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Allocations proposal is contract's big weakness

llocations are a major problem in some districts, with individual primary care organisations assigning several hundred patients per month to various practices. This dire state of affairs could spread to many areas over the next few years. The Department of Health is well aware of the problem, and in the proposed new contract has achieved a stunning victory over the profession with the Byzantine system proposed to start next year.

The proposal has been presented as a means of reducing the need for forced assignments by giving PCOs increased obligations to expand practice capacity. But it can also be seen as a complex ruse to prevent practices from closing lists and therefore to conceal an inability within the service to provide adequately for patients.

Who will benefit

The question is: 'Who will benefit from the new system, practices or PCOs?' Patients will lose out if workforce issues are not addressed, and this system seems to offer little or nothing in this area.

We are being given a three-stage option of discussion, appeal and review, with the optimistic implication that PCOs will either offer assistance to practices or become tired of the mess they have stumbled into and solve the problem.

This may happen, and good PCOs may address the issue with vigour and urgency, but how will overworked practices summon the will or ability to address this bureaucratic nightmare? This is the natural habitat for PCO man (a Neanderthal in a meeting), and these people will not be fazed by more meetings, discussion and appeal since this appears to be their very raison d'etre.

Stage one offers practices a discussion with the PCO. Very useful. Also an attempt to stay open 'with help' (unspecified). Stage two offers agreement or rejection of the proposed list closure. The final stage introduces an assessment panel with LMC involvement, and it is difficult to see how any agreement will be reached that will overturn a PCO decision. Will there be a vote, a fudge, or just an argument? Rejection once again offers 'support', which is still unspecified.

Nowhere in this shambles is real pressure put on the PCO to do its duty and make the GP workforce issue a priority, and an appeal to the strategic health authority is unlikely to improve matters since it is their influence that sets PCO priorities in the first place. It offers a bath of treacle to those brave enough to wade into it.

Increased restrictions

The final insults are the increased restrictions on the removal of patients from lists, and the threat that closed practices applying to provide enhanced or additional services are likely to find that such actions will 'prejudice' their application. All this from a contract designed to define our workload, improve the quality of care, increase flexibility and reintroduce some control over the daily life of practices.

The deal on allocations is the worst part of what is otherwise a progressive, if mixed, package. The only hope is that practices and LMCs can use the system to torture PCOs with paperwork. But it is a faint hope.

Dr Brian Balmer explains why he thinks the proposal on allocations is the worst part of a mixed contract

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