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GP negotiators knew the Carr-Hill formula would cause crisis

GP negotiators knew weeks in advance of the 'Black Wednesday' crisis that Government interference with the Carr-Hill formula could scupper the contract.

Their admission came after a BMA report into the troubled negotiations for the GP, consultant and junior doctor contracts concluded that tight deadlines set by negotiators meant they did not have enough time to properly model the formula.

The report, Learning the Lessons, concluded the lack of time meant 'no one foresaw the reaction to the global sum announcements'.

But GP negotiator Dr Laurence Buckman said it was clear in the weeks before the formula was published that ministers' insistence on removing an economies-of-scale factor meant the formula would not work.

Dr Buckman said he had wanted to tell GPs about the interference before practices were given their income details.

'I would have taken the argument about the [political] interference with the Carr-Hill formula into the public domain much earlier,' he said. 'I would have done that but I recognise that would have been a difficult thing to do.'

The BMA report concluded that both ministers and the BMA underestimated the scale and scope of contract negotiations.

It also blamed demands by the Department of Health for 'substantial rewrites' for the delays in announcing the agreement.

With all three contracts, BMA negotiators had to rely on 'a groundswell of grass-roots opinion' to wring better deals out of the Government.

The report concluded: 'The negotiators were sent back for a better deal, and notwithstanding Government insistence that the deal was

not negotiable, improvements were subsequently achieved that made the deal acceptable to the profession.'

But the report found this was not a 'sensible' way of conducting contract negotiations in the future.

Dr Ron Singer, president of the Medical Practitioners Union and a GPC member, said 'people power' should not have been needed.

He added: 'The grass-roots bailed the negotiators out from what would have been an impossible situation that would probably have otherwise resulted in a No vote.'

The GPC's report into the GP contract negotiations is due out this month.

BMA's contract post-mortem

 · Significant time pressures caused by deadlines and the scale of the task put enormous pressure on negotiators ­ this prevented modelling of the impact of the Carr-Hill formula

 · Slippage from the project plan and failure to recognise the consequences of delays or communicate these to GPs meant the GPC was seen as failing to honour its commitments

 · Lack of timely information meant GPs felt uninformed

 · Piecemeal publication of agreements bred suspicion that details were being withheld or not shared

 · Department of Health demands for a substantial rewrite of the text caused the delay in announcing the deal on time.

 · Relationship between the GPC and NHS Confederation negotiating team chair Mike Farrar prevented negotiations breaking down after 'Black Wednesday'

By Craig Kenny

and Susan McNulty

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