This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

GPs go forth

Buckman: Practices won't have time to take on DESs

Exclusive GPs are likely to take a pay cut rather than implement all the four directed enhanced services the Government is proposing from April, as the workload involved will be ‘very steep’, says GPC chair Dr Laurence Buckman.

Dr Buckman said there was ‘nothing wrong’ with the four DESs themselves, but the Department of Health would reduce patient access to GPs by forcing the additional work on GPs without any additional funding.

The impending GP contract imposition will offer four DESs - worth £3,600 each - to GPs in England to incentivise dementia case-finding, developing access to online GP services, telehealth and case-managing patients at risk of hospital admission.

The DESs are funded by the removal of organisational QOF points, and if practices decide not to take them on will result in them losing a sizable chunk of their funding at a time of rising practice expenses and a raft of new QOF work also set to be introduced from April.

The admission comes after accountants advised GPs to cut their drawings by up to 10% before the expected contract imposition.

Dr Buckman said: ‘The obvious unintended consequence [from pushing through the contract changes] is that people won’t do the DESs that the Government so desperately wants them to do. There is nothing wrong with them as individual DESs, if you look at them and their subject matter.

‘The unintended consequences are going to be reduced access. The DESs, some of them, they won’t fall flat, I am sure some people will do some of them somewhere, but I guess a lot of people will not take on all four DESs. I am not sure actually you could take on all four DESs. The workload of all four is very steep.’

Dr Buckman made the comments in an exclusive interview with Pulse, where he defended the GPC’s handling of the contract negotiations and admitted the DH ‘holds all the cards’.

He said: ‘You can’t block what governments decide to do. There are many things governments decide to do that I don’t agree with, or indeed that the vast majority of the population doesn’t agree with. But that doesn’t mean they don’t happen.’

‘Now what we have to do is make sure that GPs are as equipped as they can to cope with what is coming, that we can do our best to diminish the damage that the deal, as imposed, will put on doctors.’

He also said there was ‘no point’ in industrial action or any boycott of commissioning, even though a Pulse survey found 52% of the profession would support it.

He said: ‘Some of us suspect that the Government may not actually mind terribly much if GPs did not take part in commissioning, so we may be playing into their hand by saying: “Well then, we’ll stomp off the pitch.” Who would take over? It sure won’t be GPs.’ Watch the full interview here

The comments come as the BMA urged GPs to get involved by submitting their own responses to the Government’s proposed deal directly to the DH. It also launched a tool for GPs to calculate exactly how much funding they face losing from the proposed changes to the QOF.

Readers' comments (23)

  • Thats great leadership from the BMA.

    In summary. We can't do anything about it, no point even trying. Just take a pay cut, take a pay cut, run Commissioning groups and work harder.

    Any GP in their 50's should seriously look to taking early retirement.

    Any young doctor, DO NOT DO GENERAL PRACTICE.

    Any young GP's, this is just the start of the dismantling of General Practice. Keep ticking the boxes!

    Unsuitable or offensive? Report this comment

  • Peter Swinyard

    Having read the full "consultation document" I do wonder where I am to find time in my 12 minute consultations for the patients' agenda. Ticking the boxes, doing the QOF and asking late middle age patients if they are going doolally will take up most of that time. Is the government aware of this and do they really want a patient-centred NHS as they claim? Would I pass the Friends and Family test if I insisted on doing a MMSE on a gentleman of retiring age who came in with gout? Let's campaign for patient-centred general practice, with good continuity of care and try to help politicians to understand the long term good this will achieve.

    Unsuitable or offensive? Report this comment

  • Just to correct the above post, BMA is trying to do something (or at least collecting opinions). It's the GPC that seems to have given up.

    It is tragic we have such a weak leadership at the GPC at the time of need. Instead of having Churchill, we seem to have Gordon Brown on our hands....

    Unsuitable or offensive? Report this comment

  • Look back in history, this is how dictatorships grow. The people who can do something right at the start don't and only wake up to the fact that this is not going to turn out well when it's either too late or getting it changed/stopped/reveresed is so so bloody. As a patient, I am scared, as a father, I am terrified.

    Unsuitable or offensive? Report this comment

  • 'case-managing patients at risk of hospital admission' - if they're not already doing this, it's no wonder our hospitals are overflowing.

    Unsuitable or offensive? Report this comment

  • The government can bully us-true. But one thing they can't do is make doctors go into General Practice or stay in General Practice. THIS WILL ULTIMATELY TRIGGER A MASSIVE RECRUITMENT CRISIS THE LIKE OF WHICH WE HAVE NOT SEEN BEFORE. What will they do then??-I suspect they will devise a junior doctor quota system forcing doctors into GP land against their will and The Daily Mail will run a campaign demanding that doctors are made,against their will, to become GPs.

    Unsuitable or offensive? Report this comment

  • "The obvious unintended consequence [from pushing through the contract changes] is that people won’t do the DESs that the Government so desperately wants them to do. "

    Disagree - may well be intended & next brick in the wall. "Oh, GPs have said they can't manage these really important DESs so they're forcing us to privatise this work instead - unfortunately we'll need to give private companies more money to incentivise them."

    Unsuitable or offensive? Report this comment

  • Time for a new general election I think. Time to remove the con dems from government and any of their stooges in primary care. Th

    Unsuitable or offensive? Report this comment

  • After Major, the Tories were unelectable for Over a decade. In the next election they will be gone again. The continuation of the current government is hazardous to public health and sounds like a new election needs to be called. Labour and the good liberal democrats here this, stand up and be counted!

    Unsuitable or offensive? Report this comment

  • I thought the last lot were bad, but now I think they were perhaps just ignorantly misguided. This current lot are just plain blind and deaf to see what needs to be done or to listenining to those that know i.e the people working in general practice. I have to apologise now to you all, as I voted for them - never again!

    Unsuitable or offensive? Report this comment

  • I echo the comment
    If you are thinking of becoming a GP
    Don't
    I can't wait to leave

    Unsuitable or offensive? Report this comment

  • Canada!

    Unsuitable or offensive? Report this comment

  • If the GPC are saying not to do the DES why didn't they just walk away from the negotion table and take no part in it?
    -Would have been a more useful thing to do than the "day of (In)Action on pensions"

    Unsuitable or offensive? Report this comment

  • Yes , the real agenda appears to be to force the closure of small or so called in efficient practices to enabling them to be mopped up private providers perhaps .The providers will adopt a cost cutting model of Nurse Practitioners with a GP servicing groups of them .The only way for large partnerships to survive will be to copy their model .Not what most of us who went into practice really want to be involved with . Time to nip overseas.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Looks like Lawrence has given up more or less . Sad cos he used to be quite upfront and positive . Politics is evil and it changes your personality .........

    Unsuitable or offensive? Report this comment

  • Current BMA leadership is toothless indeed; they have nothing good to offer to their members. I regret voting people like this to lead the profession

    Unsuitable or offensive? Report this comment

  • If all GPs stop working for CCGs (usually for free) perhaps they would have time

    Unsuitable or offensive? Report this comment

  • Harry Longman

    Very large sums of taxpayers' money are being thrust at GPs for these new DESs. Where is the independent peer reviewed evidence that any of them will create any patient benefit or QALYs?
    DH is responsible for wise spending of our money. Jeremy Hunt is the democratically accountable person. He cannot duck these questions.

    Unsuitable or offensive? Report this comment

  • The workload is already steep without the DES's Dr Buckman! We have faced an exponential rise in our worload and remit for over ten years whilst the workforce has barely changed ..unlike the 34% increase in hospital consultants who seem to remain as remote and inaccessible as ever.
    And of course we cannot block what the government want to do since our 'gentlemanly' leaders foolishly believed that our unilaterally ammendable contract clause would only be altered in times of war or 'special circumstances' when it merely placed us at the government's beck and call. No new work without new money..we are a laughing stock!
    It beggars belief that we GP's are the central plank in the government's new health care bill and yet our leaders feel so weak and helpless..should that read hapless?. We have been handed a whole new work load and with it huge responsibilities& accountability in the commissioning ' poisoned chalice' without any form of balloting or agreement from within the profession that we have the will and time to undertake such an additional burden on top of our already onerous and ever expanding day job worload .(Never mind that we have had the required training to take on such a role ,or that protected time & adequate funding are highly unlikely).
    Add to the sorry mess the recent failed day of action pension protest debacle (right action but wrong topic) then we have both proved ourselves putty in the government hand. I know of few GPs who were not put under heavy pressure to engage in commissioning & who would not happily strike from all related work in an heart beat or better still say 'thanks but no thanks'!
    I am desperately saddened and angered that our leaders have essentially presided over the death of general practice as we knew it. The days of the family doctor practice team providing continuity of care are numbered despite the evidence that they are effective, popular with patients and relatively cheap. Smaller non dispencing practices are especially vulnerable as they do not attract sufficient funding once the MPIG is withdrawn.
    You will only appreciate what has been lost when it is too late and are welcome to the future..groups of federated practices working from large Health Centres with their shifts of nurses and locum GPs. We are already seeing a GP recruitment crisis evolving in many areas compounded by those age 50+ colleagues who have voted with their feet.
    Make no mistake that the 'Daily Mail' vitreolic view of GPs will increasingly apply when patients lose the bond with ' their' family doctor and cannot access health care exactly how when and where they want it ft rom these more anonymous andcremoteveervices.
    I despair that our profession has become so careworn and exhausted that we seem helpless to stop this abuse of our role and of I our goodwill.
    It I is hard not feel that the government agenda is to allow GPs to take the blame for the inevitable public anger when the mismatch between funding and demand hits home in these economically straightened times and to seize control of primary care by allowing its collapse. (whereupon they can employ us all back on modest salaries in their primary care centres). But perhaps I am just paranoid.

    Unsuitable or offensive? Report this comment

  • Do you really want the Labour Party back? We are between the devil and the deep blue sea. The country on the verge of bankruptcy due to one lot and the next lot wasting money on a top down (the reverse of what they said in their manifesto so completely without mandate) reorganisation AGAIN of the NHS. I find myself having to manage instead of doing doctoring. Why did I train for so many years when I don't get to do the job?
    But then, we probably get the politicians we deserve, and they all want to screw us over because we are still more trusted than they are.
    But what would I do if I weren't a GP? It is part of my identity and I think I would be lost without it.
    A depressed workforce is going to score QOF points and give a lousy service. Hey ho. You get what you deserve.

    Unsuitable or offensive? Report this comment

  • Anon 5:13

    How can practices be mopped up by private providers when they are already owned by private providers?

    Unsuitable or offensive? Report this comment

  • That all this was going to happen was clear to some people eighteen months ago - perhaps not in detail, but certainly in the general political goals. We watched, horrified, as the profession seemed to be sleepwalking enthusiastically into it. Remember when the BMA, etc were considered to be the most astute negotiators around? The profession has been well and truly shafted, and there's probably no way back. Politicians 1: GPs nil!

    Unsuitable or offensive? Report this comment

  • Anon 14/1/13 at 11am, I totally agree with your sentiments and wish their was a "like" button as in facebook! The state of general practice in this country is truly depressing and this is all ammunition to end our inpendent contractor status. They will not know what they have until they lose it...then it will be too late.

    Unsuitable or offensive? Report this comment

Have your say