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Gold, incentives and meh

Contract changes leave GPs cold

GPs believe the latest revisions to their contracts will mean more work and stagnant or falling pay.

A Pulse survey of more than 500 GPs reveals widespread disappointment at the freeze in quality pay and global sums and at the changes to the quality framework. A tiny minority of GPs thought GPC negotiators had struck a good deal while 44 per cent branded the agreement a bad one for the profession.

More than three GPs in five said new quality framework requirements to screen patients with diabetes and CHD for depression and assess depression severity in all depressed patients would generate 'a lot' of extra work. Almost three GPs in 10 predicted their income would drop next year, with 5 per cent expecting a pay cut of more than 10 per cent.

The scale of the disillusionment will come as a blow to GPC negotiators, who had sought to reassure GPs the changes would bring only a marginal increase in workload and were the best deal possible in the current climate.

Dr Peter Eastwood, a GP in Leeds, said the GPC had got a good deal on the first contract, but had failed with the revisions. He said: 'We're being made to do more work for no money. Any increase will not be an appreciable sum in comparison with the workload. We're just having to pay out more to get results.'

Dr Ian Strawford, a GP in Glastonbury, Somerset, said the depression screening would take an extra 10 to 15 minutes per patient. He said: 'Someone's going to have to go through all the screening results with the patients. 'It's an unknown quantity of extra work.'

Dr Colin Patterson, a GP in North Cumbria said the GPC had 'picked the wrong priorities'. He said: 'I know a lot of people are very disappointed. They should have fixed the funding before working on quality.'

Some 44 per cent of GPs expressed doubts about whether their practice had the resources to deal with the extra workload.

Dr Clive Wallis, a GP in Swinton, South Yorkshire, said: 'It's a long drawn out consultation to diagnose depression unless there are healthcare workers in the practice ­ and we don't have them.' Despite the concerns, however, 63 per cent said they would chase quality points with the same vigour as before.

Professor Andre Tylee, professor of primary medical care mental health at King's College London, who submitted evidence in favour of including depression screening in the QOF, said the benefits should outweigh the costs. He said: 'It's far better to detect depression early rather than sending a patient for unnecessary and costly tests later.'

Workload should not be a problem if systems are organised well and shared out among practice workers, he added.

What you said about - QOF changes

'The additions and extra workload leave us with the option of whether to endeavour to fulfil the requirements or not push so hard. There's a real concern over how much extra we can do.'

Dr Steven Haigh, West Calder, West Lothian

'It will involve a lot more work because there's going to have to be a lot more effort invested in chasing patients up.'

Dr Catherine Aimuwu, Enfield

'It's not that I think they're bad areas...but having agreed the money was going to be for the original QOF they are now changing the rules and what they sold us originally.'

Dr Richard Hewetson, Salisbury, Wiltshire

'It is still worth doing, but a bit of tedious extra work just to earn the same points overall.'

Dr David Johnson, Brecon, Powys

What you said about - new DESs

'We are disengaged and this sum [for practice-based commissioning] is not related to reality.'

Dr Roger Burns, Haverfordwest, Pembrokeshire

'It's no big tempter.'

Dr Peter Scott, Birmingham

'We're not getting involved [in offering choice]. There's only one choice of hospital here. It takes more than a few minutes to discuss choice with the patient.'

Dr Andrew Crank, Bolton

What you said about - the GPC's performance

'We have been sold down the river by them ­ the new contract was meant to be about being paid for new work, this is not the case.'

Dr Alison Devine, Denbigh, North Wales

'It's okay if pensions are not reduced.'

Dr Michael Martin-Smith, Hull

'The GPC got us a good deal to start off with, but now they're just walking on us.'

Dr Peter Eastwood, Leeds

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