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Promoting partnerships won’t mean new money

Contractual changes may be needed to get new positions created – but sacrifices will have to be made to get them

By Richard Hoey

Contractual changes may be needed to get new positions created – but sacrifices will have to be made to get them

Well, they do say aim high… and Pulse this week launched a campaign to bridge the gulf that has opened up in general practice and unify the profession.

It's a tough one, partly because the divisions between partners and salaried GPs are deep and entrenched, and partly because their causes are multiple and complex.

There's not many simple solutions out there, but plenty of simplistic ones.

Still, there is consensus over the root cause. The 2004 contract changes fundamentally altered the economics of appointing a partner versus a salaried GP - and starved off the supply of partnerships to new GPs.

So then, change the contract, right? But there are problems.

The Government likes the current model, because it pays by how many patients a practice has – irrespective of its number of partners – and so offers an incentive for it to expand and compete with its neighbours. Ministers like that sort of thing.

And there's another problem – with the NHS facing a 15 billion shortfall in the five years from 2011, there's not going to be much enthusiasm for offering new money.

But contractual change doesn't have to mean more cash. And nor does it have to remove the incentive for practices to expand.

A clever BMA just might be able to persuade the Government to reallocate some of the money from less worthy parts of the contract.

Take the QOF. It was never supposed to be as much as a third of GP income – that was apparently part last-minute whim on the behalf of the health secretary of the day, and part the inability of Government accountants to do their sums.

Squeezing the amount of money going into the QOF a little could mean a bit more for the global sum, which is the bundle of cash tied to list size.

Except this money isn't tied only to list size. All sorts of other facts get rolled in, in an opaque and mysteriously complicated attempt to adjust for workload and deprivation.

If you can adjust a practice's pay a little depending on whether it has a nursing home or not, you could also do so depending on its number of partners. It's just a question of mathematical tweaks.

And as long as the amount of cash on offer per partnership is less than that for expanding your list size, there's no reason why practices couldn't be encouraged to sign up partners and patients at the same time.

By Richard Hoey, Pulse editor

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