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Did contract talks really start just three years ago?

After three

very bruising years the new contract is finally to be implemented. Nerys Hairon looks at the countdown ­

and the chaos

The last three years of negotiations for a new GP contract have been turbulent, fraught with emotion and at times highly confused.

 · April 2001 GPC seeks mandate to negotiate new contract

This momentous period in the history of general practice began nearly three years ago, on April 19, 2001. The GPC decided to address the morale crisis in general practice by balloting all GPs in the UK on whether they would consider resigning from the NHS in April 2002 unless a satisfactory new GMS contract was in place, with sole negotiating rights for the GPC on PMS.

In May of 2001, the GPC was given a powerful mandate by the profession when 86 per cent of GPs said they would indeed consider resigning in April the next year unless the Government and the BMA had improved their lot.

This ballot result set the scene for three years of strife-ridden negotiations to try to achieve a better working life for GPs and improved services for patients.

GPs were asked what they wanted to see in a new contract through a GPC questionnaire in the autumn of 2001, and negotiations between the BMA and the NHS Confederation were launched at the end of 2001.

 · April 2002 Publication of unpriced contract

The publication of an unpriced framework document in April 2002 heralded a new era for GPs, with services graded as essential, additional and enhanced, and financial rewards for quality and the option to ditch out-of-hours work.

But the initial feeling of confidence soon gave way to grassroots concerns that GPs were being asked to vote on an unpriced deal. The GPC embarked on a summer of politicking by warning GPs at LMC roadshows that they would not be able to get a better deal by voting No and the GPC would be more likely to ballot on resignation.The summer of 'spin' paid off when 76 per cent of GPs voted in favour of continuing negotiations to get a priced contract, but the result was tarnished by a turnout of 65 per cent ­ meaning less than half of all eligible GPs voted Yes.

GP negotiators were sent away to thrash out pricing, resources, pensions, the quality framework, access and enforced patient allocations, and in due course come back with a priced deal.

 · November 2002 Delays in publication of priced contract

November 2002 brought the first of what would become an emerging theme in contract negotiations ­ the prospect of delay. The GPC reported that the publication of the final priced document ­ at the time scheduled for January 2003 ­ could be delayed because of Government tardiness in providing key data on GP earnings.

The expected delay did come to pass, as GPC chair Dr John Chisholm announced just before Christmas 2002 that the final document would not be published until February 2003, with a ballot in March that year.

Yet more delays occurred, when GP negotiators found themselves locked in frantic 11th-hour meetings to hammer out a deal on pensions, and Downing Street demanded to scrutinise the contract just days before it was to be published.

The result was a fiasco. Negotiators told the GPC on February 20, 2003, that the final document was not yet available and they only had a set of slides to present to journalists on the morning of February 21. The final document ­ Investing in general practice ­ the new GMS contract ­ was published on the BMA website the following week, but many GPs did not receive it until the first days of March.

 · February 2003 Priced contract published amid great confusion

Confusion reigned in the month following the publication of the final priced contract. GPs were told their pay rise could range from 10 to 50 per cent, but they were left hanging on for vital details, prompting a Pulse headline to demand: 'Where's the money?'

Information on the new allocation formula for funding general practice ­ the formula devised by Professor Roy Carr-Hill ­ soon began to emerge, but GPs were left reeling in shock when they discovered on the now infamous Black Wednesday ­ March 12, 2003 ­ that most practices stood to lose money and some as much as £200,000 a year.

 · March 2003 Black Wednesday ­

ballot postponed

At a special GPC meeting on the Saturday after Black Wednesday, Dr Chisholm announced that the 'global sum crisis' meant the ballot would be postponed while solutions were sought.

The GPC and Department of Health were thrown into frenzied talks to produce a last-gasp deal to salvage the contract ­ the minimum practice income guarantee (MPIG) ­ that would protect the earnings of the

70-80 per cent of Carr-Hill losers.

Despite the creation of MPIG, the summer of discontent was now well under way. GPs were still dissatisfied with Carr-Hill, the income guarantee and a quality framework fine of £2,500 per GP in an average three-GP MPIG practice.

The setting up of the ready-reckoner ­ intended to help GPs calculate their earnings ­ was plagued with problems after Government interference meant it had to be withdrawn only the day after a revised version was put on the BMA website. Stressed GPC joint-deputy chair Dr Simon Fradd confessed he had been 'almost in tears' at the discovery.

 · May 2003 Two GPC members ask for contract to be revised

Events took an even more dramatic twist when two GPC members ­ Dr Fay Wilson and Dr Gillian Braunold ­ tabled a motion at a crisis LMC conference in May 2003 asking GPs to order the negotiators to spend another six months 'revising and re-examining' the contract.

Dr Wilson and Dr Braunold wanted to see a revision of the Carr-Hill formula and the quality framework. A knife-edge vote at the LMC conference narrowly backed the motion and split the profession down the middle ­ amid warnings from GP negotiators that long delays would lead to GPs' pay rise being slashed that year.

But the very next day the GPC opted to defy the vote in a high-risk gamble, following more dire warnings from negotiators that a six-month delay would put back UK-wide implementation until April 2005 and the Government had set a June 23 deadline for a ballot result.

The crunch decision by the GPC gave negotiators just two weeks to come up with a better deal. GPC members said they wanted to see a move to registered lists for the Carr-Hill formula as soon as possible, the weighting of quality pay according to disease prevalence, and the removal of the MPIG quality fine.

These three improvements, and other improvements too, were secured, and GPs were urged to take a 'leap of faith' in the ballot, which was opened on June 2, 2003.

 · June 2003 79.4 per cent of GPs vote

Yes to contract

The result was announced on Friday June 20, 2003, with 79.4 per cent voting Yes to the new GMS contract, despite its highly troubled negotiation and presentation. The turnout was 70 per cent, which meant the contract had the endorsement of more than half of all UK GPs ­ 55.3 per cent.

Dr Chisholm admitted he knew many GPs had voted for the contract with reservations, but he pledged to continue to improve on the package on offer through implementation and negotiation.

 · Autumn 2003 Rows over enhanced services, IT funding and much else

But the summer of discontent quickly became the autumn of controversy, when spat after spat hit the headlines. Enhanced services were top of the agenda, sparking several rows between LMCs and primary care trusts because of the postcode lottery over pay rates, false pledges on spending and ludicrous examples of what could be considered an enhanced service.

Funding for IT and out-of-hours became prime concerns, and a row erupted between the GPC and NHS Confederation over flu pay, which was only settled when the new Health Secretary John Reid stepped in.

 · Autumn 2003 Outrage over plans to publish practice quality scores

The quality and outcomes framework became the centre of attention last September when health minister John Hutton pledged to publish practices' quality scores. This was greeted with outrage from GPs and is still under consultation.

PCTs were urged to agree timetables for contract implementation, but the process was held up yet again by vital contract documentation and guidance, which was finally published by the department just before Christmas 2003.

Trusts warned they had been given an impossible timetable for implementation as worries abounded over enhanced services deadlines and the imperative to set up new out-of-hours models. Deadlines for signing contracts were put back to March after more delays.

As Pulse went to press this week, practices were still frantically scrutinising contracts ready for April 1 ­ Thursday ­ the official date for implementation of the new contract.

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