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Tories must heed partnership call

The BMA has adopted a central demand of Pulse's One Voice campaign by proposing a national incentive scheme for partnerships. But will ministers take note?

The BMA has adopted a central demand of Pulse's One Voice campaign by proposing a national incentive scheme for partnerships. But will ministers take note?

The BMA seems to be working by the old footballing maxim as it plans for a potential change in Government next year – and getting its retaliation in first. Last week, it took politicians and NHS managers by surprise by launching its manifesto for the next general election, several months before we can expect equivalent offerings from the main political parties. The document, Standing Up for Doctors, Standing Up for Health, is a fascinating read. Certainly, it is not for Pulse to be critical, since many of its suggestions for change come straight from our campaign sheet.

BMA chair Dr Hamish Meldrum placed incentives for practices to take on partners at the centre of the association's proposals for driving up standards and improving continuity of care. That is also the key demand of Pulse's One Voice campaign, which identified a shortage of partnership opportunities as the core reason for rising friction between principals and salaried GPs. Our survey of 500 GPs found more than four-fifths supported plans to provide incentives to practices that create partnerships. Any fears that the proposals were unrealistic in the current financial climate were assuaged by the news that one PCT – NHS South-West Essex – was offering payments of as much as £225,000 to each practice that took on a new partner. If it matters enough, the money can be found.

And the BMA has an intriguing suggestion for where that money might be sourced. Dr Meldrum proposes that money be clawed back from the generous contracts lavished on the Government's national network of GP-led health centres, many of which Pulse recently revealed to be missing their patient registration targets.

Lord Darzi's polyclinic rollout is not the only Government policy initiative to have soaked up vast sums of money to little gain in recent years. Just last week, an evaluation of the predecessors to Darzi centres – the network of commuter walk-in centres – found some were working to as little as one-fifth of their expected capacity.

Not only are their costs per attendance much higher than had been projected, they are also a lot higher than traditional GP practices achieve.

The BMA is absolutely right to make a noise about waste and inefficiency across the NHS, and to call for that money to be put to more efficient use in general practice. Unfortunately, the Government does not seem to be listening. Its supplementary evidence to the Doctors' and Dentists' Review Body sets out plans to freeze income for all elements of the GP contract at 60% of practices. Not only that, but it also specifically rejects calls for partnership incentives.

The Government has made it quite clear it wants payments linked to a practice's list size, not to how many long-term doctors it has signed up. So the BMA's demands will be mainly directed at the Conservatives, who – despite the support of their own medical society – have so far remained disappointingly silent on the proposal.

With the firing of the starting pistol on the election campaign, the Tories won't be able to duck the issue much longer.

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