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A faulty production line

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)

  • 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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