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At the heart of general practice since 1960

GPC report shows problems ahead for GPs

GPC chair Dr John Chisholm admitted to a conference of GPs last week there had been much 'doom and gloom' among members of the council at its most recent meeting.

Much of this mood of pessimism stemmed from the contract implementation woes being endured by many GPs.

But judging from the GPC's annual report published this month, the difficulties the profession faces in the year ahead may well have added to the dejection.

The report showed that for every issue tied up and every problem solved by the GMS contract, there are as many remaining and several more emerging. Premises, IT and uncertainties surrounding the future of PMS top the list.

Premises

A crisis in premises funding threatens to be a 'contract breaker', according to Dr Grant Kelly, GPC practices premises sub-committee chair.

The Government is understood to have given PCTs in England just £15 million extra for improvements next year.

The cash is supposed to pay for plans set in motion by trusts since September 2003.

But for many trusts it will not be enough to cover minor repairs, never mind enable GPs to expand to take on enhanced services or work from secondary care.

For example, trusts in London have been given just £1.9 million for new developments.

'It's a bit of a contract breaker and not a serious attempt to do anything about providing modern primary care,' Dr Kelly said.

'We need to change our premises to adjust to the different ways of working. If you want to do enhanced services or take on the role of outpatient departments you need more space.'

Dr Chisholm added: 'It works out at such a low figure per primary care trust it is difficult to see how any substantial developments not in the pipeline before September 30 could go forward.'

IT

Practices have to come to terms with a bewildering number of IT changes in the coming year.

The new arrangements for paying GPs, notably the need to log data for the quality framework, will be of greatest immediate importance.

In addition, the Government's £6 billion national programme for NHS IT, encompassing the national electronic patient record and electronic booking at the point of referral, will have an increasing effect during 2004/5.

Dr Gillian Braunold, dep-uty chair of the GPC/RCGP joint IT committee, said engaging with the national programme and ensuring GPs keep a free choice of IT system was the biggest challenge.

'The programme says it wishes to engage with the profession but we have made many overtures and no meeting has been successfully arranged,' she said.

Dr Braunold added that getting practices used to entering data on to IT systems daily from other sources outside of consultations, such as patient letters, would be a big test.

Dr Jimmy Courtney, a GP in Holywood, County Down, and member of the GPC/ RCGP joint IT committee, said the quality framework had more important IT requirements than GPs had ever seen before.

'The 1990 contract introduced certain types of target but there's no doubt this new contract will take it to another level and you can't do that without good IT,' he said.

PMS

Considerable uncertainty surrounds the future of new PMS contracts.

The Department of Health has yet to spell out how PMS practices can use their return ticket to GMS, including whether they will have an equivalent minimum practice income guarantee. Further guidance on two new initiatives, specialist PMS and practice-led commissioning is also overdue.

In its annual report, the GPC said it was confident practice-led commissioning – a new power for practices to manage a budget, held by their PCT, to commission certain services – would also be made available to GMS practices.

Early Government information on the scheme indicated it would only be for PMS practices.

GPC member Dr Chaand Nagpaul said negotiators would continue to try to close the gap between the two contracts and would argue for all new PMS initiatives to apply equally to GMS.

'It will be iniquitous to simply apply practice-led commissioning to PMS. One of the objectives of it is for practices to work together. It would be ludicrous if neighbouring practices could not do so,' he said.

Dr Nagpaul added the GPC would continue to press for the two contracts to be merged, even though the Government shows no sign of agreeing to the move.

'It's puzzling because while it retains the bureaucracy of two contracts there has already been considerable and significant cross-over,' he said.

More GPC challenges

lEnsure new contract's mechanisms to pay GPs work properly and any adjustments to indicative payments are made by the end of June

lBack GPs in disputes with PCOs over their contracts

lSet up the Quality Management and Analysis System that will interrogate practices' clinical data to determine quality points

lGet new pay deal and extend out-of-hours

opt-outs for GPs in community hospitals

lStart the review group that will look at changes to the Carr-Hill allocation formula

lSet up review group to monitor changes in evidence base of quality framework

lLobby for improved golden hello scheme, or a better alternative recruitment programme

lProduce detailed guidance on partnerships

lChallenge PCOs over pressure on GPs to cut prescribing budgets

lSet up new structures for negotiating and communicating with GPs as demanded by the review of the GMS contract negotiations

By Ian Cameron

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