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At the heart of general practice since 1960

Electoral reform at GPC

Nerys Hairon talks to GPs about their growing frustration at the failure of the contract to deliver

on unpaid work

Before a scrum of reporters and under the glare of the television lights, the new GMS contract was launched with a pledge that it would transform GPs' working lives.

The GPC claimed the John Wayne mentality ­ that a GP had to do what a GP had to do ­ was at an end. GP time, it insisted, was a 'finite resource' and one that would no longer be given for free.

But now the lights have faded and the TV crews have filed away, GPs are beginning to wonder what happened to those grand promises.

Pulse's Agenda 2005 survey revealed widespread anger among GPs that there has been no end to unpaid work. The promised enhanced services have often failed to

materialise.

Dr Nev Bradley, chair of Wirral LMC and a GP in Wallasey, claims GPs are still doing a host of tasks for which they are not being paid, from writing prescriptions for blister packs to following up problems post-surgery. He estimates unpaid work takes up 10 to 15 per cent of a GP's time.

'We have enhanced services floors which are grossly low supplying services at prices which greatly undervalue ­ nay positively exploit ­ GPs,' Dr Bradley said. 'How can the Government justify paying a GP £80 to remove a sebaceous cyst which it formerly paid the hospital £1,300 to remove?'

The workload issue was raised angrily by GPs at last year's LMC conference and looks set to rear its head again at this year's conference in June.

Dr Stephen Amiel, chair of Camden and Islington LMC, said: 'A lot of GPs are doing a lot of unresourced work and it's certainly something that we will be revisiting at this year's LMC conference.

'Most GPs carry on doing these things because they always have done. The new contract is supposed to be predicated on the fact that everything we do is included in the global sum or one of the other avenues of payment.'

There are signs that GPs' goodwill is running out and that after a year of putting up with the status quo, GPs may be ready to talk tough.

Dr Kay Saunders, vice chair of Bro Taf LMC and a GP in Cardiff, said: 'I think GPs generally are getting more militant about extra workload needing the resources. Many GPs have been fairly patient but I think there will be a hardening of attitude this year ­ refusal to do the work.'

Dr Dean Marshall, medical secretary of Lothian LMC, agreed GPs' goodwill was not infinite. He said in Lothian some enhanced services, such as minor injury and minor surgery, were agreed on a 'capped' basis in the first year.

This year he insists GPs want a fee per procedure.

'I am not sure it will carry on unless it's apparent that what has been done under goodwill this year will be funded next year,' he said.

GPs are also frustrated at the tendency of secondary care to take GPs' time for granted.

Dr Andy Stewart, member of the LMC cabinet and a GP in Gunnislake, Cornwall, said the LMC has had to fight requests for GPs to screen patients for MRSA before surgery. Now the podiatry service has tried to pass foot checks for diabetes patients to GPs.

'We feel it's work moving from podiatry to general practice. It's an attempt to dump work on GPs. It was a unilateral declaration by podiatry services,' Dr Stewart said.

The patchwork development of enhanced services has brought a postcode lottery in many clinical areas, such as vaccination and sexual health.

Many GPs have not been paid for vaccinating teenagers with MMR and country-wide negotiations over enhanced services for public health campaigns are being carried out in Scotland and Wales but not in England.

Dr Richard Vautrey, GPC negotiator and secretary of Leeds LMC, said there were problems in his own area over sexual health, with no GP services commissioned.

'We have immense difficulties,' he said. 'We are finding huge numbers of patients turning up to practices saying they have not been able

to make an appointment [at

a clinic], and GPs are faced with the difficulties of not

having a service funded for them.'

But Dr Vautrey insisted the new contract gave GPs the ability to say 'no' to unpaid work. In the coming year, GPs may start exercising that right.

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