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At the heart of general practice since 1960

Personal administration may no longer exist in England and Wales

The new contract offers no evidence of a brighter future for either patient care or for professional fulfilment in the form of job satisfaction or remuneration.

After 30 years in general practice I have seen many changes, all heralded as the bright new future, and none have yet delivered.

The mantra of the negotiators when presented with any criticism would appear to be 'look at the overall package and see how much better things are'.

Many of us, having received our notional list sizes, now have a clearer view and can see only more hoops to jump through regardless of the patients' wishes with, for many practices, lower remuneration or about the same remuneration even with the achievement of around 750 quality points.

To achieve these quality standards we will need more clerical and nursing staff, but the staff budget is built into the global sum. This means any additional members of staff will either have to generate an increase in practice income equivalent to their salary or a reduction in net profit will result.

There would appear to be no way to negotiate increased funding for extra staff (except possibly for enhanced services) to meet these targets. This may well result in GP vacancies being filled by a mix of nurse practitioners and clerical staff.

Additionally ­ and very importantly ­ in the paragraph headed 'dispensing and stock order', which may have been ignored by many prescribing practices and not fully understood by many dispensing practices, is the statement 'will be scoping the feasibility of introducing a stock order system....'.

If this is negotiated (and it is separate from, and follows after, any main contract negotiations) then personal administration, as is already the case in Scotland, will cease to exist in England and Wales for both prescribing and dispensing practices. This will lead to the loss of income of at least £3,000-£5,000 per annum per principal, which includes some £1,500 of superannuable income. These figures represent a 5-8 per cent pay cut on top of the negative or neutral financial situation many GPs face if the contract is accepted.

It is time for the GPC to be more explicit about the less immediately obvious ramifications of the contract and also to let the profession know its strategy if the ballot results in rejection.

Dr Richard Maxim

Royston, Herts

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