA meant that the ballot to ratify the proposed deal, originally scheduled for March, had to be postponed. The Patients' Association also had reservations about the new out-of-hours arrangements, worried that they might disadvantage non-urgent elderly patients.
GPs themselves are split: there are worries that they might be disadvantaged financially. The formula for calculating practice income, in a way that favours the most deprived areas with the sickest patients, remains a cause for disagreement, as the BMA recognises.
It is vital that doctors assert their independence to obviate circumstances where managers are able to hold sovereignty over clinical decisions affecting individual patients. But modernisation of the NHS must also be pursued as part of the wider agenda. Issues of morale and recruitment and retention will be resolved only through effective negotiation - a settlement is urgently required so that the organisation collectively can concentrate on serving the general patients' interest.