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At the heart of general practice since 1960

'Job advisers will not harm GP care'

Your future in their hands?

The new contract? No question ­ last year saw probably the biggest change in general practice since 1948. But what of this year? On the face of it there's nothing that major on the horizon, the worst should be over and GPs should be able to look forward to life on the sunlit uplands ­ or wherever it is you practise.

But the deal finally unveiled last year was a blockbuster by any standards and as with any Big Bang, the repercussions will continue well into 2005.

As things stand, dense tangles of loose ends and unfinished business remain to be sorted out. And GPs are facing a multitude of other uncertainties, as a glance at our AGENDA 2005 survey will show.

One crucial issue to be resolved in 2005 is what the profession will actually earn under the new

system. A preliminary answer to this will be provided in March when the results of the Valentine's Day reckoning of disease prevalence become public. GPs will know then and only then how much they've earned. Cash on delivery, the system is not.

And even with GPs likely to rack up an average of 950 quality points, there will be winners and losers. But that's not the end of the story. PCOs are facing dire financial straits as they try to stretch budgets that assumed an average of only 777 points per GP.

And with the Department of Health refusing to stump up more cash, PCOs may be forced to syphon funds from other budgets ­

those for enhanced services, for example. Meanwhile, spreading the debt is likely to hurt GPs in deprived areas.

This year, too, the Carr-Hill allocation formula is under review along with the entire Q&O framework ­ both works in progress. Architects are sampling the rare luxury of refining their work once it has been built.

GPs realised what they were in for when the announcement that the Q&O system was up for review came almost immediately after its launch. The review won't report until April 2006 but its immediate impact will be to intensify the tight scrutiny the profession is already under.

In his presentation to the NPC prescribing lead conference in November last year, GPC chair Dr Hamish Meldrum said the review would be carried out by three groups. An expert panel will independently develop recommendations. A plenary group will ultimately sign off the final review, while a 'subgroup of plenary' will help steer the expert panel.

In other words, three tiers of bureaucrats (and Drs Church and Buckman of the GPC) will pore once more over the innards of general practice. A scrutinised profession will be scrutinised once again.

According to Dr Meldrum, the expert group will run a fine-tooth comb over existing indicators, recommend new ones (obesity?), consider the balance of points per indicator, look at changing bonus payments and recommend on data collection. The group will also look at possible changes to the Q&O framework in exceptional circumstances such as a change in the law and at submissions from outside interest groups who want a say on what GPs earn.

And still there is unfinished business. Threats to publish Q&O scores have yet to materialise; they may do so in 2004.

Expect even more scrutiny in the continued fallout from the Shipman inquiry. The serial-killing Hyde GP's sinister legacy continues to haunt his former colleagues nationwide. The first bombshell from Dame Janet Smith's mammoth inquiry has already hit.

The epic that was the GMC's revalidation scheme has ground to a halt. It turned from a Cecil B de Mille production to farce. It should have begun in April but is now stricken and under review.

CMO Sir Liam Donaldson and his grey-suited apparatchiks will become the latest band of scrutineers to clamber over general practice. Given the scientific nature of his usual remit, Sir Liam will no doubt be taking a microscope to the profession and its regulation. His brief is to audit the GMC's revalidation plans in depth, but he won't be able to achieve that without some invasive procedures, some close-up and personal examination of GPs' day-to-day working lives.

Dame Janet called for knowledge tests, videos of consultations, clinical governance data and patient surveys to be included in the revalidation. Sir Liam's men may be coming your way, requiring evidence for his report in six months' time.

Then there's pensions. The consultation period on last month's review ends in 90 days and counting. GPs could lose their unique dynamising factor based on increases to profits in favour of an NHS-wide factor based on inflation. Changes could come into effect in 2006 for new members of the scheme. But decisions about the future may have to be taken much sooner than that. And GPs are already preparing to forfeit the proverbial arm and a leg when under Agenda for Change, the new pay scales for NHS staff come into view later this year.

Meanwhile, the National Programme for IT will bring Choose and Book by the end of the year, with the NHS Care Record hot on its heels cranking up the pressure for GPs to change IT systems.

Expect more GPs to come over all retro-futurist and plump for practice-based commissioning. As many as one in four of your colleagues nationwide could take the plunge. And expect some to pool their budgets in quaintly termed 'multifunds'.

Clinically, the procession of drugs going OTC will continue whether GPs like it or not, presided over by a relaunched, 'squeaky-clean' MHRA.

And an end to Big Government? Soothsayers are predicting PCT mergers to increase purchasing power as the economics of the NHS become harsher.

They are also backing scary foundation trusts to absorb general practices and suck their funds dry like urban vampires.

That's another story but it brings us neatly to the election. The best-guess date is May 5 although it could be as late as June 9 or 16.

If Labour wins a third term, the Blair faction is likely to supervise an extension of the consumer 'choice' agenda, ie more private providers in the NHS. And any change of government is likely to bring more change for GPs.

But this time, at least, it's their future in YOUR hands.

Quiet year? You'll be lucky.

AGENDA2005

·See the insert survey coupon for your chance to shape the agenda for the year ahead and

·Win a fantastic holiday in Switzerland ­ more details on page 20

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