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CAMHS won't see you now

The GP contract is sucking up everything in its path

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A lot of people are using the phrase ‘contract creep’ in relation to the recent negotiations between the GPC and the Government. But I don’t think it’s fair to call Jeremy Hunt that. As he’s repeatedly pointed out, he loves us really.

It is true to say, though, that the contract is expanding into a monster that is threatening to eat us - and the GPC just seems to be standing by making menu recommendations.

Remember when the idea of the contract was to define what we do, and to ensure that anything bolted on was an enhanced service, which had to be paid for? Things have changed a bit since. What happens now is this. A new bit of work starts life as DES. Then, after a while, it magically transforms from ‘enhanced’ to ‘essential’. And so it’s absorbed into the contract and becomes ‘core’.

This happened last time with the Online Patient Access DES. It’s happened this time with the Patient Participation DES and the Alcohol DES. And who’s to say it won’t happen next time with the Unplanned Admissions DES?

It’s OK, we’re told. The money’s recycled into the global sum. Well, yeah, supposedly, but cash in hand feels a lot better, given the smoke and mirrors tactics beloved by the DH. Besides a) recycling dilutes out the amount, because it pays everyone, even those who didn’t previously participate and b) it removes our choice of deciding whether we have the capacity to add work onto what was our core contract. So it’s lose-lose.

That’s contract creep. That’s our contract sucking up everything in its path until we’re doing everything, for everyone, all the time, regardless of our inclination or capacity.

Back in the day, I went to a ‘new contract roadshow’, and I was specifically promised that the bad old times of the John Wayne, ‘A GP’s gotta do what a GP’s gotta do’ contract were behind us. Well they’re not. They’re here now, and they stretch before us ad infinitum. Time to act, I think. Otherwise, as the contract continues to creep in one direction, there will be a stampede of GPs in the other.

Dr Tony Copperfield is a GP in Essex


Readers' comments (8)

  • Spot on as usual Tony and with a welcome laugh.
    Response from the GPC and /or the negotiators to set the record straight and reassure us Tony has got it all wrong would be welcome but unlikely.
    Why don't the GPC come clean and admit this is the case and will be per omnia secula seculorum so everybody young and old knows the score?

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  • Una Coales. Retired NHS GP.

    I would suggest US healthcare providers may be 'sucking up everything in its path' in a series of mergers and acquisitions. Simon Stevens' UnitedHealth Group has a long history of M&A.

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  • Problem is it's difficult to see who the GPC are working for these days...

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  • " And who’s to say it won’t happen next time with the Unplanned Admissions DES?"

    what prophetic words.

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  • Ivan you are very wrong, giving more autonomy to GPs works , reduces stress, and improves patient outcomes, and will improve recruitment.
    I understand it's hard concept to understand but it's true.

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  • Nhsfatcat

    Wayne said this line in "Hondo"
    "Well, there's some things a man just can't run away from."
    --but we can resign

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  • We need a GP union, not a GP Committee.
    NHS desperately needs GPs, we have a very strong hand. Fees for consultation/service or mass resignation. No NHS GP means NHS wont last. Very strong hand indeed!

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  • Copperfield and Pev both echo all GPs.
    Here are the indisputable facts
    We have suffered a 25% fall in income, in spite of all the LES, DES,and all other forms of rubbish, [ here in NI from £ 80 to £ 60 profit per patient year] and a 50% increase in Consultation rates [ from 4 to 6 ] in the last 9 years so a fall from £20 to £ 10 per Consult - a 50% cut in pay - nothing is more straightforward - we are being brutalised as Dr Jane Lothian so clearly explains in Pulse.
    But if we factor in all the other changes such as pensions,MPIG, seniority, we
    are being singularly targeted for mass slaughter, no matter how much Jeremy Hunt says he loves us.
    1 stab wound may be coincidence, 2 may be happenstance, but 3 or more is deliberate as Bond would say.
    Mr Stevens wants us to talk up General Practice.
    Well, do talk up a 50% reduction in pay in 9 years.
    Do talk up a brutal Tory regime.
    But as Dr Martindale states in BMA news review - when is the BMA going to realise enough is enough.
    After all, we are Independent Contractors and we can say it, if we ie the BMA so wished, in stead of all this whingeing and crying.
    I, for one, having done over 700 of 80 hour weekends with 3 or 4 hour sleep on many occasions, realise the BMA really does not look after its members. Consider this, there are A+E Consultants still doing 80 hour weekends with a few hours sleep. I know several of them.
    We doctors have the power to pull the plug, if we choose.
    And MPS getting 10% pay rises is the reason to do it.
    If we take any individual item of work

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From: Copperfield

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