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How will success be measured?

As the new contract comes into effect,

Ian Cameron asked the major figures

involved in its creation how they will judge its success in both the short- and medium-term

The negotiators who worked on the new contract have never wavered in their confidence in the promises they made for the future of general practice. Failure is not a word in their vocabulary.

Other key players have been no less positive. Despite being faced by an often sceptical profession incredulous of pay, pension and workload claims, the negotiating parties have survived and continue to present an upbeat view of what GPs will face in the next months and years.

'General practice becoming the most popular choice of medical career for undergraduate doctors', 'spectacular improvements in the way patients are treated', 'an end to the crushing burden that the profession has been carrying' ­ these are just some of the visions negotiators say are totally achievable.

So what do the big names involved in the contract negotiations forecast for the future? How will they judge the success of the new contract?

Dr John Chisholm

GPC chair

By the end of the first year we will see a spectacular improvement in the management of chronic disease. Patients will notice a more organised and evidence-based approach even in practices that have provided high-quality services for years.

I don't expect to see overnight change in morale and recruitment and retention ­ it's a more gradual process over three to five years.

But once morale starts to improve and knowledge about the better rewards spreads, we can tell a good story to undergraduates and young hospital doctors.

I think it's achievable that general practice becomes the most popular choice for them.

Dr Peter Holden

GPC negotiator

I would judge the success of the contract in the next three or four months by a lack of disruption to cash-flow to practices; in the medium-term by a sizeable hike in pay and not doing out-of-hours; and in the long-term on whether we get recruitment going.

It's essential people see the crushing burden of workload of being a GP has disappeared.

I think our reputation will stay high among the public, but I suspect secondary care is going to complain they no longer get first refusal on funding. I expect snide remarks to be made about the money coming into general practice ­ but it's about bloody time.

Dr Andrew Dearden

GPC Wales chair

The success of the new contract? It's simple. Over the next 12 months GPs will earn more, but it will be money that's superannuable and pensions will rise.

Second, GPs will see a reduced workload in out-of-hours and may have stopped doing other work, or will be getting paid for work they are already doing.

If those things don't happen we will have failed.

Over two to five years one would hope morale would be better and over that time we've got to be talking about an expanding proportion of doctors in general practice, putting it on more of an equal footing with other medical careers.

Dr David Jenner

NHS Alliance

For me, there are three key things when it comes to judging the success of the contract. First, more doctors being recruited to general practice and being retained once in position. Second, an improved quality of service to patients, improving year on year. And third, a range of new enhanced services designed locally and sensitive to patients' needs.

The first year will be more to do with bedding in and implementation and I don't think the contract should be judged a failure if all the above haven't happened by then. But I would hope to see things happening before the end of March 2006.

Dr David Jenner was NHS Alliance contract lead and a member of the

external contract reference group

John Hutton

Health Minister

A key measure of success will be whether PCOs and practices work together to use the new contractual arrangements to provide an expanded range of accessible, responsive, high-quality services closer to people's homes.

We also want to see significant improvements in patient care, with GPs using the Q&O framework effectively to improve the quality of life for the 17.5 million people in the UK with chronic illness.

The most obvious measure of success will be seen in the improvements to GPs' working lives. The contract will be an essential way of attracting doctors into general practice and retaining the skills of our experienced GPs.

Professor Martin Roland

Director NPCRDC

Nobody would expect everything to be wonderful from day one. Any major reorganisation always causes more work initially.

Income is unclear for some practices at this stage; there may be a pretty slow response to better recruitment; and the way the quality and outcomes framework pans out will probably take two to three years. But I think we'll see tangible change to GPs' working lives by then.

Consultations will be changing and patients will have noticed a difference in the care they get as it becomes more pro-active and they are monitored more closely.

Professor Roland is director of the National Primary Care Research and Development Centre and an architect of the quality and outcomes framework

Dr Mike Dixon

NHS Alliance chair

Improving quality of care will be an early indicator of success ­ we are already seeing that by the number of points practices are aspiring to and GPs don't like to be bottom of the league.

I think GPs will know this year whether they are earning what they feel they are worth or whether they are flogging themselves for no added benefit.

Our reputation with the public is crucial over the next year. With 95 per cent satisfaction with GPs, anything that makes general practice different from that public perception could be very damaging and we face a big challenge to show we are still there for our patients and not just ticking the boxes.

Dr Gill Morgan

NHS Confederation chief executive

We recently wrote to PCTs setting out the key tests by which the success of the contract can be judged.

Within a few years I would hope to see greater patient choice in primary care, new care pathways in more areas resulting in more patients treated without being referred to hospital, and a more efficient system of emergency care in place.

I believe the contract will improve both recruitment and retention of GPs, and I would like to see more GPs developing their skills so they can offer more for patients.

The contract presents an opportunity to modernise primary care, and further develop its entrepreneurial culture.

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