It's been a big and bruising week for general practice. Lord Hutton's pensions report set the mood, outlining a brave new future where GPs now in their early 30s can expect to work to 68.
They will presumably cast envious glances at the rest of the profession who face, as Pulse warned back in January, merely having to retire at 65 or, for those in mid-career, 66 or 67. Then along came the contract deal, complete with 0% for the global sum, a 0.5% overall uplift to cover expenses soaring by far more than that, and a whole bundle of new work, some firmly belonging to the new world of efficiency savings and commissioning. There will be a few GPs out there wanting the old world back.
The GPC described the agreement as a ‘fair deal', and it's true negotiators have won, as well as made, some significant concessions. GPC chair Dr Laurence Buckman has, doubtless through a herculean effort, kept the UK-wide contract together. QOF points to reduce outpatient referrals and emergency admissions by crafting more efficient care pathways are there to support commissioning, but by avoiding the term by name, the contract manages just about to cover Scotland and Wales too. The 2.53% uplift on QOF points is better than the dark expectation of zeros across the board, and the abolition of the hated points for the patient survey, revealed in Pulse in January, is a significant plus.
But this is no time to be grateful for paltry mercies. As a package, the deal piles significant new work on the profession that it not only lacks the time or resources to do, but in some cases the expertise. Expecting every practice in the country to ‘reshape care pathways' is simply not the same as asking each to call in patients for cholesterol checks. It's big stuff, of the kind health secretary Andrew Lansley promised would not be imposed on those GPs who just want to be doctors.
Then there's the cut to funding for extended hours, which may have been a compromise, after suggestions the DES could be scrapped entirely, but feels more like a calculated trap. Even with reductions to the DES requirements, it is difficult to see how practices will be able to run extended hours profitably at £1.90 a patient. Yet if they stop opening late, then when practice boundaries disappear, patients will be positively encouraged to go too.
In any case, the contract deal cannot be viewed in isolation. It came the day after Lord Hutton's report, and the two will be inextricably linked in GPs' minds. It is no good on one hand telling the profession it has been granted a stay of execution, if on the other you are tightening the noose.
Still, there are grounds for optimism in the clout GPs still wield. The Government shied away from a full-scale, APMS-style overhaul of the GP contract for fear of permanently alienating the profession.
GP negotiators may have conceded some ground on the contract, but they must fight as though their lives depend on it to ensure GPs don't have to work until they drop.
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