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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)

  • 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.


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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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