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CAMHS won't see you now

Landmark contract deal cuts QOF by 40% and boosts global sum - but will force GPs to publish their pay

GP practices will have their QOF work slashed by almost 40% next year as part of a sweeping new contract deal which will increase the value of the global sum, create a new emergency admissions DES and see GPs forced to publish their net pay.

Under the new deal, practices will see 341 out of 900 QOF points removed from the framework - the equivalent of £54,000 for the average practice - with the majority reinvested in core GP funding.

But in return, GPs will have to accept ‘named GP’ responsibility for all patients aged 75 years and older, publish their net income from 2015 and commit to police the care their patients receive from out-of-hours providers.

Seniority payments will be reduced by 15% each year and eventually phased out and practice boundaries will be abolished completely in October 2014, although practices will not have responsibility for home visits for patients out of their catchment area.

Some 238 points (£37,000 for the average practice) will be reinvested in the global sum, and a further 100 points (£16,000 for the average practice) from the axing of the quality and productivity domain in QOF, will be ploughed into into a new ‘inappropriate hospital admissions’ DES. Three points will be invested in the learning disabilities DES.

The new DES will mean GPs will have to case-manage vulnerable patients and allow emergency providers to contact GPs to decide whether patients should be admitted to hospital or A&E.

Practices will have to publish the ‘full net income’ of their GPs from 2015, in line with the Government’s drive on transparency on public sector pay. But the BMA said that any changes would only be made alongside other healthcare professions.

A statement said: ‘We have negotiated the establishment of a working group to ensure that the calculation and publication of earnings are on a like-for-like basis with other healthcare professionals and that the published earnings would be GP NHS net earnings relating to the contract only.’

The main thrust of the changes to the GMS contract for 2014/15 are:

  • Reducing the size of the QOF by 341 points, with 238 QOF points being put into the global sum;
  • A new DES to prevent patients being inappropriately admitted to hospital, with an overall budget of £162m. This will replace the current risk-profiling DES, with extra funding from the removal of 100 QOF points from the quality and productivity domain;
  • Practices will have to publish the full net income of their GPs from 2015;
  • Complete abolition of practice boundaries from October 2014, although NHS England local area teams will take responsibility for the home visits of patients from out-of-area patients,
  • A new contractual obligation for GPs to monitor the quality of out-of-hours services when used by their patients and report any concerns;
  • Reduction of seniority payments by 15% each year, with no new entrants from April next year;
  • ‘Named GPs’ will take on accountability for patients over the age of 75, to be the main point of call for providers outside the practice;
  • Practices will have to display the result of their CQC inspection in the waiting room;
  • The introduction of the Friends and Family test from December 2014 asking patients how likely they are to recommend a GP practice;
  • The introduction of new IT systems including the ability for patients to book appointments online and access their Summary Care Record

GPC chair Dr Chaand Nagpaul said that the new deal would deliver real benefit to patients and help ease the pressures on GPs.  

He said: ‘The BMA believes that through constructive talks we have reached an acceptable deal that will help to relieve workload pressures on GPs and is a first step towards enabling general practice to meet the challenges that it faces in the coming years.’

RCGP chair Professor Clare Gerada said: ‘This is welcome news for patients and for GPs as it will help us to get back to our real job of providing care where it is most needed, rather than more box-ticking.’

Dr Peter Swinyard, chair of the Family Doctor Association, also broadly welcomed the deal, but he warned that the ‘devil is in the detail’.

He said: ‘I think this is a good deal for GPs as it will take off many of the things we have been arguing about for the past year or two. It will reverse some of the complete daftness of the contract imposition from last spring and it will allow GPs to have a little more headroom to look after people and start planning care rather than spending their entire lives ticking boxes or going through their colleagues’ notes to check boxes were ticked.’

Dame Barbara Hakin, chief operating officer and deputy chief executive at NHS England, said: ‘As a GP myself for many years, I know the importance of being able to do what we have been trained for - to use our professional clinical judgment to provide care and treatment that meets all aspects of a patient’s needs.’

‘We know that patients who receive a proactive and coordinated health and social care service are less likely to need to be admitted to hospital. In fact a fifth of hospital admissions could be avoided if this happened every time, and we know that this is particularly important for the most vulnerable patients with complex needs where properly coordinated care makes such a difference.’

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Readers' comments (74)

  • Hussain Gandhi

    Devil in details.This was said about HCSB and look what that lumped us with.

    No comment on specifically which QoF changing and limited detail on the admission DES and named clinician aspect. I can see 2am calls happening. ...

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  • Well done BMA

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  • No you will NOT have 2 am calls or any ooh disturbance. You don't think that as one who helped negotiate both the 2004 and now this 2014 deal I would consent to any return to that slavery?

    Wait and read the detail in the morning when the embargo comes off!
    There are NOT bogeymen around every corner!

    Peter Holden

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  • Bugger about seniority payments - I only started getting it this October.

    That pays my gym membership you bastards!

    Oh we'll, guess I'll just get far and die young.

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  • Ya and look what a load of sh@te the 2004 contract turned out to be.Less than 8 weeks to go now for retirement.

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  • As I thought - they've removed the part of QoF which can be done by non GPs and added work that can only be done by a GP. My practice is a high QoF achiever so this means no additional pay, more work for me.

    And as seniority pay disappears, we are looking at real term pay cut (again). To be honest,I might as well resign from partnership and look to work as salaried GP on BMA model contract. Far more sustainable work load and responsibility and hardly any drop in real money earned/hour.

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  • Out of interest - has anyone actually had concerns with ooh care in their locality? I get daily gripes about AED and secondary care but don't recall looking at ooh entry and thinking 'this really should be better'.

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  • Have to agree with Anon 0.13am. Can't see that we will have lost any work done by GPs on 1/4/14. Work done by nurses might reduce a bit but GPs will have a lot more responsibility and liability. Loss of seniority will see most sensible senior GPs being lost to the profession when taking into account the previously imposed pension contribution hikes and fines for overpayment

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  • I left the UK 3 years ago. Anyone with any sense will do the same before April. If you stay you will face massive increases in indemnity fees, pay through the nose for your pensions and earn less per hour than your practice nurse.

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  • Peter Holden, a bit of premature high fives amongst some GPs. 2004 contract said QOF had to be evidence based and only changed by negotiation, MPIG was to be paid in perpetuity and contract could only be changed unilaterally in emergencies. That didn't pan out. Once concept of GPs being responsible and sometimes available OOH is established in 2014 DoH will gradually push boundaries and we will doing more and more.

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  • T Roscoe

    Nothing on the BMA web site about PMS practices getting this.

    Bet they don't.

    No practice boundaries is going to be interesting

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  • What will happen when there are a high percentage of over 75s on your list? Are they a going to be a help or a liability to income?

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  • Interesting to hear from our cohort of pessimist GP colleagues, I suspect that there will always be pessimism, no matter how well a contract has been negotiated. This is a true win-win for patients ( especially the old and vulnerable), GPs and Jeremy Hunt. Everyone has successfully achieved the best deal.
    From a GPs perspective , a big well done and congratulations to Chaand Nagpaul and the GPC team on negotiating such a sensible deal. Considering that we are in times of austerity with a dearth of resources, it would have been tempting for Jeremy Hunt and the treasury to have pressurised for a significant clawback . The GPC team have done well to highlight the folly of pushing GPs beyond breaking point and have negotiated what appears to be a sensible list of changes . Well done on getting rid of ridiculous aspects of the QoF. The changes described are a basic revision that most of us as GPs would have recommended anyway. The DESs should hopefully be the correct vehicle to allow JH to pursue some of the more complicated areas.it would be helpful for CCGs to strengthen and value the ability of Primary care units by opening up more admission and in- necessary referrals busting community based initiatives that are resourced from CCG budgets through LESs or other innovative vehicles. The CCG development team at NHSE need to stimulate/enable CCGs to divert reduced admission/ referrals funding initiatives to Primary care "gatekeepers". We can all learn to deal with "conflict" related issues as they arise. The GP contract should not always be seen as the main vehicle to seek reductions in A&E attendances and other secondary care activity.

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  • Having left the UK 2 months ago this does NOT make me want to return anytime soon --- either put up or shut up - I left a profession with no integrity who complain about changes but never unite in protestation about the demolition of the profession. No backbone - shameful.

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  • Strike or take it, it's simple, it's another paycut and gloom for us gp's aged 30's - another deal done for the oldies...........

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  • I think I will reduce our practice area significantly, as the patient can stay with me and somebody else can do the visits! Lovely!

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  • Bob Hodges

    I'm in my 30s, and have just started getting seniority payments, so I guess that I crossed the drawbridge just in time but I'll look forward to a big pay cut when I'm 44.

    I will still be looking to drop from 8 session per week to 6 sessions and look to expand my portfolio of better paid, less stressful and more interesting work in OOH, commissioning and the private sector.

    I don't see why the choice should be 'yes' or 'strike'.

    The GPC should be working on alternatives and not take 'defend NHS at all costs' line as the default position. We cannot give informed consent without reference to the alternatives.

    GUERNSEY OPTION DISCUSSION NOW!

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  • More shuffling the deck chairs on the titanic. Will this really make a difference for the frailest patients? Of course we were all neglecting them before this contract change! Policing OOH??? Has anyone ever seen a colleague make a mistake? Have any of us ever made mistakes? Were we always right? Its so frustrating that we have to negotiate with politicians who don't understand medicine and health? What the NHS really needs is less meddling. Sadly it will never happen.

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  • removal of practice boundaries, roll on the private providers cherry picking patients. This 'negotiation' is far worse then expected. 'named responsibility' will carry huge legal consequences and we haven't negotiated a discount on the medical legal cover.

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  • Why on earth do we have to publish our pay Dr Nagpaul? How is that a good thing?

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  • Its a shame that I learnt about MY contract changes from the BBC news this morning rather than from the BMA yesterday.

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  • Sadly there will never be enough money to save the NHS, its up the creek without a paddle. What is needed is more Drs providing private health care in more private hospitals and clinics, and a change in the attachment by the general public to a failing NHS which will always let them down. Please don't believe if we keep plugging away in this vein, that the headlines in 10 years time, with an ageing population and scant resources will be any better. Paying doctors more won't work, deckchair shuffling schemes won't work. With a huge expanse in private health care and acceptance of this by the public, there could be enormous pressures taken off the NHS, resulting in a much better service for all. Sadly not only patients but also doctors are against this expansion. Can't see it happening. But only a paradigm shift will improve matters.

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  • The GMS contract already requires a GP to care for any patient who is physically in their practice area as a temporary resident, either in the surgery or on a home visit. There is no fee payable for this.
    So, register near work and your " home GP " will visit for free when required. Urban GPs will get the funding and not do the home visits, commuter belt GPs will do the visits and not get any funding. Fab!

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  • reduce earning by reducing qof point and in exchange take responsibility of ooh. they call it exchange? money saved will be ploughed in. would we see money in gp's pocket? if gobal some goes up but a practice has high correction factor they will have net pay cut? whar are the benefit of declaring gp's net income?

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  • The death spiral continues apace,this is really going to save the NHS!

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  • Seniority payments were the only thing that stopped me from becoming salaried or locumming previously. Now there will be absolutely no advantage and certainly lots of disadvantages to being a partner. I know what I am going to do

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  • Patient registered with a GP near work gets flu/ URTI/ has operation and requires certificate or management of post op complication. Not well enough to commute to GP so needs surgery appointment near home. Again, I suspect they will be seen by local GP as a temporary resident for free.
    It's not just home visits that need to be funded.

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  • Once again the Boomers rob Generation X. I presume they agreed for us to publish our falling incomes so they can have a laugh at our expense. GMS is dead - time to walk.

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  • What does 24/7 actually mean -- does it really mean anytime of the day weekend night try can call me and say give me a history diagnosis etc etc , what if the patient has registered 1 week ago ? What if they are from Europe with no history so far ? What if they have a whole list of problems ,register and then do not come for 3 months ---should one read every body above 75 commit to memory --I am not sure if a hospital doctor knows all the ward patients especially if it's post take
    What if I am on a honeymoon , kids birthday ,bankruptcy discussion with bank-- it happens even to us --- what if am at a funeral ?
    What exactly does anyone know what this means

    And yes please explain net income ? Just how is that relevant to anything except I suppose one will suddenly see that most of do not get anywhere near what is quoted , and then I suspect one will be penalized for poor management and business acumen and then a bankruptcy , foreclosure discussion etc etc

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  • How the hell do you interpret this as " boomers rob generation x"?
    I am younger than a boomer but feel we are all being shafted. More experienced GPs now have NOTHING to work for. No career progression, no seniority pay, no allowance or credit for hard work, extra qualifications or experience. Once you become a parity partner, that's it. No progression to aim for within a practice except for your own self esteem.
    It is the government who have done this, not baby boomers.

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  • Dear Dr Nagpaul
    I believe the BMA has made it worse. We are a very high QOF achievers and most of this work is nurse led. This is taking 40% of this work away from nurses and dumping it on the GP. We see more added work --more work on appointments/home visits on just picking up the phone by elderly pt's relatives, the social worker, the district nurse, OOH services etc etc " dump it on the GP". On the over 75 we find most issues are minor medical problems but the health impact are social- from poor heating, poor nutrition, social isolation rather that a specific core medical problems. We now are the carer- legally responsible on the over 75's.If anything goes wrong on this class of pt, "say an unavoidable death" we are legally responsible and in court or the GMC complaint . In this group, the medical care and social care cannot be clearly differentiated and is a grey line. The buck( the legal liability and full responsibility ) stops at the GP!!!! Does anyone out there thing law is better career?

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  • 10.00 It's true! The GPC have repeatedly failed in pension negotiations although we are still shoveling cash at anyone over 60. They now agree that younger GPs will loose out on seniority payments. This represents a net transfer of resources to those who still have the option of retirement. This breaks the traditional compact of passing wealth down generations. In fairness, I agree we're all being shafted but those under 40 are bearing the brunt of it. If you aspire to home ownership and a decent retirement then the only solution is to leave GMS before the Boomers run off with your future.

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  • 10:31 law is better always was always will be ..sure hard work conquers all but I know from experience it will all be the GP fault ....all others will step away and say GP should have known , families are absolved of all responsibility , unless I am mistaken here we are all potentially everybody's Mom Dad and Guardian ....unless there is a profit a sent to one office for all the social care , one for all secondary care but even after all that it's a huge lawsuit coming a huge law suit coming
    Lawyers love it they will all have jobs , increase GMC staff jobs , probably lots of destruction of doctors families , divorces , suicides -- all hidden or worse still blamed that the dr could not handle stress and hence could not be doctors etcbetc ---but we have to wait and see
    I believe this is a win win for patients and that is what will always be the guiding rule , doctors we are born to serve the patent be it rain snow or hell , as a vocation we must not complain never utter a word abut our health as doing so will make us look unfit and need I really elaborate
    Soon we will run or told to run the community as. Hospital ward without adequate staff, adequate investigations , adequate monitoring , adequate anything ,daily ward rounds to all the Homes ie houses and care homes pre surgery post surgery ..and if anything ever is not just right we will get hauled up the the GMC, and we all know what happens there
    The above is an opinion and maybe things will be totally different so we wait and see

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  • Boomers rob generation X? I am a 'boomer' and marvel at these comments. Being female and having the temerity to have a family (when the profession was still male dominated) early on I spent several years in low paid (but long hours) salaried partnership which had a hugely detrimental effect on my eventual pension, which was reduced even further by me retiring a couple of years early. For some 20 or so years my pension contributions did not provide 'widower's' benefits even though I paid exactly the same as my male colleagues. A challenge to Europe made the change but it was not backdated so my other half will only get a small proportion of what I paid for if I go first. But that said, I still get a comfortable sum - GP pensions are generally excellent so there is a lot of wriggle room.

    There was no working time directive for my hospital years and the vast majority of my GP working life involved 24 hour responsibility for patients - including being contacted by other ooh providers for information even when I wasn't on duty. It wasn't a big deal, it was just what we did.

    The new contract sounds good in part, especially reduction in 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 .

    Big shame about seniority pay but, dare I say it, more money need not be the only thing worth hanging on for - GP offers a great range of opportunities to enhance work satisfaction once you've got to the point when the core work fails to challenge as much... and you may even get extra pay for some of it. I thoroughly enjoyed the extra (unpaid) stuff I did in the latter years and it was only when I was unable to keep that going that I decided to retire.

    A curate's egg indeed. Headline in the Telegraph (dreadful rag - I only look online to see the Matt cartoon) reads ' New GP contract heralds return of 'proper doctors' ' Were we ever anything else?

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  • 11.10 I agree the Boomers have worked hard for what they have but as a cohort, they have an infinitely better deal from a financial perspective. Unfortunately women's role in the workforce has never been appropriately recognized or remunerated but at least you had the option to retire early. This will be impossible for Gen X and the deal is becoming so poor that few younger GPs can afford take on unpaid work. I doubt we'll see all that QOF money that has just been extracted either!

    I don't remember the rotas changing much when EWD came in, the hospitals just started pretending we were doing less hours!

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  • Does declaring net income mean all GPs (and practices) will be forced to move to a single year end?
    The HSCIC figures for GP income from NHS sources come out 2-3 years after the end of the financial year at present - and I would have thought personal income was personal information under the DPA?

    I'm very interested in obligations over SCR: it looks as though firstly signing up practices for SCR will become contractual obligation and secondly SCR will have to be redesigned to allow individual patient access. What happens to RBAC security measures?

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  • Doc's please read through the contract changes slowly. There is a lot of good in this, its not all good but when ever was it. I appreciate the GP bashing has gone on a little longer that Health Visitor bashing and the Daily Mail diatribe has taken its toll. But!! there really is some good stuff in these changes, for patients GP's and their teams.

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  • I've jsut done a count - we have 741 patients who are above 75 years (and counting). That's almost 10% of our practice list.

    We have 4 full timers. That means each of us will have to somehow personally know 185 patients each - that's even before having to know some who are under 75! Even if I saw them once a month at the surgery, it will take me more then a week to see all of them. If some of them are house bound, it'll be more like 2 weeks of full time work to see them all.

    So does this mean anyone under 75 should be told their GP appointment is effectively halved?

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  • We should have seen the GP contract and voted on it.
    Some policies show politicians out of touch with medicine.

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  • 12.34pm
    I agree this is a bad deal and see nothing good but helps a politician- JH- to say GPs "will" reduce hospital work and admissions. Just dump it to the GP - have a hospital bed at home!.

    This will take time away from the 92% of our patients who equally need doctors on same basis. We now have even a more-- very stressed, overworked, GP who will now have a full legal responsibility- more juice for the lawyers.

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  • There can be no reason whatsoever for GPs to declare their net income. ....unless it is to bring more criticism and scorn on their heads from patients. I would like to know how much each of the negotiators earn in total and net?

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  • Absolutely agree we a lot of the above. Another deal for the Boomers at the expense of the younger GPs. No point at all becoming a partner now. In fact I feel sorry for my STs - why would anyone bother to become a GP here. I'd be off to Oz like a flash if I was at the start of my career.
    Publishing our earnings - great news for the tabloids and unhappy patients.
    Great contract if you like positive headlines for the 'profession' - Bad deal if you are a GP.
    Was the BMA meant to be a trade union? Time to save those fees.

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  • Strike!!!!!!

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  • Vinci Ho

    Steve(editor),
    I think we need some in depth analysis and interpretation of this contract. Are these changes going to make it easier or more difficult for the government to impose 7 days opening without extra funding?
    One thing might happen is hospital A/E just turned patients away to GPs as they attended the department 'inappropriately'

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  • Thanks for the comment Dr Ho - we'll be looking at doing more analysis on this next week. If anyone has questions they would like answered relating to the contract, please email them to me at steve.nowottny@pulsetoday.co.uk and we will put them to the Department of Health.

    My understanding is that the pilots of seven-day opening are beyond the scope of this contract deal, although that's something we'll be following closely as well.

    Steve Nowottny
    Editor

  • Agree....why do they need to know about our net pay...the only light at the end of that bleak tunnel is that maybe the public will see that we dont take home £150K popular to contrary beleif and that after taking out MDU, Locum and other expenses we probably earn less than them!
    And maybe there should be another section to add in our 'un-billed' hours....

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  • Reason for publishing pay?The CQC will demand higher staff to patient ratios and those practices with higher net incomes will be looked at more closely under the guise of "value for money"

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  • wir sind uber gefucht

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  • WOW

    So to summarize:
    No new funding to General Practice.
    No attached pay deal [ Ever hear of a trade union doing that?]
    Reduction in pay through seniority phase out.
    Increased responsibilities.
    Loss of privacy and confidentiality [ declaration of earnings].
    No meaningful reduction in workload through QOF changes.

    What a dross of a contract. I'd rather have one imposed on me year after year by the DOH.

    Wish I was a tube driver or had their trade union.

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  • When Virgin or Tesco take over practices will they be asked to publish how much profit they make out of healthcare? I doubt it. I suspect we need to move away from a personal partnership model to contracts being held by LTD companies which we are share holders in.

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  • If the GPC are prepared to sign off dross like this it makes you wonder if the BMA are still relevant? Perhaps we would be better off forming a campaign group to decouple general practice from political control and take back ownership of our profession? We need to leave GMS and move to a fee paying model like the dentists. This is the only route to freedom.

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