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GP takes a break on the high seas

Pulse returns to five typical GPs to see how they are dealing with the demands of the new contract

Urban GP

Dr Clare Davison

Newham, east London

Practice profile

Urban, PMS

•6 whole-time equivalent GPs

•2 nurse practitioners

•5 administration staff

•10 part-time receptionists

10,500 patients

Very mixed practice population, including a range of minority ethnic groups and people on low income

Quality points aspiration


What has changed?

We are recruiting a full-time practice nurse and a part-time salaried GP – the funding for that will come out of the aspiration payments and the quality money. We have been addressing the diabetes and coronary heart disease national service frameworks for years and we have already recognised how that changes a consultation. As a doctor you have to make sure you do not lose sight of patient-centredness, otherwise it becomes a consultation between the doctor and the computer with the patient watching.

How are you progressing against Q&O?

At the moment we are scoring 92 per cent of what we said we were aspiring to. But it's creating tension in the partnership, in that some partners are more keen to fill in the templates more assiduously.

Have you stopped doing any services?

We are doing insulin initiation and management. I have been trying to get a local enhanced service for diabetes but the PCT has not agreed to fund it yet. We do coils and I hope we are going to be paid for it.

Are you working harder?

In trying to meet the quality targets it's necessary to spend time going through lists of patients to see whether it's appropriate for them to be exception reported, or what needs to be done to get them to meet the target. It really is time-consuming stuff.

How would you describe your morale now?

I think maybe I was naively optimistic. It's not bad but it's certainly not perfect.

Rural GP

Dr Gordon Baird

Sandhead, Dumfries

Practice profile

Rural, GMS

•2 partners

•1 nurse

•3 administration staff

1,600 patients

High proportion of elderly CHD and diabetes (4% of patients)

Quality points aspiration


What has changed?

We have put in the GPASS software. It's all right. The biggest change has been about enhanced services. I have taken more blood pressures, I have got good staff who nag me to do that. I have asked patients if they smoke, and blaming the Government for it.

How are you progressing against Q&O?

Fairly good to very good. We are doing better than we thought we would. Although what the point of it is, is not really clear. My heart is not really in the new contract. I am confident we will reach the targets but not confident we will get the pay.

What about prescribing?

It has increased. We are prescribing more statins, more nicotine replacement and more antihypertensive treatments.

Have you been able to opt out of out-of-hours?

Not yet. I have been told it's October but I don't believe it's achievable because of a lack of organisation.

Are you working harder?

I'm not working harder

but I don't feel more

able to control my workload.

How about income?

We need the MPIG so overall I think the global sum will go up but MPIG will not go up. I don't feel I have had a pay rise.

How about morale?

I feel more apathetic. Morale is poor, probably poorer.

Commuter-belt GP

Dr Shah-naz Whitear

Hadleigh, Essex

Practice profile

Suburban, GMS

•4 whole-time equivalents

•1 salaried GP

•1.5 nurse practitioners

•2 health care assistants

11,500 patients

Relatively affluent area with high numbers of elderly and commuters

Quality points aspiration


What has changed?

We have got new software. I have been able to send out letters to patients to see what information is missing, for example for diabetic checks. We have also got two health care assistants – we had planned to have them anyway and it's not new contract funding. For depression I go through the criteria step by step. I think 'I have got to collect this data'. The biggest impact is that I became a trainer this year and we have to video consultations.

How are you progressing against Q&O?

Not as well as we should be. As doctors we are quite

busy so we rely on a lot of our other staff to do work for us.

Have you been able to opt out of out-of-hours?

No not yet, not till January. It's a bit of an anti-climax. I have got three children and one of the things I was looking forward to with the new contract was to opt out.

Are you working harder?

I am working harder, trying to collect data, there are

lots more meetings, and there has been a lot of extra work.

How does your practice income compare?

The pay cheque I have received for the last three months has been more. I am hopeful it will go up.

Dispensing GP

Dr David Bevan

Upwell, Cambridgeshire

Practice profile

Rural, dispensing, PMS

•5 whole-time equivalent GPs

•1 nurse practitioner

•1 nurse practitioner in training

8,300 patients

Quality points aspiration


What has changed?

We've accelerated an existing programme making sure coding was clean and clinical care was properly referred to in record keeping. We've started revisiting every pathway for chronic disease management. We are using templates and making sure we meet both the aims of the consultation and chronic disease management. That will extend consultations a small amount but that's better than calling people back.

How are you progressing against Q&O?

We started at 800 points and are liable to hit over 1,000. We are already hitting the law of diminishing returns.

Have you been able to opt out of out-of-hours?

This is expected in October or November and just as in the rest of the country I am anxious as to whether it will work. PCTs only had one year's notice – the GPC and Department of Health should be ashamed of themelves.

Are you considering switching back to GMS?

Going PMS was one of the best things I've ever done. I'm ridiculously pleased

with myself as I get the core PMS income and with GMS I get money hand over

fist for stuff I was doing already. It's a fine position to be in.

How about your morale?

The contract has delivered on the pay rise but out-of-hours is an unmitigated bloody disaster.

Singlehanded GP

Dr Michael Smyth

Maguiresbridge, Co. Fermanagh

Practice profile

Singlehanded, GMS

•1 practice nurse

•1.5 receptionists

•1 full-time practice manager/ primary care pharmacist

2,000 patients

List dominated by teenagers

and over-30s; rheumatic diseases most prevalent

Quality points aspiration


What has changed?

We are using templates to get chronic diseases as well as what patients are attending for, so if anything consultation are a couple of minutes longer. Our surgeries are fully booked and it's quite busy.

How are you progressing against Q&O?

We aspired to 900 points and are probably two-thirds of the way there. We're doing well in some areas – cardiovascular and diabetes – but have some concerns around COPD and asthma, for which we are considering doing phone consultations.

What impact has there been on prescribing?

We seem to be increasing

in certain areas such as

ACE inhibitors and


Are you working harder?

We are working harder as we are trying to be proactive in contract work and the reactive work from patients requesting to be seen has not been reduced

Are you considering PMS?

If things keep going the way they are I would consider it, unless this turns out to have been a temporary blip.

How does your practice income compare?

It's too early to say. Income will go up but I'm concerned about expenses and profits and my take-home pay may decline. Another concern is that superannuation is based on profit now.

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