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No escape from Choose & Book


Andy Jones

Our BMA negotiating team are entering the second round of negotiations, revising nGMS. We have all read submissions for new disease areas, and await the next challenges.

I thought it would pay to look back at the negotiators' successes. At the start, the contract was controversial. Speakers wore flak jackets and helmets to present their initial efforts. But now practices are beginning to see just how well things have gone. Round one of the contract has certainly gone to the BMA negotiators. The Department of Health is said to be bemused at how rapidly many of the targets have been hit.

The QOF was drawn up by a painstaking process, but ultimately, the targets are driven by political aims. The Government thought we would all flounder around 300 points, the BMA suggested it would be nearer 500. Eventually, the Government planned for 750 points. Blow one came when GPs averaged 91 per cent across all areas – a net excess payout of £200 million.

The bottom line

The aim of the Blue Book was to inject £1.9 billion into primary care. It was planned to increase GP earnings by about 30 per cent over three years. Earnings had fared poorly compared with consultants', and we were in the ludicrous position of using earnings to pay for staff. Typical ratios of 60:40 have been the norm for staff reimbursement.

Figures are still to be collated, but it has been suggested that GP earnings have increased by 30-40 per cent in the last two years already. Staff reimbursements are now closer to a ratio of 90:10. Ministers are wondering why little of the excess cash has been needed to increase staff or care provision.

The Government forgot about pensions in the contract. Yes, forgot. No mention was made until it became clear that pensions had been missed out from the global sum. Superannuation has been added later in three miscellaneous lumps, such as uplifting pounds for points.

Don't forget, our pensions are also uprated by a dynamising factor every year, usually a measly 2-3 per cent. For the next three years it will be increased by the average percentage earnings rise across general practice, somewhere close to 12 per cent this year alone! We're unlikely to see anyone retire early before April 2006 then!

So has the department been hoodwinked? The BMA says no – this is work that goes on day to day; the Blue Book has just provided a mechanism for payment. After round one of discussions I would suggest our negotiators deserve warm congratulations. Round two is clearly going to be trickier.

Andy Jones is a GP in Stamford, Lincolnshire

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