The GPs who shaped NHS general practice: Dr John Chisholm
As the 70th anniversary of the NHS approaches, Emma Dent takes a look at the GPs who influenced NHS general practice over the decades, introducing the 2000s with a profile of former BMA GP Committee chair Dr John Chisholm, who spearheaded negotiations for the pivotal 2004 GP contract
As the chief negotiator on the 2004 GP contract, Dr John Chisholm was lauded for the benefits of the deal – particularly the out-of-hours opt out – and criticised for its drawbacks.
A Berkshire GP, he was no stranger to the highly charged world of medical politics when elected chair of the BMA’s GP Committee (GPC) between 1997 and 2007, after 20 years’ service on the committee – including being joint deputy chair. His hobbies of being a chorister, conducting and playing the flute led to jokes about his ability to lead and to turn hot air into harmonious music.
He is described as having a razor sharp mind and elephantine memory, both of which must have been tested by the negotiating process.
As well as stopping GPs being obliged to offer out-of-hours care, the new contract meant they could choose to provide enhanced services such as contraception and immunisations and was intended to increase collaborative working across primary care. The debate on how much the contract increased the average GP partner’s salary is ongoing.
After the vast majority of GPs voted to accept the contract, Dr Chisholm said he believed it would signal a ‘new era for general practice’. But his next move would invite controversy, when after stepping down from the BMA GP Committee role he formed Concordia Health, a company that went on to win a number of APMS contracts, with fellow ex-negotiator Dr Simon Fradd. He also championed a realignment of skill mix in general practice.
Currently Chair of the BMA Medical Ethics Committee and of the Men’s Health Forum and an RCGP Trustee, he continues to practice as a GP.
The NHS Plan brings in a significant increase in funding for the NHS, and targets including a pledge for all patients to be able to see a GP within 48 hours. Massive contractual change sees the Red Book abolished in favour of the 2004 General Medical Services contract. This introduces QOF and its greater emphasis on performance related pay.
Serial killer GP Harold Shipman is jailed in 2000 for killing 15 patients through administering lethal doses of stockpiled diamorphine. The Dame Janet Smith inquiry into his actions concludes Shipman murdered at least 215 patients, most of whom were elderly women. The inquiry calls for tighter controls on regulating controlled drugs and for the GMC’s role in both investigating and punishing doctors to be split, with doctors disciplined by an independent body and the entire process to be subject to regular review.