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A classic example of divide and rule

This week ministers have revealed a touch of the Robin Hood with their plans to take from PMS GPs to give to GMS practices, thereby creating 'winners and losers'. So will their dastardly plan work?

This week ministers have revealed a touch of the Robin Hood with their plans to take from PMS GPs to give to GMS practices, thereby creating 'winners and losers'. So will their dastardly plan work?

This Government is full of old tricks, and to divide and rule is one of the oldest in the book. But the latest plans to renegotiate GP funding are breathtaking in just how blatant they are about it. Ministers plan to indulge in a spot of the Robin Hood, taking from supposedly rich PMS practices and giving some of the cash to their GMS counterparts – in return for meeting stringent new targets, of course. As a new NHS policy document, revealed in Pulse this week, brazenly puts it: ‘Creating winners as well as losers will help the politics of the situation.'

And it will. What is proposed here is yet another squeeze on PMS practices, which at best face new work for no new pay and at worse will see their contracts renegotiated on poorer financial terms. The profession should be up in arms, on the perfectly reasonable grounds that GPs are already suffering from sliding profits, after three successive squeezes on their pay.

But it will be very difficult for the BMA to provide a robust response on this one. GMS GPs have long grumbled that they are underfunded compared with their PMS colleagues. Many will jump at the chance to earn new money to offset falling income from elsewhere in the contract, even if they have to chase PCT priorities to get it.

And here's the catch – the Government knows the GPC will find it hard to fight against, and potentially delay, a set of proposals that could be a financial lifeline to the hardest-up practices.

The Government has form with this kind of tactic. As an excellent letter published in Pulse this week argues, it was ministers who first promoted salaried GP posts, precisely to foster the division and discontent that has since resulted.

Divide and rule may be a transparent and well-worn strategy, but it has already been highly successful in keeping partners and salaried GPs at each other's throats, when they might be snapping at the Government's heels. It's hardly surprising that ministers are now planning just the same strategy in pitting PMS and GMS practices against one another.

The key for the GPC will be to stick to some general principles. Just as with partners and salaried GPs, it is important the profession speaks with one voice, and for that it requires both GMS and PMS practices to feel they are getting a fair deal. The profession should acknowledge the importance of reviewing all contracts to the same standards. Where PMS practices are genuinely overpaid compared with their GMS colleagues, it is right that some of the excess should be redistributed. But contract reviews must properly and fairly recognise the range of services PMS practices provide, using going rates for extra work agreed with the BMA.

And PCTs should not be allowed to play this as a simple exercise in division – pitting GMS against PMS. Should not PCT-run practices, and those with APMS contracts, including Lord Darzi's GP-led health centres, be assessed on the same terms?

Only by demanding a genuinely level playing field, across the whole of primary care, can GMS and PMS practices avoid jealousy and resentment of each other.

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