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Alan Johnson ups ante in contract crisis with letter to GPs

By Ian Quinn

Health Secretary Alan Johnson has written to all GPs urging them to accept the Government's controversial contract offer, it was revealed today.

In a move which saw relations between BMA leadership and the Government plunge to new depths, Mr Johnson is bidding to go above the heads of the GPC in order to persuade GPs to accept new hours.

In his letter, he says: 'We believe that a guaranteed 1.5% increase in practice income, combined with an additional 30 minutes opening per week for every 1,000 patients, represents a balanced offer that both increases investment in primary care and provides a better service for patients.'

Health minister Ben Bradshaw told the Today programme on Radio 4 this morning: 'The main thing that the taxpayer and the public tells us about the health service now in terms of compaints they still have is being able to see a GP at a time that's more convenient fopr them and I don't think it's unreasonable as a Government responsible for the health service to try to ensyre that the public and the patients get what they want.'

Richard Vautrey, deputy GPC chair, told the show: 'GPs have seen the resources for their practices cut back over the past two years – The average between 40 and 50 hours a week – most GPs will start seeing patients at 8 o'clock and will close their surgeries at half past six, most GPs are working 10 sand a half hour days – what the Government is requesting is that they work additional hours into the evening.

'GPs are prepared to open in the evenings and weekends and we've said that repeatedly to the Government – and in return we wanted an end to this constant renegotiation of the contract that the Government seems to be set on year on year

The Conservatives attacked Mr Johnson's move, with shadow health secretary Andrew Lansley saying: 'This is classic Labour and yet another admission of Government failure to negotiate a contract with which GPs are happy and patients are satisfied.

‘Just four years ago the Government allowed a new GP contract to go ahead, which doubled the costs of providing out-of-hours care and led to worsening services for patients. Now they are trying to undo that mess with a letter.'

Alan Johnson: has sent a letter to GPs urging them to accept deal Alan Johnson: has sent a letter to GPs urging them to accept deal Alan Johnson letter to GPs Alan Johnson letter to GPs

To all GPs in England

Dear Doctor

Improving access to GP services

I wanted to write to you to set out why the Government is seeking to improve patient access to GP services.

General satisfaction with GP services is high, and the quality of our primary care is admired across the world. However, significant numbers of patients consistently tell us that improving access to GP services should be a priority for the NHS. This includes not just greater choice of appointment times, but continuing improvements in ability to book advance appointments and fast access to GP appointments.

We want to work with all GPs to achieve this aim. Last year we asked NHS Employers to work with the General Practitioners Committee (GPC) of the BMA to develop a package that would increase access to meet the needs of patients.

Extended opening hours

The proposal put to the GPC is that practices should provide 30 minutes of extended opening per week for every 1,000 of their registered patients – or three hours for an average-sized practice. This would be achieved by reinvesting £158 million from access incentive schemes (the Access and Choice ‘Directed Enhanced Services') that come to an end this year, not from the Quality and Outcomes Framework.

In return for this, we have offered a 1.5% increase in investment for primary care, worth around £12,000 of new money for an average-sized practice or just over £100 million nationally. The first call on this investment would be any inflationary uplift agreed through the annual Pay Review Body process.

We believe that a guaranteed 1.5% increase in practice income, combined with an additional 30 minutes opening per week for every 1,000 patients, represents a balanced offer that both increases investment in primary care and provides a better service for patients.

Quality and Outcomes Framework

We and the GPC also had to consider how to re-invest a number of indicators in the Quality and Outcomes Framework (38.5 QOF points) that negotiators had agreed were no longer needed and could be reinvested in other areas. After careful consideration, the Government took the view that these resources (together with 20 QOF points which the negotiators had already agreed could be released from local patient surveys) should be used to strengthen the focus on patient experience. We regard patient experience as an important indicator of the overall quality of care.

This would mean beginning to move away from incentives for carrying out patient surveys and instead rewarding practices that have high levels of patient satisfaction as measured through surveys. The two areas of patient satisfaction on which we propose focusing for 2008/09 are the ability to book advance appointments and the ability to make a GP appointment within two working days.

We are disappointed by any suggestion that this proposal to strengthen rewards for patient experience would damage care for older people and for heart disease. The QOF already rewards GPs for high quality care for heart disease and other vascular illnesses, as well as other illnesses that affect older people, such as dementia. Our proposals do not in any way reduce the substantial existing investment in these areas, and this sort of care is at the very heart of general practice.

The QOF clearly cannot cover every aspect of care for all diseases. There have been some suggestions that GPs would need to wait for additional pay incentives before following best practice and guidelines on the care of people with osteoporosis and peripheral arterial disease. We do not believe this is the case: indeed, we know that many GPs are already adopting this best practice.

We fully support, however, the case for developing the QOF to meet emerging challenges, and we have signalled that this is one of the areas we wish to review with the profession and other stakeholders as part of our wider strategy for primary and community care in the future.

Next steps

We were disappointed that the GPC was not able before Christmas to agree the proposed contract changes for 2008/09, but we still hope that front line GPs will back the proposals.

However, to avoid reaching an impasse and being unable to make any changes for 2008/09. We are consulting the GPC on an alternative set of proposals, and we began this process before Christmas to allow 12 weeks for consultation as we are legally obliged to do. In the meantime, if there is agreement on the negotiated offer, we would not of course need to complete this consultation.

Our alternative proposals are based on the same underlying principle of improving access to services and patient experience. The main difference is that they would give greater flexibility to Primary Care Trusts to work locally with GP practices and patients to decide how best to improve services.

The proposals would maintain current levels of investment in GP practices, but would enable the NHS to work locally with GP practices to make better use of some of the resources in the contract (around £35,000 for an average sized practice). These resources would come from the current access incentive schemes (the Access and Choice DESs), the QOF resources associated with local patient surveys, and a number of out-of-date or duplicative QOF indicators.


While we await the BMA poll, we would encourage GP practices to discuss with their PCT how to take forward improvements in extended hours, either under the proposed national framework or under locally agreed arrangements. Whichever route you choose, it will clearly require careful discussion between GP practices and PCTs to ensure that new arrangements reflect the needs and wishes of local patients and deliver tangible improvements for patients.

We want to continue to work with the profession and wider stakeholders, not only to improve access to GP services but also to support wider improvements in primary care. We are developing a wide-ranging strategy for primary and community care that is looking at how to develop services in ways that focus ever more strongly on promoting health, preventing illness and managing long term conditions.

Once again, thank you very much for all you are doing to improve health care in this country. I hope that you will feel able to support these proposals to improve services for patients

Yours Sincerely,


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