Acting like sheep has alarming implications
I see that having followed their leaders, the sheep (or are they actually lemmings?) are now appreciating the true implications of the new contract. No colleagues I have spoken to have been other than alarmed at the implications flowing from their global sum/MPIG budgets – that is if they have managed to understand them.
Consider the position of a PMS practice. The global sum will effectively be equal to the present contract PMS payments plus the uplift (pay rise) for April 2004 and 196 quality points (the number that PMS practices have been deemed to have included in their present contracts).
Any quality points achieved above 196 will attract extra money at the rate of £75 per point (for an 'average practice') in 2004/5 and £120 per point in 2005/6. No PMS practice will have an income lower than last year's.
Consider now the GMS position. The global sum/MPIG will be less than last year's GMS income – in some cases a lot less. GMS practices are expected to top this up by earning quality points and providing enhanced services – if they can agree any payment for these!
Without this extra income they will be substantially worse off than they were last year – one practice told me today by 25 per cent.
Then we come to the 'high trust, low bureaucracy' part. As the 'audit' requirements become clearer – protocols for almost every aspect of the operation of a general practice, even to the extent of listing those responsible for taking back-up tapes each day and which of the administrative staff have opted out of formal resuscitation training, to name only two of the silliest – the Red Book starts to look like a masterpiece of simplicity and common-sense.
Where are the winners? The 'pool' effectively remains, as has been demonstrated by the 'adjustments' made to the sum paid per patient in the later part of the negotiations and the 'fair shares' corrections applied to list sizes.
That entire 'fair shares' means that anyone who has worked hard to achieve some advantage for themselves or their patients is deprived of it and anyone who didn't bother gets it anyway – a fine incentive to improve!
Dr Michael Blackmore