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Peace - or just a break in hostilities?

The new contract agreement announced last week has been hailed as marking an end to hostilities between GPs and the Government. But does it really?

The new contract agreement announced last week has been hailed as marking an end to hostilities between GPs and the Government. But does it really?

A new dawn has apparently broken.

After years of watching ministers bully, spin against and - it has to be said - often outwit the GPC negotiators, observers of this long-troubled relationship could be forgiven for wondering when Alan Johnson is going to march out of Richmond House to declare peace for our time.

The health secretary was last week moved to laud his old chums Dr Hamish Meldrum and Dr Laurence Buckman as fellow trade unionists who were 'absolutely on the same side'.

Mr Johnson's new-found compassion for GPs even extended to a pledge to ensure practices hit by the MPIG phase-out would get a 'soft landing'.

GP negotiators have been a little less fulsome in their outpourings. The deal to overhaul the contract could be seen as a calculated gamble struck by a team desperate to avoid the disaster of another imposed settlement.

They may be banking on the fact that, because every practice will get at least something from any global sum uplift, anger will be muted among GPs whose slice of the national funding pie will shrink.

But what's gone comparatively unnoticed amid all the focus on the correction factor is the potential impact of the scrapping - in one fell swoop - of the square root formula. A year of hiatus will apply before the pounds-per-QOF point calculation switches to a true prevalence basis, creating a whole new set of winners and losers.

Worst-off at PCTs' mercy

If practices hit by the MPIG phase-out are rightly being promised a cushioned landing, then surely the same principle must apply to those affected by the scrapping of the square root formula.

The GPC admits the worst affected practices will see their income fall by £100,000 next year. Yet negotiators have agreed to leave such practices at the mercy of PCTs, who will be urged by 'strong DH guidance' to treat affected GPs 'fairly'.

But the recent history of general practice is littered with examples of trusts ignoring toothless Government guidance. Only time will tell whether this guidance will be worth any more than the paper it's written on.

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