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A faulty production line

DH is forcing GPs to choose between money and patient safety, GP leaders warn

The Department of Health’s GP contract imposition forces GPs to choose between maintaining funding levels and ensuring patient safety, GP leaders have warned.

The imposition, announced on Monday, made few concessions to GPs, pressing ahead with plans to introduce higher QOF thresholds, new QOF indicators and four new directed enhanced services. The Government will also continue with plans to phase out the Minimum Practice Income Guarantee (MPIG) over seven years from April 2014.

The GPC said that practices will not be able to ‘chase every single demand placed upon them’, compromising patient care in the process.

It also warned that these changes will reduce patient access and staffing levels.

GPC negotiator Dr Chaand Nagpaul said: ‘The important message to practices is that they need to start to develop strategies to ensure that they are prioritising their workloads in the most effective way for patients and within safe limits.

‘What practices must not do is try to chase every single demand placed upon them, and in the process unwittingly compromise patient care.’

GPC chair Dr Laurence Buckman warned that the final contract terms will ‘divert valuable clinical time and resources towards box ticking and administrative work’ and will make it difficult for practices to maintain services at a time when many are already struggling under a rising workload within shrinking resources.

He said ministers have ‘completely failed to take on board the concerns of thousands of GPs’ about the impact of the imposed terms.

Dr Buckman said: ‘A BMA survey that drew nearly 8,000 responses demonstrated that the impact of these changes would result in GPs considering reducing patient access and staffing hours.

‘It is unacceptable that the Government has ignored this weight of opinion and ploughed ahead with so many ill thought out proposals that run the risk of destabilising patient care.’

Dr John Hughes, honorary secretary of Manchester LMC and a GP in Crumpsall, Manchester, reiterated the warning to doctors.

He said: ‘I am disappointed that they are imposing things that don’t have any evidence base such as the dementia screening. We actually don’t have services to refer people in to. There is a lot of talk about how this will improve care by early referral but there is no point in making us do it until there are services in place, nationwide.

‘I am also very concerned about the raising of thresholds on the clinical QOF. They are demonstrating ignorance. It will result in overtreatment of hypertension patients which may result in increased falls, fractured neck and femur and serious consequences.

‘It will be up to the individual practitioner to decide whether they chase the extra points or whether they act in the best interest of the patient, in which case you wouldn’t. But the problem is that we are having huge amounts of money taken away.’

Dr Nigel Watson, chair of Wessex LMCs, added: ‘We will have to look at what is achievable. Practices will need to look at what they doing if there are things here that are a priority, then maybe need to stop doing other things to achieve it.’

Meanwhile, GPC negotiator Dr Peter Holden warned that the imposition will result in a GP workforce crisis, as the Government cannot continue to get away with asking GPs to ‘subsidise the NHS’.

He said: ‘The Government will rue this day. You cannot keep financially abusing GPs. The thing that really annoys GPs more than anything else is the duplicitous way in which they have negotiated - they had no intention of coming to a deal, none whatsoever - and the fact that they are not even paying the expenses of the NHS.

‘Because the Government controls entry to medicine, it controls the value of the contract. It controls everything, in other words we are utterly ripe for exploitation.’

He added: ‘GPs are in shortage and under normal market forces that would push a pay rise and that would make the job attractive and market forces would correct it. The Government is trying to buck the market because it suits them, but a lot of GPs will turn around and say “why should we bother”. But we need the workforce crisis, because the only way we have ever managed to pull off decent contracts is in times of workforce crisis.’

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

You can find out more about how to protect your earnings at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers. Richard Apps, partner at RSM Tenon, will be presenting a session on how to maximise your practice income and keep an eye on your cash flow.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.


Readers' comments (12)

  • Surely if you say- GP`s " choose between money and patient safety" as a response/bargaining chip, the first thing our public will think, is " well they are already well paid, they should be concerned about our safety , whilst they drive their Aston Martins!". The Public perception of GPs is appalling at the moment.
    Can PULSE/ BMA/ RCGP, please consider a campaign using modern public relation techniques to improve our image, so that we can be seen as being not as money grabbing, uncaring ,stuck up and out of touch, and instead present as the caring hard working, underpaid professionals that we are!
    The public need to be aware of what they could lose, when the older generation retire, and us younger GP`s look at other options such as becoming salaried and "General" practice becoming a thing of the past.

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  • "so that we can be seen as being not as money grabbing, uncaring ,stuck up and out of touch"

    Rather than spending money PR to improve public perceptions (polishing the proverbial), how about improving actual performance and actual customer service?

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  • Anonymous | 19 March 2013 9:48am
    "so that we can be seen as being not as money grabbing, uncaring ,stuck up and out of touch"

    Rather than spending money PR to improve public perceptions (polishing the proverbial), how about improving actual performance and actual customer service?

    Well done Mr anoymous!Point well proven. How is the Daily Mail?Bet you`ve been to that Tesco`s recently they do customer care rerally well. For Profit, and there is an awful lot of them. and the hard word working workers there get really well paid, I`m sure they spent their 20`s at University for 5 years, and then 5 years of working their backsides off to join that profession.
    Have you had health care in America recently?
    Just in case you didn`t know, as you are too busy trolling websites-
    Iit`s very expensive to be have healthcare there for the individual.Dr`s there will not see you unless you can pay orare insured, and believe it or not will not do things if you just ask for it and are not covered/ unable to pay Just like it will be here soon! I bet you are going to love it!
    Ps an awful lot of Dr`s in the states have eg Aston Martins.
    Bring It on "Tesco" NHS.
    PPS please troll Day break website instead.

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  • I think the point "Mr Anonymous" was making was that patients believe that GPs care about them and so money should not even enter in to the equation. Patients are not stupid and think that GPs are already paid handsomely and so the dilemma between money and patient safety should be a no-brainer.
    Lots of graduates "work their backsides off" and don't get half the rewards GPs get, so for once climb down from your own posterior and get a grip on reality - or are you one of those who think you should be paid handomely and sod the patient? I do hope not

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  • Most of us will only be truly happy once we are paying to go to work, working 20 hour days 7 days a week, then we will finally have proved how caring we are just before we all have our first MI.
    I want to get paid a reasonable amount for doing a good job and not be made to feel guilty about it. Being paid properly is not mutually exclusive to patient care.

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  • Persnally, I've given up trying to be a Saint long time ago. I work hard (12-13hours/day hard enough for you?), study in my spare time and cope with unsociable hours (often 7:30-8pm). I don't get to look after my health, like eating at lunch time or evening meal 2 hours before bed, or exercise (where do I fit that in?).

    Yet I don't complain. I think my current income is not too unreasonable even though it is comparably less than other professionals working similar hours such as consultants, dentists or solicitors. And yet, the government wishes to drive our income down further and expect us to do more work.

    It's funny it's always the people who's never done the hard work as we do who seems to think we are over paid. Most people I speak with, including patients, who knows what hard work looks likes often sympathises with our increasing workload and diminishing income.

    So I think a PR campaign is needed..........

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  • This financial year my partners and I have taken an 18.5% percent cut in income, and it looks like we will be doing something similar in the next financial year. Workload is, of course, up.

    Do you think this is going to make me 'care' more or seek to work harder? Do you have any understanding of basic human nature? If we're not appreciated or valued as a profession, then you'll see the results in the service.

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  • Pulse, it's minimum PRACTICE income guarantee, not minimum price income guarantee.

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  • Thank you for noticing that. This has now been corrected

    Pulse moderator

  • Mark Struthers

    Back in 2009, 'Our Beloved Leader' (pictured) made the following statement to the press:

    “The ‘quality framework’ that earns us a lot of money, I negotiated that. There happen to be fewer dead people as a result of that contract. About 8,500 people are not dead, where you would have expected them to die.”

    I wonder where Dr Buckman got his figures for the lives saved by QOF?

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