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Independents' Day

More work,same pay...

GPs will have to do more work from April for no extra pay as a result of a series of changes to their contracts.

GPC negotiators were forced to agree to a freeze in both global sums and quality rewards after fierce pressure from the Treasury to clamp down on GP pay. In addition, 138 points- worth of indicators have been added to the quality framework, with 'easier' areas and holistic and quality practice points culled.

GPs' pensions are also under threat after the Department of Health said significant increases brought about by the contract were unaffordable. Crunch talks on the issue will begin this month, with GPC negotiators vowing to fight off any department demands which would cut pensions.

NHS Employers negotiators hailed a saving of 6 to 8 per cent on GMS and PMS spending as a result of the contract review. New disease areas added to the quality framework include depression, atrial fibrillation, chronic kidney disease, dementia and palliative care. Nine points have been added to mental health and GPs will also get eight points for setting up a register of obese patients.

Dr Hamish Meldrum, GPC chair, conceded the agreement was 'far from ideal'. But he said it drew a line under perceived 'over-delivery' by GPs, which has led to a £1.5 billion overspend on the contract. The only extra money for GPs comes in the form of four directed enhanced services, which focus on the Government's priorities of choice, practice-based commissioning, access and IT.

GPs will get £1.90 per patient for taking part in practice-based commissioning. Under the one-year deal, 95p per patient will be given to practices for developing a plan detailing how they will save money. The other 95p per patient will be given on achievement of the plan, but only if savings made by the practice are swallowed up by PCT deficits.

A new enhanced service for access will replace the 50 points in the quality framework and the expired 24/48-hour access enhanced service.

Practices will have to offer a consultation with a GP within 48 hours, advance appointment booking, ease of phone access and choice of practitioner. A new patient survey will determine achievement. The IT enhanced service will pay GPs up to £1.30 per patient for implementing electronic prescribing, GP-to-GP record transfer and the NHS Care Records service.

Other changes include a 53 per cent increase in discretionary maternity, paternity and adoption leave; quarterly calculation of 'normalisation' and amendments to pay arrangements for dispensing doctors.

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