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CAMHS won't see you now


Dr Peter Holden, Mike Farrar and

Dr Eric Rose offer their perspectives on how the contract will develop

Dr Peter Holden's view

·Sort out unfinished business on pensions, premises and appraisal funding

·Resist the Government's 'never mind the quality feel the width' approach to patient care

·Keep negotiating focus on contractual matters with NHS Confederation

Now that GPs are busy implementing the changes introduced by the new GMS and amended PMS contracts, it is vital we do not forget the wider professional environment.

Every GP must read the Government's NHS Improvement Plan as its proposals range from the 'sensible to explore' to the 'has populist appeal but is not thought through': if implemented these will massively change general practice as we know it.

Remind yourselves of the unique contributions the GP-led team makes to the delivery of primary care in the best UK traditions of our specialty. These are spelled out in the recent discussion document from the RCGP entitled The Future of General Practice. All GPs with a concern for their professional future must read and contribute to the debate provoked.

Why does the Government seek such massive and constant change? First, it wants to control GPs in the mistaken belief that it can obtain a more accessible health service on the cheap by skill-mixing at a dilution that would threaten quality patient care ­ the 'never mind the quality feel the width approach'. It pursues this policy because successive governments have failed to act upon the workforce statistics resulting in inevitable service delivery difficulties for the next two decades because of skill shortages compounded by demographic shift and working time legislation.

Second, politicians cannot bear the fact that GPs are trusted and respected by the communities they serve. They resent the fact that our independent streak can be relied upon to shine a light on shaky, unsound or unprincipled proposals, especially if such proposals are designed purely to save money, generate political sound bites, or get politicians off a hook at the expense of patient service.

Clearly there are several areas of unfinished business with the new arrangements. Pensions, premises and appraisal funding are just three. The immediate task must be to ensure smooth detailed implementation of the contract and the shift of negotiating focus on purely contractual matters away from dealing with the departments of health to the 'employers organisation' ­ the NHS Confederation.

Shortly the formal review of Q&O will begin, as will the negotiations for the 2006/9 NHS financial settlement in respect of general practice. Matters will be complicated and delayed by the inevitable general election and the 'purdah' that prevents public servants progressing issues during the election campaign. The next financial settlement will test any government's commitment to general practice. A first charge on any new money will have to be on making good the significant current financial shortfalls in respect of paying GPs 'employer' contributions on newly superannuated work, fully funding appraisal and restoring the premises budgets. Only then can we consider future service developments.

On the wider professional front, the first appraisal cycle is nearing completion and the first GMC revalidations start shortly. Both topics will consume a great deal of the GPC's attention as will the major work that will be necessary to preserve professional self-regulation and sanity in the wake of the Shipman Inquiry which is expected to issue its final report in December.

The Government had better not squander any goodwill it may have with GPs by seeking to suffocate the most trusted profession of all through gross over-regulation and scrutiny (the like of which no other profession has to endure) all because of one evil man. To do so will simply exacerbate the delivery problems in the most cost-effective best-loved part of the NHS.

It is going to be an exciting and challenging time!

Peter Holden is a member of the GPC negotiating team ­ the views expressed are personal ones

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