there is a BMA "model contract" for salaried doctors, which very clearly maps out what is reasonable to do in a session. I propose that we, en masse, work that "to rule". any work which is surplus to that capacity will need to go to WIC/A&E (where it will attract extra funding, thus giving CCG's/NHE an opportunity to consider the wisdom of investing this money in primary care to reduce costs at the WIC/A&E). this way, excess workload becomes the problem of the commissioners - and we simply make sure that all GP's work no harder than the BMA has been saying for years is the reasonable workload of a session. if we all did it - in the name of SAFETY (overworked doctors are more likely to make mistakes), it is defensible, and the time commitment is pretty reasonable.
I personally feel - having worked in Saskatchewan, Canada, as a single-handed GP for the best part of a year - that the block contract GP nhs contract is dead. or, more accurately, killing off good GP's. my senior partner retired a few years ago after his heart attack, and the current tsunami of patient demand is probably leading me in the same direction! When I worked in the Canadian system, patients didnt pay, but each consultation or procedure had a relevant code -and I claimed for each visit, consult, coil fitting or minor operation as I worked. The more I did, the more I earned. The more quiet things were, the less I earned. If I got really busy, I had resource to invite a colleague to help out. So simple, elegant, self-regulating. The NHS GMS model - particularly since the pay freeze in the last 4 years (and if anyone can call a sub-inflation "raise" anything other than a cut in pay, they should go back to primary school to refresh their maths!) has been increasingly unfit for purpose.
I think the NHS "vision" of 7 day primary care delivered by "doc of the day" salaried part-time doctors whose only subscription to continuity of care is a shared electronic record is going to be less than satisfactory for patients.
I believe that as this "model" of what the NHS is prepared to fund gains traction, there will be increasingly a space for fully private primary care to flourish. We can charge patients for the service they want and are prepared to pay for - if they don't want to pay for it, they are welcome to the sausage-maching/cattle press that NHSE is promulgating.
I don't think this is necessarily the end of the world - the dentists have largely embraced a hybrid NHS/private model and their quality of life compares rather favourably to mine in terms of time/earnings and autonomy.
if our negotiators believed the profession had a spine, then perhaps we could engage in a robust renegotiation of the ludicrously unfit contract we are currently saddled with - but given the singular lack of will to confront authority evident amongst our ranks, it is likely that the sheep will bleat and stand still to be sheared in compliant ranks, whilst the goats leave for NZ/Oz and perhaps Canada.
I think we need to be working - NOW - on an alternative contract to GMS, a private contract between the doctors and the patients, without the constant and pernicious interference of bureaucratic busybodies who feel it is their job to instruct us in how to do our jobs. It would be nice to just concern myself with the patient's medical needs for once, without trying to "save the system" at the same time!
actually, this dreadful contract might just fall over and have to be renegotiated. if we stop trying to so hard to hop through hoops and trying to be popular, and just delivered what we are paid to do (an appt with a doc in 2 days, any quicker go to A&E- they are funded for it), stop trying to work so hard on prescribing savings (doesnt do us a blind bit of good, it involves working more for no real reward) and simply disengage from any LES or QOF target that doesnt pay more than it costs to deliver (Health Checks, anyone?). if our patients paid £9/ month to be members of our practice, and paid £10 for a consultation, we would probably make as much as we do now - and at least if we see more patients it would be financially viable. the current block contract for primary care rewards the department of health shoving as much extra work into the same envelope as they can. until GP's grow a pair and start refusing to do this stuff, they will continue to do it. My hope is that this year will be SO painful, that we as a profession will finally grow a spine and start taking action, not just whinging and hoping someone will take pity on us.