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GPs go forth

GPC: Contract imposition 'is all about saving money'

A leading GPC official has said the Government’s wide-ranging QOF changes proposed as part of its GP contract imposition are financially driven and not patient driven as the Government has suggested.

Dr David Bailey, Welsh GPC chair, branded the English policies as ‘bad medicine and bad government’ when interviewed for Pulse’s Big Interview video series last week.

The DH is making a ‘huge mistake’ in pushing ahead with its contract imposition, he said, and warned that it would lead to a recruitment crisis in England in the long run.

He said: ‘We are continuing to talk to people at the Department of Health and we are continuing to explain the problems we have with the imposition and why we think that they should look at changing it to something that is more manageable, to something that does not focus practices too much on a narrow, box-shifting way of delivering general practices and away from the professionalism of GPs and the professionalism to provide holistic medicine to patients. We think that is being lost more and more by a Government which seems determined to put in more and more targets rather than allowing us to be professionals.

‘Although they say that it is patient driven, a significant driver is clearly financial, and they expect the amount of money they pay to GPs to drop next year. They say they don’t, but I don’t believe that at all. We think that this will be a significant problem for practices, to remain financially viable next year.’

‘So, I think it is all about money. To some extent I think that is always what the English Government has been focused on [but] the sponge is sodden and it is dripping on the carpet and I just don’t see how much more capacity GP practices have to absorb.’

He went on to criticise the heavy focus on the QOF in general practice and said the Government does not understand what professional, holistic general practice is.

He commented: ‘QOF is still a very narrow set of criteria. QOF doesn’t cover the whole human condition. This is accountancy thinking, not medical thinking. Most incentive schemes in other walks of life don’t make up 40% of your entire income. Ten percent or 15% might be something that people could live with a bit better. QOF doesn’t measure everything, it doesn’t even measure most of everything. Government trying to force everything into those small number of measurements is bad medicine, it is bad government and it is by a Government which doesn’t understand what professionalism and what providing good, holistic care for patients is all about.’

But, despite the harsh criticism from doctors, Dr Bailey does not think that the DH will budge from its imposition.

He said: ‘I think it is very unlikely that they will reconsider. The secretary of state has said they are consulting, but the tone of his letter seems to be quite clear that there is no real appetite for turning.’

‘We hope that we will persuade them that one or two of the stupidest things, like moving from 15 to 12 months for [QOF] reviews, some of the minor issues of detail in the contract relating to QOF which we think will actually be bad for patients and bad for the doctor-patient relationship – we hope we might persuade them on the peripheries of that.’

‘But do I think that they are going to change the grand thrust of their imposition? No I don’t think they will.’

Click here to watch the full video with Dr Bailey, where he discusses the Welsh GP contract, pensions, GP premises and the English contract imposition.


Readers' comments (5)

  • The Government wonders why Mid Staffs happened.

    It all started when I qualified in 1980 and Thatcher was determined to get the 'market ethos' into the NHS. People where I did my house job all knew each other and took great pride in their local hospital in Surrey.

    If they needed to stay on longer to complete their job, no problem, after all it was for the good of the local service and really you would do it for nothing.

    Along came ' The Market' and out rushed ' Good Will'
    Pay was docked if you were 10 mins late never mind the fact you would have done hundreds of hours unpaid work over the previous years.

    Nowadays staffing levels are as tight as possible. I just look at the old acts on 1970's TV where the plate spinners rushedd around trying to stop a disaster! Well thats your average Nurse working on an average NHS ward in 2013.

    QOF is the same. It makes you depersonalise patients and view them as as money earning tick boxes. Politicians ask ' where has compassion and caring gone' IDIOTS it was their managerial cultures and market places which snuffed it out.

    I retire in 7 weeks 4 days time and fear medicine is no career to persue nowadays for a bright young person.


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  • Peter Swinyard

    Sad to see my colleague's pre-retirement blog above. David Bailey is as always right on target.
    I brought this very issue to a senior DoH civil servant last week in London and will do the same to others in Leeds tomorrow. After the imposition I can imagine the consultation: "Good morning Mrs Bloggs, let's see what the computer has for us today. Well, I've got 10 items on the QOF reminders so lets go through those...and can I just ask if you are losing your memory? About what you came for? Just as well. Sorry, but you've had your 8 minutes (plus walking to consulting room time). What did you say? Chest pain? Sorry Mrs Bloggs, no can do. Please make another appointment on your way out or call a paramedic. They deal with acute medicine. I'm just here to tick the boxes"
    At which point it's time to hang up the stethoscope or emigrate...

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  • Its clear the government are determined to claw back all the earnings uplift brought about by the 2004 GP contract and they will not rest until they have done so,even though they are destroying the profession in the process.

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  • Vinci Ho

    I think if we conclude that these changes are bad medicine and bad for our patients , the argument needs to be presented to the public . The media , whether you like them or not, has to be a medium to wider discussions. Some political sound bites are necessary to raise a public campaign or petition against the government . Or else , accept and swallow the imposition ??

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  • The Govt. is discriminatory. It targets GPs for systematic pay-cuts and increased pensions contributions.. Do you any other group likewise targeted ? It breaks the law when it encourages trusts not to honor EWTD and junior doctors routinely work illegal hours. It is a bully. Some of the doctors are still working 80 hours plus continuosly in smaller hospitals with very little sleep. This is torture. Why do we stay in the NHS?

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