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Gold, incentives and meh

1% is peanuts, but it is all part of Hunt's grand plan

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The rumours were true. The new contract brings little to make a big difference to the hole general practice has fallen into.

There are some welcome developments – binning the controversial dementia DES and no changes to the QOF – and an actual inflation-busting 1% pay uplift is welcome. 

For the first time in many years we also see a real effort to address rising practice expenses, with an additional 2.2% to cover recent hikes in indemnity costs and employers’ national insurance and pension contributions. After nearly a decade of pay cuts, I guess GPs have paid their 'penance'.

But this is all pretty small-scale stuff when you consider the massive problems with recruitment, the rising numbers of patients displaced by practice closures and the devastating impact of cuts in MPIG and PMS funding.

Jeremy Hunt is playing the long-game 

And there are some potentially significant pieces of additional work that are buried in the small print. Practices 'will aim for’ at least 10% of registered patients to be using online services and will have to record data on evening and weekend opening hours and 'the number of instances where a practice pays a locum doctor more than an indicative maximum rate as set out by NHS England’. Sounds ominous.

All the rhetoric about putting the ‘inspiration and magic back’ into GPs’ working life looks a little bit hollow.

But I get the sense that the health secretary wants it this way. He wants to engender a sense of dissolutionment before he comes in, superman cape fluttering with a lovely pert 'package‘ of measures that will 'save’ general practice.

He wants to make the national contract look like a bag of the proverbial as it suits his longer-term aim to undermine it and introduce his own sparkly seven-day ‘voluntary’ GP contract to push forward his manifesto agenda.

Watch as GPs are promised extra funding in return for a whole list of new responsibilities that will make Mr Hunt’s boss in Number 10 very happy and will suit perfectly the aims of the Five-Year Forward View.

I may be wrong, but I sense Jeremy Hunt is playing the long-game here, and the forces are being gradually lined up to divide the profession and side-line the BMA and Labour's maligned 2004 contract.

For some GPs this will be a welcome release from the constraints of the current system, and in the short-term it could prove lucrative for practices to make the leap and start to form a truely primary care-led NHS, but there will be no going back once the genie is out of the bottle.

A similar game was played with the juniors, now it is GP’s turn.

Nigel Praities is editor of Pulse

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Readers' comments (16)

  • yup, well read and he will succeed as GPs are divided and some will sell their souls for money. Expect there to be a vocal supportive contingent for Hunt's 'package' - with the rest either doing what they are told or resigning. Without comprehensive support for action the GPC will be impotent (as usual).

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  • Mr Mephisto

    BBC Radio 4 "The Report" broadcast last night (18/02/16) did an in depth analysis on the facts and figures behind Mr Hunts 7 day NHS plans. The government did not come out well in the analysis of the figures. It’s about time the BBC showed its journalistic credentials before the all turn into a bunch of sofa- longing morons who have lost all credibility and morphed into C-list TV personalities. Anyone who appears on Strictly Come Dancing on Ice etc... should be stripped of all journalistic credentials forthwith. Some people will be sad to see Bill Turnbull drift off into retirement but he will be no great loss to journalism. As for Naga Munchetty I bet politicians are absolutely terrified of her – it won’t be long before she takes over the anchor job at Newsnight.

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  • Ivan Benett

    Hey, I was going to be on that programme, and I'm not a C-list TV personality.

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  • Spot on again Nigel - PMS2 is the phrase. But we keep falling for it. Your odds on the new offer including co-pay?

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  • Mr Mephisto

    Dear Ivan. Don't worry your time will come - they will be after D-list celebrities soon enough. Have you been approached for Channel 4's"The Jump"? If they pay Bill Turnbull £5500 to turn up at some backwater NHS awards ceremony then I'm up for it! How to I get on this personality gravy train? D-list here I come. Now I know what to do if the GMC decides to "de-list" (D-list) me - get it! Boom Boom Boom! PS.I didn't know that you had journalistic qualifications.

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  • There's a lot of this "let's be thankful for what we have got" going around. The same is going on in our CCG regarding the PMS premium - "be thankful for what you've got back and don't worry about the enormous workload associated with it"

    I will not be thankful until the GP budget is back up to a minimum of 12% of the NHS budget and neither should anyone at the GPC.

    Quite frankly, this headline has made me miserable. Any there is a sinister side to it - recording of extended hours appointments and locum pay. Big brother is definitely watching over me.

    The "package" will be equally underwhelming.

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  • I am gettinI out of general practice. I am spending 60 hrs a week on my bum.Aprt from trying to meet unbeliable demands from patients,I am working as HO to all my hosptal colleagues,carrying out their orders. I am sure I will find something else to do, as I can not see how I can sustain this for remaining years of my working life. Thank you Mr Hunt. May God make your life as miserable

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  • The NHS is run by a policitian - I am surprised you guys expected anything different.
    Your dream world is a healthservice run by a co-operative run by doctors/healthcare staff - dream the dream - play the rollover lottery today!

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  • Working as a locum at the moment, aged 51, waiting to see if GP Partnership or other longterm role interests me to jump back in..no way in H*ll with this kind of trivial vacillation. Please understand that the DoH doesn't want GMS in any form and has to walk the line of looking like it is helping, so that when we walk away it can be our fault in the eyes of the Media. Look at how they did this with NHS Dentistry. Message to BMA: please spend your efforts on positioning us well with the (Inter)National Corporates which is where we will end up. Yes, without this, we will all be in £50k pa 8-session contract drudgery for ever. GET ON WITH IT BMA! No more deckchairs, man the lifeboats. Please send a message to the SS Carpathia that we are coming, but at a premium. The Gong-seekers at the BMA know this already.. yes you do!

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  • Vinci Ho

    One day of politics is long enough........to make the circumstances even more extraordinary :
    (1) As soon as Boris Johnson declared his allegiance to the 'Leave' EU campaign, another 'election' has started . On the surface , this is about far right politicians taking advantages on people's rage and anger to complete their longstanding 'grand plan' . Deep down , this is dividing the Tory party right in the middle , just like the last and present governments have split the country into two poles. What goes around , what comes around. Staying or leaving EU can easily turn into a campaign of voting for Cameron or Johnson to be the PM.
    (2) The signs of a mutiny were already there : Cameron's dispute with the council leader of his own constituency about radical cuts in spending in public institutions , the young Tory wannabe Mayor of London candidate's row with Cameron about the third runway in Heathrow Airport etc. Rome is not built on one day!The promise of this referendum bought a ticket for him for a PM second term but could also easily invoke his demise . Ironic?
    (3) Not sure about Johnson's views on NHS(you are welcome to enlighten me). Cameron's besie-mate , the 'honourable' health secretary is entangled right in a mess with the junior doctors and of course , having a historically low reputation amongst all NHS professionals. This current governing regime is showing signs of crack , as I said before.
    (4) It is perhaps not logical to put this referendum mutiny and NHS crisis together but the political meanings behind seem to be firing more and more arrows right towards the PM's heart .
    (5) Has this got any implication on how we are fighting in our own war? May be we need some enlightenment some where, somehow?

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  • Quite well put in the article I think. Essentially J #unt wants the doctors to pack up and leave, preferably to co-pay or private healthcare. That opens the door to bring in his buddies Netcare and the US companies, whilst blaming GPs. The problem is that neither NHS Trusts (ever the misnomer) nor BMA put large chunks of money into Tory Ministers' bank accounts.
    It's a decades-long strategy, rolled out with patience. If we care at all for NHS, we have to work out what's happening and what's next, and work out a plan to foil their plan.

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  • Nigel - correct analysis as usual. 3 successive governments have repeatedly and systematically destroyed any of the potential that could have come from the 2004 contract - remember high trust, low bureaucracy? remember 'no new work without new money? agreements repeatedly reneged? And now, a token reimbursement of expenses yet to come - no mention of expenses past. Meanwhile It is now patients who surely are paying the penance, as well as us. It is not so different from the juniors argument. Exhausted GPs can't do or take any more. Its not safe and its not fair. We must get that simple message out and harness their power. Not just national patient groups, but in every SoMe forum, in every patient participation groupie every surgery, in every waiting room, and yes, in every consultation. One message, One Profession All patients.

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  • Took Early Retirement

    I think Ivan is at least B list and possibly A. I don't agree with some of his analysis but he has a brilliant coiffure.

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  • Vinci Ho

    Would say the same thing about Boris, John. And please stop using difficult word that I had to look up in the dictionary. You know my English is not that good!!!!

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  • Spot on again Vinci. The last financial crisis saw a lurch to the left and intervention in the market. The coming financial crisis will be addressed by a lurch to the right, and allowing 'market correction' (Keynes vs Hayek all over again).

    The impact? Trump & Boris. TTIP. Pound in freefall. 5YFV predicated on a financial fantasy and £22bn in savings looking further away than the moon. Simply, there won't be enough money to pay the bills.

    Austerity v1.0 will look like childsplay. The cuts so far will look like trimming the toenails - v2.0 will look like full scale amputation. Look at the public sector changes in Greece for cues.

    And the evidence: http://moneyweek.com/endofbritain/

    So, co-pay? Certainly.
    Two tier system? Yup.
    Loss of the NHS? I think you all know the answer to that.

    The question now: How much of what you are doing currently will surive the paradigm shift? And how much of what you are planning for is predicated on the right model?

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  • Can you explain a difference of £500 per patient or even £200 in a county like Dorset

    http://www.pulsetoday.co.uk/your-practice/practice-topics/pay/how-much-each-practice-gets-funded/20009192.fullarticle

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