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At the heart of general practice since 1960

'If I were a GP, changes are needed for me to vote Yes'

Professor Alan Maynard has not always been sympathetic to GPs, but when it comes to the new contract he thinks the profession has every reason to feel aggrieved

f I were a GP I would not be at all surprised by the mess that is the contract. As we all know from Yes Minister, policy tends to get cocked up when different parties work in isolation.

And look at the situation we had here. We had one policy group seeking to equalise the geographical distribution of finance (the Carr-Hill formula) and another revising the contract. It might have been a good idea to collaborate and do a trial run of the policies, but no, Whitehall, bless 'em, demonstrated once again that they were unable to work together but brilliant at screwing up.

So now we have the minimum practice income guarantee (MPIG), which restores income but delays the geographical equalisation of funding.

The essence of the new contract, like its counterpart for consultants, is to reward the activities of practices so they deliver more timely and cost-effective care.

This can be paraphrased as do more and do it sooner, so that patients' expectations and Prime Minister Blur's targets are met.

However, I imagine most hard-working GPs are already knackered by their practice workload. Some will probably calculate that they are moderate performers on the

clinical and managerial targets and will need to invest vigorously to get up the performance ladder. Can they be bothered?

Of course they want to deliver timely and appropriate care. But where are the extra staff they will need? While the Government tells us that three million new nurses will march into town tomorrow, so far they haven't come into GPs' surgeries. Recruitment is a problem, and GPs need help with it.

Furthermore, GPs need clarity about clinical responsibility. If staff occasionally make a mistake, who is clinically responsible? To err is human, but I wouldn't want to be held clinically and financially responsible for mistakes made by other people.

I have some other concerns. The clinical targets are all very well, but will they be left alone as time goes by? Once GPs are achieving 100 per cent, what processes will be used to shift the goalposts? For instance, they may have good pain control support for housebound patients. Who will determine how and whether this and a multitude of other possible new targets are adopted? Will such targets attract new payments and will these be complements or substitutes for the current proposed loot?

We have been hearing the rhetoric of 'a primary care-led NHS' since the time of the Blessed Lady Thatcher, but what does it mean? Most practices have no incentive to blow the gaff on the possibly shambolic nature of their local secondary services. The new contract will require GPs to use these services even more. What incentives are there for them to manage demand for hospital services efficiently?

What incentive is there for the local hospital clinicians to improve service delivery for patients? The PCT is a long way away from doing this, and better incentive structures are needed. Given that Mr Blur has reinvented most of the Thatcher internal market, perhaps it is time for fundholding once again.

I like the principle of the new contract, provided practices get their MPIG. But where's the evidence it will get the whole NHS to 'act smarter'?

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