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Independents' Day

Backlash from grassroots GPs as survey highlights fears over contract compromise

Exclusive: Almost two thirds of GPs believe this year’s contract agreement represents a ‘poor’ or ‘very poor’ deal for the profession, with plans to publish GPs’ earnings, scrap practice boundaries and phase out seniority pay causing most concern, a Pulse survey reveals.

The 2014 contract deal, which was announced on Friday, has been welcomed by many GP leaders, with the GPC declaring the compromise ‘acceptable’ and the RCGP and Family Doctor Association also broadly supporting the outcome.

But a Pulse snapshot poll of some 360 GPs over the weekend suggests many grassroots GPs have misgivings about the deal.

Some 73% of respondents backed the reduction in the QOF and 78% welcomed the reinvestment of some QOF funding in the global sum, while moves to improve online appointment booking, give all patients access to Summary Care Records and offer repeat prescription requests online were also welcomed.

But 78% were opposed to plans to publish GPs’ earnings, 76% did not agree with the phasing out of seniority pay and 73% were unhappy with the removal of practice boundaries.

Around half of GPs were also opposed to some of the more high profile changes, including the introduction of ‘named GP’ responsibility, a requirement that practices monitor the quality of out of hours care and the creation of a new unplanned admissions DES.

Asked how they would describe the deal as a whole, 3% said it was ‘very good’ and 33% ‘good’, while 43% said it was ‘poor’ and 21% ‘very poor’.

GPs commenting on the deal on Pulse’s website were divided over its implications.

Dr Shaba Nabi, a GP in Bristol, said: ‘I get the feeling that if the GPC was punched in the face, they would be grateful for not getting a broken nose. Where is their backbone?

‘The loss of seniority has got to be one of the most sinister and stupid ideas yet. If we have thousands of GPs over 55 waiting to retire…this has got to be a massive reason to do so. So what exactly is that going to do for recruitment and retention?’

Dr Fadi Khalil, GP in Sunderland, said: ‘The named clinician part is still very vague. Are we talking information sharing or actual involvement in every decision no matter when why or how?

‘Obviously there is no extra funding and I suppose within this reshuffling of contracts, money will be siphoned out as always. I expect a reduction in total income again for GPs. At a time where we haven’t had a paylift for 10 years and we have had had real-term painful pay cuts as well as a rise in expenses and salaries, I think this contract does nothing but politicise the contract. It makes it beneficial for the Government to brag about meaningless objectives while we are doing the hard work and getting nothing back.’

Dr Coral Jones, a GP in Hackney, east London, expressed concern over the removal of practice boundaries.

‘This will be the end of general practice which is able to provide comprehensive care for every person registered in the UK for about £140 per year. This is incredibly good value. Abolishing practice boundaries is just a gift to the private sector to sweep away more of the NHS.’

But Dr Janette Lockhart, a retired GP from Ashton-under-Lyne, Greater Manchester, said: ‘The new contract sounds good in part, especially the reduction in the QOF. I hope that eventually disappears completely as, for me, that was the thing which had the most detrimental effect on enjoyment of the job.’

Responding to Pulse’s survey findings, GPC negotiator Dr Peter Holden pointed out there was a small sample size but defended the deal, insisting it was ‘the best we could do’.

‘You have to remember the environment - there is no new money and the Treasury wanted to impose something far, far worse,’ he said.

‘People need to wake up and smell the coffee. This was the best we could do, we were offered far worse and we were against a timetable.

‘I actually think when people really see the detail and analyse it, the devil is absolutely in the detail this time.’

Readers' comments (34)

  • Thank you for what will be no change to my workload and a significant pay cut over my working life. Which undergraduate in their right mind will choose GP as a career path.

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  • Hazel Drury

    Pulse, once again your survey ignores single handed GPs. I ticked "GP other" (as opposed to GP Partner as I am not in partnership with anyone) so the survey ended. Doh!

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  • I think the contract changes are fine. Most of the things in the contract I already do, like taking phone calls from hospitals and ambulances about patients. I think the named clinician makes sense and most people over 75 already see one favorite GP. This just formalizes that.

    The contract gets rid of the pointless QUIPP meetings, which take up a fair bit of time and scraps some of the terrible DESs (remote care) etc.

    The red line for me would have been if I had to be awake/ sober/ around between 6.30pm and 8am. That has not changed.

    The real test will be if seniority does in fact get rolled into the global sum (and not sold as a pay increase). At the early stage of my career - that will work out about neutral for me. It penalizes those towards the end of their career as they have not benefited from the increased global sum in the early part of their career.

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  • I think that there is some progress with this contract, particularly the recognition that QOF has gone tto far down the boxticking route. My major concern (given the governments track record) is how we ensure that these monies (QOF, seniority, MPIG etc) genuinely get recycled into the global sum. I can't help thinking that the global sum will not increase as much as a mathemetician would calculate it should. Let's face it, the government does not have transparency as it's watchword.

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  • 24 hour responsibility for single handed practitioner is extremely unfair. some area may only have one or two practices in village . if gp's don't get on well with each other then where are they suppose to go?. working with other practices !! patients who change doctors do not want to see previous gp's. would it not reduce patients choice to change gp's.
    qof bureaucracy is is reducing, is good news but actual money saved should be added to correction factor for those who have small global sum.

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  • Publishing pay is a good thing. Corrected for expenses and employers superann as then people will see we don't earn 100 or 200k but more like 80k. And I think most people would think that reasonable.

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  • if anyone is naive enough to think there will be genuine recycling of QOF, seniority monies, they need their heads examined. Equally I don't think published pay will be post superannuation, it too will be published in an unfavorable way.

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  • The contract is one of the worst negiotiations in medical politics

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  • This comment has been deleted by the moderator

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  • "publishing gp's income " is there so it can be removed. they will say we compromised on this and seniority allowance and in return gps will support changes.
    is is no big deal to publish gp's earning. let them know doctors earn decent wages from their independent business.

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  • As a locum GP now retired from my long-term Practice, I can perhaps view the new contract with a wider perspective. The important issue (which I have not seen reported on in any of the press reports) is the question of Target Net Income. If this concept is still retained in pay negotiations, GPs as a whole have some protection against market forces (though there will be individual winners and losers). If not, the future is very worrying.

    As regards QOF, I guess this has achieved its major (and most important) objective. It has changed forever what general practice is about. Before QOF, general practice was essentially about what came in through the door. The College and enthusiastic GPs practiced some population-based care, but this was not consistent across all general practice. Our responsibilities now extend to continuing care, even of those who do not present. We have utilised the unique UK general practice asset of the registered list. We have reduced mortality and morbidity. We have improved our patients' health. We should be celebrating this… and so should the Government.

    Governments will always govern. This one seems to be particularly insensitive and autocratic and particularly unwilling to embrace evidence. But it will not be here forever, and there will be another one behind.

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  • I'm surprised no one has asked the question "why". Ibet the GPC probably has asked themselves but are too scared to ask (or too scared to publish the reasons!).

    So lets see if I can figure it out:

    GP pay publication:
    Why? Is it to show how cost effective we are? But surely income/hour is a more realistic way of showing this. Even if this was the case, why would government suddenly want to enforce this when they have run smear campaign for several years? Is it to police over earning GPs? But this is easily done by submitting accounts to CCG/NHS england and would be far more acceptable to the profession. The truth is, they think we are over paid and wants public to think this too.
    Outcome - GPs will be villified again by the patient group. Expect to see "fatcat" map of GPs in the Daily Mail in 2015.

    Reduction in QoF
    Why? Is it because they truely want GPs to do less meaningless work? If so why have they suddenly changed from years of non evidence based enforced tick box exercise. And why not just retire the QoF all together if it wasn't effective. I suspect they know we will have to carry out majority of the retired QoF anyway and treat the increase in global sum as "pay rise" and refuse to increase our pay scale in accordance with DDRB.
    Outcome - low QoF achievers might benefit here. High achievers will see no real reduction in work but continued paycut.

    Abolishment of seniority pay
    Why? Do we truely believe DoH wants to make it fair for new GPs by putting this into global sum? Surely recognizing the experience and paying accordingly will persuade a young GPs to stay in NHS and work for longer. If DoH is not going to save any money, why risk back lash from GPs? I suspect this is in line with the increased pension age - they want us to work for longer with no additional pay.
    Outcome - we will earn less over our life time. No incentive for GP partners to carry on and we will be salaried profession

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  • GP pay has not compared apples with apples for years now is our opportunity .Watch this space

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  • At long last I can now go to a GP who cares - not about their pocket, but about us. I need to ensure that I develop a relationship with my GP not with all the part timers in the practice. Service will improve and be when we need to. I am the only one to lose out financially at the moment when I have to visit my GP instead of working. A&E will now become an A&E, not just an after hours GP.

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  • It seems to me , with regard to the outcome of contract negotiations, we would be better advised to use the word capitulation rather than compromise, which in my opinion is highly inaccurate.

    Government and Department of Health agenda has been swallowed 'hook line and sinker' -- yet again.

    In fact, one might even contend that it is rather insulting to be patronised with the suggestion that this is a good deal for GP's.

    Now would be a good time for younger GP's particularly to consider forming their own representative body with a view to looking at all the options including resignation, which might permit them to be truly independent contractors. It seems that this rather obvious option is completely off-limits as far as the GPC is concerned, they are not prepared even to canvas their members.

    Unless I am guilty of severe misjudgement, there is no obvious readily available supply of replacement GP's waiting in the wings, public expectation of a good standard and ready availability of health care is rising by the day, therefore it seems unlikely that unemployment would be the consequence of resignation.

    No I am not a Marxist, far from it, permit me to use the quotation nevertheless, 'All you have to lose is your chains'.

    By the way, the politicians have clever ways of manipulating us, publishing earnings is just yet another way of cowing us into accepting an ever rising workload -- the real issue for grassroot GP's is not their earnings per se, rather it is the amount of money paid for the amount of work done -the latter part of that equation is where the problem lies.

    It is next to impossible for any group of workers to increase productivity as much as general practitioners in the UK have been asked to do -- can we not just step back for once and compare like for like, specifically the financial resources devoted to health care in other wealthy nations such as Germany,France and the USA versus the outcomes delivered?

    I would contend that, by capitulating to yet another set of unreasonable government demands, unless our negotiators truly believe that they can now achieve a rapid input of extra resources by negotiating further behind the scenes, the recruitment crisis is likely to deteriorate rapidly.

    Whilst it is generally prudent to look on conspiracy theories with a tad of scepticism, it does look increasingly likely that the real political agenda is for privatisation, achieved stealthily by the politicians but with great rapidity so that it cannot be reversed after the next election -- the politicians seem to want to make general practice so unappealing that options will narrow down to being driven out of business due to ever dwindling profitability or selling out to private contractors.

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  • GPC negotiator Dr Peter Holden pointed out there was a small sample size but defended the deal, insisting it was ‘the best we could do. You have to remember the environment - there is no new money and the Treasury wanted to impose something far, far worse,’ he said.

    This says it all. If you are going to buckle to this kind of threat, you might as well not bother "negotiating". The government will now use this tact year on year and GPC will just bend over year on year

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  • The U.S. is already short 20,000 doctors, a number expected to increase more than six-fold by 2025 .
    While the shortage is partly due to the anticipated increased demands from Obamacare, here’s a factor no one’s talking about: The rising cost of medical school and the low pay of primary care physicians, relative to specialized doctors, the result is that fewer students are choosing to practice general medicine, according to a report released this morning by Nerdwallet Health

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  • 6:05 post - meant to add quotes before and after and some witty strap line about how there is no attractive career in GP land for those coming through.

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  • No pay rise since 2004 . Inflation eroding income by 25% during this time . No practice boundaries to enable to the private sector to cherry pick the working well . Loss of seniority pay , increased pension contributions ; increased time to collect a pension . 24 /7 responsibility paving the way for a return of OOH work . Our negotiators should hang their heads in shame .

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  • Allowing registration from a wide area will allow private companies to cherry pick the mobile affluent patients, whilst ordinary GPs will be left to be the named clinician for the frail and elderly. Recruitment will suffer as how many junior doctors want to be community geriatricians?

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