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At the heart of general practice since 1960

The devil really is in the detail

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If I might be allowed to indulge in a little smugness, I’d like to say ‘Told you so’ about the much trumpeted ‘Named GP’ contract upheaval. Told you so. It’s not so much a game-changer as a barely discernible extra bit of injury time.

Unlike the new DES on Unplanned Admissions. My reflex reaction to this was another ‘It’s what we do already’ moment. But reading what detail there is suggests it is, in fact – unlike other bolt-on, take-it-or-leave it DESs – a role-transforming contract within a contract. And if my back-of-a-fag-packet calculations are correct, the money attached isn’t enough to interest even the most excitable GP-bashing headline writer.

This new DES will corral us into the frustrating, time-consuming, medico-legally fraught and evidence-flimsy world of admission avoidance, far more so than we are already. And while I’m quite happy to wave a two-fingered goodbye to over a third of QOF tick-boxes, I’m not sure that justifies me selling my soul as a generalist so I can become a part-time vulnerabilist.

And this DES, too, acts as a smokescreen to other contract changes which seem to have snuck in pretty much under the radar.

Such as the abolition of practice boundaries, with all the already well-aired, bonkers implications. And the abolition of seniority payments, obviously in the hope that senior moments will mean those afflicted won’t even notice. And the abolition of financial privacy with the publication of our ‘salaries’. This latter innovation has been accompanied by the weakest medico-political justification I’ve ever heard, along the lines that it will let the public judge whether we GPs are ‘value for money’ – so it’s not really just a new stick for editors to beat us with, as if they needed one, it’s a prompt for concerned tax-payers to switch to a more cost effective GP, or, failing that, storm the barricades of the College.

My first at-a-glance view of the new contract read like a minor victory. The second filled me with doubts. And the third has left me feeling distinctly queasy. As the old saying goes, the devil’s in the detail. Yes, and quite possibly the Four Horsemen of the Apocalypse, too. Anyone feeling vulnerable?

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield. 

 

Readers' comments (7)

  • Unfortunately Tony, you have a job to do whereas for politicians it is more important to be seen to do, though anything will do as long as it seems to be, what's the word of the moment, ah yes, robust.

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  • I absolutely agree. This contract is gives us some short term satisfaction such as getting rid of some QOF nonsense (QP, GPPAQ...) only to inflict long term suffering ( blamed GP, declaration of income, scrapping of seniority). Sounds a bit like what politics is all about and probably the BMA should be more regarded as a political organization than a trade union.
    It might make life temporarily bearable for anyone able to retire in the next decade at the expense of the ones coming after that.
    The only advise for young doctors or medical students though can be - Don't go into General Practice unless you're a serious masochist or a completely deluded do-gooder.

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  • Surely publishing the salary cannot be that bad as long as it is net take home pay and you can give the hourly rate. Maybe some patients will see that you don't actually earn that much per hour worked.

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  • I consider publishing gp salaries to be an infringement of their civil rights. I am a nurse

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  • I and my whole practice will be quitting the BMA who seem totally unprepared to "robustly" represent us. And also the RCGP who seem he'll bent on leading everyone up the garden path. Until more Gps do this things will only get worse!

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  • While I have no issue with publishing GP salaries, I would rather publish details relating to the provision of services especially enhanced services. Patients expect and deserve more than basic care and when practices can simply opt out of provision because they are too busy it is providing an inferior service. Practices that are too busy to provide additional services are normally not organised well enough to provide core services.

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  • How about the politicians publish their salaries + expenses)? Especially bearing in mind they hold several posts...

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder