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Analysis: Scottish talks strain UK-wide deal

One of the advantages of devolution, is that the four countries get to learn from each other. Scotland has certainly done that with England’s much maligned health reforms, and has decided to go completely another way, says Deputy Editor Nigel Praities

One of the advantages of devolution, is that the four countries get to learn from each other. Scotland has certainly done that with England's much maligned health reforms, and has decided to go completely another way.

As soon as health secretary Andrew Lansley published his market-focussed white paper in 2010 it was perhaps inevitable that Scotland would try something different.

The Scottish NHS model was already increasingly divergent from England's, with health secretary Nicola Sturgeon opening saying she wanted less private sector involvement, not more, and seeking to integrate commissioning and providing services in health boards, rather than divide them.

Since then the gap has become ever wider - and so it was little surprise when Ms Sturgeon announced last December that she aimed to make up to three-quarters of the GP contract in Scotland locally determined, with a particular focus on public health.

As we report this week, that process is now well underway, with plans to start refocusing the Scottish QOF on public health and patient safety from next April and meetings with GP forums, health boards and LMCs to ask them what areas of the contract they think should be locally determined.

This fits in with the wider plans for increased integration in Scotland, with health and social care partnerships designed to bridge the gap between the NHS and local authorities.

While the implications of the Scottish changes are far-reaching and stretch south of the border, there's a marked contrast with the way England introduced its health reforms. Scottish ministers seem to be keen to do all they can to avoid the car crash politics of the health bill.

A programme board involving GPC Scotland and health boards will take these ideas forward, but there are dangers for GPs in this.

Can the GMS contract survive as a UK-negotiated deal if there is little in common between countries, and will that mean diminished negotiating power for the BMA?

Nigel Praities is deputy editor of Pulse

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