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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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  • Of course publication of pay will improve patient care and enlightened public will ask for pay cuts,so another problem will be sorted and we will look forward to another pay cut next year. Brilliant ideas never end.

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  • Ok then so if many of us think it's terrible why don't we reject it and complain?

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  • All this makes me wonder why I bother paying my BMA subs...better plan, get onto one of their committees and supplement my dwindling take home by doing very little!

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  • What is the big real about pay. Pay per consultation is £6.00 before tax etc. Take home is £3.00 as several folks have pointed out. \the GPC caves in to threats. I wonder what might have happened if they said ' Sod off' ' instead of just falling over. I wonder why the GPC does not ask it's workforce whose subscriptions they take if we GPs are indeed prepared to walk away like the dentists. If they did and we chose to remain then and only then can they accept this constant badgering.
    They have overseen a real term pay cut of 50% per consultation in the last 9 years.
    GPC , why do you not ask the GPs if they wish to stay?
    Even the USA cannot recruit doctors. There are only NHS GPs here because of the GPC. If they triggered a vote, there would be no NHS GPs.

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  • How about all you anonymous cowards standing for GPC then stand for negotiator. Declare who you are or shut up!
    Peter Holden

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  • I am not sure that the phrase anonymous cowards is helpful or accurate.

    In answer to the question however -- I suspect the reason many doctors post anonymously is because , as has been highlighted in official reports, there is a problem with the culture in the NHS which scapegoats it's staff, particularly those who voice any misgivings.

    Secondly, most grass root GPs want to be GPs, not medical politicians -- they do rely on those elected however to represent their views and we have several surveys of GP opinion recently suggesting that is not the case.

    Although I don't think it is helpful to phrase the question in terms of personal bravery or cowardice, my own questions to the GPC are firstly why do they not seek to highlight the unreasonable workload which has been heaped on primary care, rather than being outmanoeuvred on the chosen government battleground of pay and secondly why do they not survey their members regarding the resignation option?

    It seems pretty obvious to many grassroot GPs that the current direction of travel is going to lead to a pretty severe recruitment crisis, which of course means that many GPs will have been driven into premature retirement and/or ill-health as well as many young doctors being lost to the profession. Is it still better to cooperate with the government when we know this is going to happen? It seems like loose, loose, loose for GPs, patients and I suppose the politicians -- although on reflection, they will still be chugging along on the gravy train.

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  • I meant lose, lose, lose of course.

    oops.

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  • anonymous posts should not be allowed.
    My name is Peter Maksimczyk and I practice in Weston Super Mare

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  • No other organisation -apart from PLCs -would allow publishing of their income.The press & the general public think we already earn enough as it is and this will create even more of backlash which will be used to bring our income down even more. Do not do this !
    We are supposed to be independent contractors -not directly employed by the NHS.

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  • Peter Holden | 21 November 2013 0:17am

    How about all you anonymous cowards standing for GPC then stand for negotiator. Declare who you are or shut up!
    Peter Holden

    I agree that we need to get more pro-GP representation ... perhaps those GPs close to retiring could take the lead and put themselves forward.

    but i disagree re:anonymous posts. i've seen too many colleagues speak out and then lose their jobs or worse and if you don't understand that then YOU shouldn't represent us.

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  • There is a feeling that the leaders of the profession ie the RCGP ( who seem determined to give sticks to the government to beat us with) and the GPC ( who do volunteer for the job) seem to be out of touch with grass roots GPs- I am reminded of a time when as a child I voluntarily agreed to get my trousers wet in the sea in order to avoid a complete dunking by the prevailing bullies and realised later it would have been better to have kept my pride. The removal of seniority pay is a kick in the teeth to the more mature GPs and I agree that removing practice boundaries will ultimately destroy the current mode of general practice as those that can will move to practices that offer longer appointments - at very convenient times and never run late - because they have a vastly reduced workload - 90% of our workload is for the elderly and the very young. The only way General practice pays is because of the large number of registered patients who use us rarely - the pay for looking after the high users is dreadful - I can see big problems ahead. I am considering withdrawing my support from both organisations as it is the only protest that seems available.

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  • Worst-case scenario (which of course is what we have been delivered year on year since the big win of the last contract) -- the big corporations will cherry pick the young and healthy patients, accelerating the death spiral of true general practice, leaving the sick, the elderly, disabled without a proper GP service. If you don't believe me -- find out what happens to patients like these seeking health insurance in America.

    GPs will soldier on as long as they can until they are driven into the ground, health breaking down, premature retirement, bankruptcy in some cases. Their reward, since nobody seems to promote the good work they do in the media nor attempts to promote the idea of a sustainable contract, is that the public will blame them resulting in ever increasing vitriol and dissatisfaction at the diminishing service and lack of availability of appointments.

    Our leaders in their unceasing requests to broker a compromise with vindictive politicians , will instead deliver ever more punitive contract agreements which will simply cause the downward spiral to reach the plughole quicker. Of course, this might just be the figment of an over feverish imagination.

    Maybe next year's contract will be a reduction in workload with no reduction in pay, morale will go up, recruitment will soar- is that an emperor I see resplendent in his finest clothes?

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  • Well, best that could be negociated? I am looking towards a 9k pay cut for the last 2 years of my career in General Practice. Following on from the loss of my personal allowance, an exponential rise in superannuation contributions, a tax charge on pension contributions and a further tax charge on 'excess' pension benefits. Dr Nagpaul enjoy the future, I will be doing something 'anything' else.
    A once great job, to which I gave more than I had to give, I am counting the days.......

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  • I'm looking for the exit. I am only 50. I keep reevaluating how much I need to live on. I am probably going in the next two years but I may go sooner if another country will have me to do locums.

    No point in doing locums in this country as it is still the same old …..

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