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Independents' Day

GPs must adapt to age of austerity

With ministers pushing ahead with the MPIG phase-out even as they demand another pay freeze, GPs have no choice but to tighten their belts

With ministers pushing ahead with the MPIG phase-out even as they demand another pay freeze, GPs have no choice but to tighten their belts

Chancellor Alistair Darling's demand last week for another freeze in GP pay was depressing, but maybe not that surprising.

In an environment where all the main political parties are competing to show they are the niftiest with the scissors, the general practice wage bill was always going to look a prime candidate for cuts. Weekly attacks on GPs from the Daily Mail had made sure of that.

But the Department of Health's evidence to the Doctors' and Doctors' Review Body reveals that, as ever in general practice, the true situation is more complex than it had first appeared.

The DH is suggesting a gross uplift for GPs of 0.5%, which it expects to result in a 0% net uplift. As usual, the Government's estimate fails to reflect the true rate of increase in practice expenses, so if even ministers are not expecting pay to go up, there is a very strong chance it will actually come tumbling down.

For most practices, though, the news is rather worse even than this implies. The DH's evidence makes clear that it wants to press ahead with the fiendishly complicated formula used last year to begin the phase-out of the MPIG, which would award percentage uplifts for the different parts of the contract in a 7:5:2:2 ratio.

MPIG thresholds are lined up for the least generous part of that formula, meaning that for the 68% of practices still reliant on correction factor payments, the proposed deal would mean practically no new money at all, and another pay cut in real terms.

You might have thought that was enough bad news for one week, but the Conservatives had other ideas.

Shadow chancellor George Osborne plans to kick off a new Tory age of austerity with yet another pay freeze, this one lined up not for the next financial year, but the one after that.

For many GPs, that would be five pay freezes in six years, which represents an unprecedented cut in income. It is, to use the economists' term, an abrupt ‘correction' in GP pay, in the same way house prices have suffered a correction over the past two years.

All of this is likely to provoke huge consternation across the profession. Since the 2004 contract, GPs have been sucked into greater and greater workload, as bars have been raised and targets toughened, and all for shrinking rewards.

But hand-wringing is pointless, and the GPC instead needs to use the profession's current predicament as a bargaining chip.

There is something that both main political parties, and particularly the Tories, want from GPs – their willing involvement in commissioning as a key tool for driving NHS efficiencies.

Yet politicians must understand that in such straightened times, GPs will simply not countenance devoting time to activities that are not core to general practice unless the rewards are substantial.

Politicians may hope that keeping GPs lean and mean will make them enthusiastic commissioners, eager to make savings for themselves and the health service.

But if a government of whatever hue wants what GPs have got, it will have to stump up the cash to make it worth their while.

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