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Gold, incentives and meh

GPC to reject contract deal

Exclusive: The GPC will reject ministers’ proposals for sweeping reforms to the GP contract and instead wait for an independent assessment of GP pay – even though the Government has warned it may impose a worse deal as a result.

The Department of Health has offered a 1.5% funding uplift if GPs agree to an unprecedented series of changes to the contract, including a raft of new QOF work next year and from April 2014 the phasing out of the MPIG and a rewrite of the Carr-Hill formula.

Although ministers said the proposed changes were not ‘set in stone’, the DH is pressing ahead with preparations to impose a deal and warned waiting for the Review Body on Doctors’ and Dentists’ Remuneration’s report in February could land GPs with a smaller funding uplift than is currently on the table.

The DH will begin a formal consultation on its plans this month, after which it can impose them without further negotiation.

The GPC has been tight-lipped on how it will respond, and is assessing the full impact of the changes. But its chair Dr Laurence Buckman told Pulse the additional workload involved was ‘unsustainable’.

‘We would have to agree to absolutely everything [to get the 1.5% uplift] and we said we will go to the DDRB, as we were going to anyway,’ he said. ‘We will continue to talk to the Government, to the profession and we will take any steps necessary to preserve general practice in the UK.’

GPC negotiator Dr Chaand Nagpaul added: ‘We are in an impasse at the moment. Ultimately the Government has got powers to make unilateral changes – but that doesn’t make it a wise thing to do.’

He added: ‘We are not negotiating with the Government on those proposals.’

The proposed deal would hit practices with 22 new QOF indicators, raise QOF thresholds and shift around £19,000 from the organisational QOF domain into new DESs covering dementia, online access and chronic long-term conditions.

It also includes a commitment to move towards more ‘equitable’ practice funding by abolishing MPIG over seven years from 2014 and revamping the Carr-Hill formula to favour practices in deprived areas.

Dr Asad Mubarik, a GP in Oldham, said there was ‘a feeling of anger among grassroots GPs’.

‘Loss of the MPIG will destabilise many practices,’ he said. ‘The proposed QOF changes do not follow good clinical care but are simply a cost-cutting exercise. We are relying on the BMA to fight our corner but after past conflicts such as pensions I have little faith.’

A DH spokesperson told Pulse the DDRB would be asked to make a recommendation if the GPC did not agree to the deal.

She added: ‘[The DDRB] could actually come out and recommend less than a 1.5% uplift, so that is a risk they could take.’

Readers' comments (12)

  • Peter Swinyard

    I don't quite understand why the government is unhappy with the DDRB reporting - they claim to use the same formula as the DDRB uses. I never understood why the DDRB was asked to report an everyone except GPs. Has the government overlooked some expenses element? DDRB will at least have (mostly) the confidence of the profession.

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  • I agree with Peter Swinyard. I also don't understand why the government thinks it needs to use bullying tactics by threatening us with a worse deal if we don't accept the original. Surely the costings are already accounted for. What we are asking for is a sensible conversation on what comprises reasonable contractual arrangements for GPs, without sending us all into early retirement, which would be counterproductive

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  • Would it be counter productive? I fear the government is trying to achieve what Alison Davies is describing above and sell the primary care off to number of interested commercial companies.

    Anyhow all this is silly. GPC has no real negotiating power as the Government can simply enforce the contract. They are a bit of a toothless tiger really.

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  • The GPC yet again shows it incompetence and weakness. It has made so many significant errors with their negotiations and has been totally outplayed time and time again by NHS employers. To think the Organisational QOF would not be removed was a considerable lack of judgement as all is covered by either CQC registration or now goes under the control of public health. They should have been predicting this for the last few years. Unfortunately far too much is unknown over the new DESs for anyone to make.a judgement and unless they get back to the table they will never know until it is too late.
    Surrounding MPIG I think the negotiatiors need to declare their own positions. For far too long the has been an inequity of funding in primary care and those who are underfunded traditionally have shown what you can achieve. It is time for equitable funding so we can play on a level playing field. It is hard to see if we have genuinely impartial negotiatiors without them declaring their own practice positions. Many people who have traditionally been underfunded or from deprived areas may consider the proposed changes as the opposite from the BMA position as one of the most exciting & fair changes to hit General Practice in many a year.
    BMA get back to the table and do what your members pay you to do!

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  • The only way for equitable funding is a fee for service structure anything else will still have winners and losers. HMG won't go for this as they know we do so much in the UK GP which is not funded.....hence the madness persists.

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  • already given up hope NI GP

    Lets just hope we dont get the ludicrous call for so called "industrial action"We all know what a debacle that turned out to be.It also sent the message to this government that it could do what ever it pleased.GPC needs to address the Reforms in a more constructive and honest way.Disengage........

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  • If we work in the NHS, we have to accept perforce, Govt. diktats, changing goalposts, broken promises. We are fair game. We have to ask ourselves this - even if we were completely altruistic, would we work for nothing ? If not, what is the minimum we need to work for the NHS ? and are we not there already. In which case, is it not time to resign?

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  • God, I'm glad I'm private. My "contracts" are with my patients.

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  • As the saying goes, "Divided we fall". We should all unite and threaten to resign en masse from the NHS, and if the govt. tries to call our bluff, then we should carry out our threat. I am sure the remedy lies with us

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  • we have to react politically-stop ccg work and let's see how the government would cope-also a campaign re privatisation/incentives and threats to reduce referrals and admissions-the nhs is not safe in tory hands!

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