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At the heart of general practice since 1960

How new contract betrays GPs toiling in the inner cities

Nowhere in the new contract is there a policy statement or strategy addressing the issue of inner-city deprivation, or which recognises the need for additional resources to provide basic-level care to vulnerable groups.

The argument that funding for these groups will come from enhanced services is disingenuous. Extra resources are required to provide basic care for vulnerable patients given the range and complexity of their health and social problems. A decade of working in the inner city has taught me that unless refugees are given extra time, and provided interpreters for consultations, for example, their essential, basic needs cannot be met.

Without extra resources the heavy burden of illness and social problems experienced by drug misusers and homeless people also cannot be addressed by the practice team.

The new contract downgrades the health needs of such patients to non-essential enhanced services and sends a clear political message, whether intended or not, that the care of these people is not essential but is an extra which GPs can opt out of should so wish.

The problem is not so much the small group of GPs who will resist providing care to such patients no matter what, but rather that larger group in the middle who will elect not to provide these services on the understandable grounds of inadequate core resources and lack of priority from the centre to do so, in the face of overwhelming workload.

Dr Jonathan Fluxman

London W2

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