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GPs angry over lack of detail on next year's contract earnings

GPs' faith in the new contract is being severely stretched by doubts over funding for enhanced services and IT systems, Pulse's contract survey reveals.

Many GPs also complained lack of information on the detail of the contract means they still have no clear idea what they will earn when it comes into force next year.

Of the first 220 surveys returned, 80 per cent of respondents were dissatisfied with their primary care organisation's plan for funding enhanced services.

Some 70 per cent of GPs did not expect to get new money promised for enhanced services and 72 per cent were unhappy with PCO provisions for reimbursing IT bills.

Dr Victoria Aziz, a GP in Hendon, north London, said she did not believe money was there for enhanced services.

'We are in the dark, we don't know where the money is or when it's coming,' she said. 'I attend every PCT and LMC meeting, I read every paper, but I still don't know what is happening.'

More than 80 per cent of GPs said they have no clear idea what their earnings will be next year.

Of the few who have been able to estimate their income, the majority believed it would rise a little.

Dr David Spackman, a GP in Banbury, Oxfordshire, said he was willing to be patient to see whether the contract would get enough financial backing.

He added: 'Give it another year and we'll be able to see if the money is there to carry the promises through.'

GPs were divided over whether GPC negotiators or the Government were to blame for the widespread dissatisfaction.

Dr Joe Borg-Constanzi of Eccles, Manchester, said the Government had 'lied and reneged on its promises' to GPs.

But Dr Ruth Newhouse, a GP in Handforth, Cheshire, said GPs had been 'badly let down' by GPC negotiators.

'Now we are faced with the burden of spending more doctor hours carrying out administrative duties,' Dr Newhouse added.

GPs planning to maximise profits by taking on extra staff

GPs are planning to take on staff rather than make cuts in order to maximise profits.

Forty-five per cent said they would need to hire extra employees compared with only 5 per cent planning to make cuts.

Some GPs had forecast practices would make cuts because they will have to pay for staff out of their global sum, rather than be reimbursed by their PCT.

Dr Mike Walton, a GP in St Albans, Hertfordshire, said his practice would need extra administrative and clinical staff now and more GPs in future to cope with added workload and enhanced services.

But he predicted a struggle finding the required people because of chronic shortages of skilled nurses and clinical staff. 'There is also a problem with funding for new staff. PCTs still haven't been given the money to do this.'

Brush-off for 48-hour GP access

One-third of GPs will shun the Government's 48-hour access target by opting out of the

access to GMS directed enhanced service.

GPs can earn 50 'bonus' quality points by offering 48-hour access after ministers insisted the target was included in the framework. But many GPs have decided it is not worth the £375 bonus in the first year of the contract.

Leeds GP Dr Simon Fellerman said his practice would opt out because 48-hour access was 'unworkable' in current conditions. 'The system doesn't allow it, it would be nice if it did, but it doesn't.'

Of national enhanced services, anticoagulation monitoring was the most popular with 54 per cent of GPs saying they will offer it.

Half said they would provide IUCD and depression services, but fewer than one in three GPs plan to offer sexual health services or services for alcohol and drug misusers.

Only 6 per cent of GPs want to provide enhanced care of the homeless.

Aiming high but with scepticism

GPs expect to aim for high marks in the quality framework even though many remain sceptical whether it is the right mechanism to improve quality of care.

Some 37 per cent of GPs plan to aspire to more than 700 points next year and a further 41 per cent will set a target between 400 and 700 points.

Fewer than one in five GPs (19 per cent) said they expected to aspire to between 250 and 400 points and just 1 per cent less than 250 points.

Health minister John Hutton warned last week GPs scoring less than 200 points would be reported to the Commission for Health Improvement.

Dr Vijay Bansal, a GP in Warrington, Cheshire, said he would aim for more than 700 points, but doing so would risk harming the doctor-patient relationship. 'Doctors are being encouraged to focus on questions that can be irrelevant to the patient's actual problem,' he said.

Dr James Hogg also plann-ed to aspire to over 700 points but was planning to cut staff at his practice in Somerton, Nottinghamshire.

He said: 'Clinical standards will improve with quality points, but the financial incentive to prune the team may well undo the improvement.'

Shortage of cover after out-of-hours opt-out

Out-of-hours providers will be struggling to find cover for shifts when GPs are able to give up 24-hour responsibility.

As expected, more than 90 per cent of GPs said they planned to ditch out-of-hours under the contract. But only 47 per cent of respondents said they were willing to work shifts for a co-operative or deputising service.

Dr Robert Leach, a GP in Leicester, said he was so

overworked during the day he could not possibly contemplate doing shifts on nights or weekends.

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