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GPs' options for a pay and pension fightback

There appears little doubt that a concerted campaign is under way, stoked by ministers, to push GPs off their lofty perch as the most trusted professionals.

So what can the GPC and individual GPs do to shore up public trust and

strike back at the Government over the pensions cap and pay freeze?

Pulse's Christian Duffin spoke to GPs and experts to assess five possible options and rate their chances of success.

1 Boycott Choose and Book

Pros Little adverse impact on patients, because most just want to go to their local hospital. Many GPs already not using it because of IT problems and hospitals failing to fill up the directory of services to allow GPs to book slots. Take-up is

only 39 per cent at last count.

Dr Prit Buttar, a GP from

Abingdon, Oxfordshire, says: 'This would be the easiest weapon to use. We do not even use Choose and Book here, because it does not work. You can demonstrate that the value it adds to healthcare is trivial.'

Cons Ministers may win public sympathy by claiming GPs are blocking an initiative designed to expand patient choice. Choose and Book, if working properly, could help GPs.

Dr Wendy Collins, a GP from Cambourne, Cornwall, says: 'Patients quite rightly want choice, so why shouldn't they have it? Withdrawing would make the Government annoyed, but it would not help

patients see our point of view.'

Prospects of success 7/10 Best bet in terms of direct action.

2 Boycott practice-based commissioning

Pros Enormous PCT deficits in many areas mean there is little chance of GPs making savings, so there would be little financial cost in the short term. PBC is also a huge amount of work for which practices are not

necessarily being rewarded.

'Boycotting it could be more successful than boycotting Choose and Book,' says Dr Bapi Biswas, a GP from Skelmersdale, Lancashire. 'For a start, in most areas it has not taken off anyway.

'We know that it is a form of rationing. I think it will be gone anyway in three years.'

Cons An element of cutting off your nose to spite your face. PBC ultimately gives more

power to GPs, which would be lost by withdrawing. It would also open the door to private providers to fill the gap.

Dr Paul Zollinger-Read, a

GP in Braintree, Essex, and chief executive of North Essex PCT, says GPs should go 'flat out' with PBC and achieve

such good results that the

Government will be forced to reconsider its view of GPs as money-grabbers.

Prospects of success 2/10

Too much to lose.

3 Strike/day of action/work to rule

Pros Huge impact because

direct action by GPs is very rare. Extensive media coverage would raise public awareness of GPs' anger. Politically damaging for the Government.

Dr Helen Groom, a GP in

Oxford and campaigner for Keep Our NHS Public, says such action should not be ruled out. 'GPs in other countries have done it in the past. As far as I know we never have, but it might be that we are forced to.'

Cons Public goodwill for comparatively affluent GPs likely to be in very short supply.

'Firefighters and miners tried strikes and it did not help them – they had a hell of a rough time,' says Dr Biswas.

Dr Buttar says: 'Striking for a day just means we have to see 60 extra patients the day after.'

Prospects of success 3/10

Too risky, but a potential last

resort should all else fail.

4 Withdraw from the quality framework

Pros Less bureaucracy and

paperwork filling in forms

and collecting necessary


Dr Phil Brookes, a GP in Heaton, Newcastle, says: 'Let's all stop all QOF work as of now, take a huge cut in income, and hand all chronic disease management back to PCTs. I would happily see 10 sick patients twice a day and play a lot more golf!'

Cons Where's all my money? Boycotting the QOF means

boycotting hundreds of

thousands of pounds worth of income for practices. With most practices scoring almost 100 per cent, the QOF is also an important indicator of GP


Dr Zollinger-Read says: 'We would shoot ourselves in the foot if we left the QOF.'

Dr Biswas says: 'We would cut off our nose to spite our face.'

Prospects of success 1/10

The worst of all the options.

5 Generate positive coverage

Pros Raises awareness of GPs' unseen work and how much more they do to earn their money than public realise.

Dr Collins says: 'A PR campaign would show how we are now better meeting patients' needs. It could also raise awareness of what GPs do behind the scenes in a stressful job.'

Dr Buttar says: 'Our publicity should be telling people our consultations are £20 a pop. Compare that to the cost of a lawyer's consultation or what a vet charges to see your dog.'

Cons Patients may see GPs as highly paid professionals

who have, whatever their

complaints, done very well compared with them over the past three years. National advertising is expensive and may not achieve a good return.

Prospects of success 8/10

(local) 5/10 (national)

Good – championing GPs' work via the media on a local and

national level could educate

patients and ministers.

What a PR expert advises

Courting local newspapers and media for coverage of new initiatives and services is a key way for GPs to boost their image, believes health PR expert Justin Wilkes.

But threatening patient care by withdrawing co-operation from initiatives such as Choose and Book and practice-based commissioning would be the wrong way to go.

'Policies need to be Government-led, but if you have some GPs not following the guidelines it just creates confusion nationally for patients,' says Mr Wilkes, chair of the health and medical group of the Chartered Institute of Public Relations.

'You do need to have a national approach to healthcare.

'Individual practices and PCTs should be doing more on the local level to get practices to interact with the community. Information should be circulated on opening hours and the availability of GPs out of hours.'

Mr Wilkes says the RCGP in particular is failing to properly support the profession and boost its image. He says: 'The college is not proactive in supporting GPs – if they were that would help in putting a positive spin on the profession.'

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