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GPs go forth

Half of GPs call for contract renegotiation

Exclusive Nearly half of GPs think that the GP contract needs completely replacing, with many calling for QOF to be scrapped and for practices to be given greater control over out-of-hours services, a Pulse survey has found.

A survey of 309 GPs revealed that 49% believe the 2004 GP contract should be renegotiated as it is ‘out of date’ amid declining income and a growing recruitment crisis.

This year’s negotiations for the 2014/15 GP contract saw the monthly global sum payments rise to £73.56 per patient and a reduction to QOF of nearly 40%, which the GPC said would remove ‘box ticking’.

But respondents to Pulse’s survey, carried out earlier this month, said the negotiations did not go far enough to reduce bureaucracy.

Dr Hadrian Moss, a GP in Kettering, Northamptonshire, said that core services have changed beyond recognition since the 2004 contract was introduced, and should be re-priced to prevent surgeries from failing.

He said: ‘The 2004 contract defined what were core services and what was considered “extra” work that practices could undertake if they had capacity to do so. The situation many practices are in now is that extra work is a necessity in order to survive.’

‘The GP workforce is finite and this model is therefore unsustainable. The future for general practice as patients currently know it is very bleak.’

A report, drawn up jointly by the Nuffield Trust and King’s Fund think tanks in July last year, suggested that NHS England introduce a brand new contract ‘in parallel to the GMS contract’ to incentivise GPs to form networks or larger groups to provide services to improve mental health, elderly care and social care. NHS England said at the time that the report would be ‘helpful’ in forming its longer-term strategy for the NHS under the Call to Action banner, which it is yet to release.

However several survey respondents called on QOF and the ‘waste of time targets’ to be abolished, while others voiced frustration at the DES-related ‘bureaucracy’.

One GP partner wrote: ‘It is no contract at all: it binds GPs but not NHS England. The Government is allowed to change the rules, parameters and income as they see fit and we have no recourse - hardly the contract of independent contractors’

Some cited the need for GPs to have more flexibility in the services they choose to provide, and the ability to reclaim responsibility for out-of-hours services.

One GP locum respondent wrote: ‘The opt-out from 24 hour responsibility has been a disaster (for patients). We need to take it back, but only if it is adequately funded. We also need a contract that stipulates minimum acceptable manpower levels.’

Dr Andrew Thomson, a locum GP from Forfar in Scotland, said: ‘All contracts reach the end of their useful life and this one is rapidly heading in that direction. The 2004 contract was a great step forward, but successive Governments have managed to paint the contract as a tool to deliver additional income to GPs, rather than the true intention of trying to deliver additional resource to GP Practices.

‘I would like to see future GP contracts that have the ability to limit the transfer of un-resourced work around the health service.’

NHS Alliance Chair Dr Michael Dixon told Pulse that it was ‘completely inevitable’ that the GP contract would be scrapped within the next ten years.

Signs that the contract is losing relevance for many GPs are already evident in Devon and Cornwall, he said. Dr Dixon described the recent decision of Somerset practices to ditch QOF completely as ‘the ‘beginning of the waters coming through the floodgates’.

He added: ‘The contract hasn’t kept up with general practice, which has extended its remit. A lot of GPs are looking for simpler contracts, and they’d like more flexibility in terms of what they can do instead of being hemmed in by tick boxes.

‘The absolute priority must be to support practices to take on more and to make it easy for them to do so. I think the local contract is probably the best way.’

But Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, told Pulse that the problems that have affected general practice since 2004 are due to underfunding of the contract, rather than the contract itself.

He said: ‘Inevitably, [the contract] hasn’t delivered in a lot of areas it should have done. It needs some changes, rather than complete renegotiation. In particular, it needs some sustained, targeted investment to increase capacity in general practice.’

‘We have to get the Government to understand that general practice is a solution, not a problem. We’re fed up of being told that we’re to blame for everything, or the contract is to blame.’

Just over a quarter (26%) of respondents to Pulse’s survey said that they thought the contract should not be renegotiated, while the remaining 25% said that they didn’t know.

Survey results

Question: Do you think that the 2004 GP contract should be renegotiated?

Yes - 152 (49%)

No - 83 (26%)

Don’t know - 78 (25%)

About the survey: Pulse launched this survey of readers on 30 June 2014, collating responses using the SurveyMonkey tool. The 29 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey. As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. This question was answered by 313 GPs.


Pulse July survey

Samsung HD TV - win - online

Take Pulse’s July survey and have the chance to win a Samsung Smart TV.

The survey covers a range of areas, from prescription charges to mental health, and discrimination to PMS reviews.



Readers' comments (28)

  • Reduce unnecessary bureaucracy and box ticking?!?!
    What on earth does the unplanned admissions DES involve? Even more box ticking, bureaucracy and work than before!!

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  • It is sad that the survey shows 26% of GPs are happy with the Contracts as they are. Are these the privileged few who get the cream of NHS funding or are they the naive ones who believe this is great. Or are these the cynics who believe change is not possible? I wonder.

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  • When NHS England has publicly declared its intention to change almost everything in the nGMS contract (and other GP contracts) unilaterally to suit their views, having been given the powers to do just that, what do the terms "negotiate" and "contract" mean?
    Was the imposed "contract" of 2013 preplanned?

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  • I think it may be better the Devil you know - any renegotiation will surely lead to even less income & more work, maybe we should just stick with at least what we've got rather than rocking the boat?

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  • 10.59 Yours is the counsel of despair. We are actually in quite a strong negotiating position in terms of market forces it just needs the GPC to wake up and smell the coffee. GMS is a zombie contract living on borrowed time that did little to address the reality of demographic pressures and rising expectations in the context of a global financial crisis. The current demands for more services and regulation are like an avalanche burying primary care in its path. GP's should stop contracting with the government and contract directly with their patients to whom politicians are supposedly accountable.

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  • Took Early Retirement

    Astonishing that only 49% think it needs re-negotiating. Mind you, it was a small sample at just over 300.

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  • any renegotiation will surely lead to even less income & more work, -- It did in 2004!
    The treasury has been hounding the DH to claw back money from GPs so whilst workload has gone up so what HMG gets for it's pennies is even more value. Problem is to get our incomes back to a level that is commenserate to the workload the government will look weak as it has long painted us as incompetant, lazy and overpaid. Any move to being fair to us and our patients will be grist to the Daily Wail mill. We're stuffed until as one we say no, down tools and drive HMG to the table- a bit drastic? Look what they've imposed on us since 2004- oh yes master doffs cap and does additional hours, doffs cap and fills in another QoF clinically irrelevent box, please Sir may I have some money now? - yes but we're having it back in pension contributions and removing tax rebates and making you pay for clinical waste services- oh thankyou kind Sir.

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  • Graded capitation fees related to age of patients-much more weighted to 75 plus but overall increase of 30% to return to previous income level . No QOF . No CQC . No revalidation . This is a starting point for re - negotiation . No OOH for 1 month to drag HMG kicking and screaming to the table .

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  • We need a different contract to be sure..but why would anyone seriously believe a new contract wouldn't be anything other than a complete stitch up. A contract is meaningless when it's changed and tweaked at will by the government. Anyone really think we'd get a more sensible deal if we 'negotiated' a new contract...dream on...sorry to sound fatalistic but were screwed anyway you look at it.

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  • More to the point who are the indecisive 25% who have no opinion??

    We really are a wooly bunch aren't we?

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