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CAMHS won't see you now

GPs are heading for a messy divorce in 2016

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Journalists often feel pressure at this time of year to become hostages to fortune. Pulse perhaps rather prematurely bade ‘Bye Bye’ to the QOF last January and, although it has been replaced in some areas of England and is due to vanish in Scotland next year, most practices are still labouring under the framework.

Perhaps unwisely, I now venture an even more ambitious prediction: unless something drastic happens, 2016 will see the beginning of the end of the national GP contract. Yes, I forecast the once-fairytale marriage will fall apart by next December.

The honeymoon was short-lived. After a sizeable boost in take-home pay in 2004 and the lifting of out-of-hours responsibility, there was a sense of hope in the profession. Things were not perfect, but as a cub reporter, I wrote story after story about the shortage of GP partnerships and salaried GPs clamouring for each vacancy. How things have changed.

Fast-forward 12 years and we are in the throes of a breakdown. Many practices face a severe shortage of GPs and hardly anyone wants to be a partner. Funding has been cut progressively, leaving many practices fighting for survival. An exhausted workforce is drowning in a blizzard of paperwork, gratuitous regulation and patient demand. The GP contract has not caused all this – but it hasn’t helped.

The devolved nations have already gone their own way; Scotland is developing a ‘salaried lite’ contract north of the border for 2017.

In England, though, GPC insiders tell us there is little on the negotiating table for the 2016/17 contract to ease the pressure on GPs; instead, ministers are mooting a new DES to roll out seven-day access. Beyond that, there are signs that there will be little more than tinkering to a deal that is looking well past its ‘use-by’ date.

Of course this may change by April, but health secretary Jeremy Hunt has not hidden his distaste for Labour’s ‘disastrous’ GP contract – he even let it slip last year that GPs were being made to pay ‘penance’ for agreeing to it. It would be a huge coup for him to break up the national deal, and preparations are already being made for the first GPs to sign up to an alternative voluntary contract by the end of 2016.

GP practices in Manchester will lead the profession in this trial separation. They are preparing to dump their individual contracts from next November and merge into large ‘local care organisations’ that could buy up their premises and provide seven-day access and more specialist care in the community. And this will be a model for the rest of the country, as NHS England draws up its voluntary deal for practices as a way of driving forward the ‘new models of care’ in the Five Year Forward View in 2017.

I imagine few GPs retain any affection for the 2004 contract and the new voluntary deal is likely to come sexed-up with pledges of additional funding, the removal of the QOF and partnerships with secondary care.

Many will see this as a chance to realise the dream of a primary care-led NHS. However, the GPC has warned national collective bargaining will be lost and practices risk the same precarious fate as those who opted for the once-shiny PMS and APMS contracts.

But the GPC and its old contract are starting to lose their appeal – unless they can win back a disillusioned profession, we are heading for a messy divorce.

Nigel Praities is editor of Pulse

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Readers' comments (12)

  • Vinci Ho

    Messy divorce does not imply people will marry again . Many will walk in fact......

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  • Vinci Ho

    It's the terror of knowing this is about . We watched some comrades screaming ''Let me out!''
    Keep coming up with love in this 'marriage' is so torn and slashed .
    Why can't we give the love one more chance?
    Cause' love is such an old fashioned word
    And love dares you to care for
    The people on the edge of the night
    And love dares you to change our way of
    Caring about ourselves .
    This is ourselves
    Under Pressure

    Altered and Quoted partially from my all time favourite song ,Queen and Bowie's Under Pressure

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  • The 'battle' was lost some time ago...I don't know exactly when but some time during Gordon Browns rein general practice was pointed toward the dust bin and is been heading there ever since. For me personally the introduction of compulsory late evening opening and idea that people should be able to register anywhere they like, that was about the time when our future started to become inevitable. This wasn't a Tory initiative, it was the Labour Party. Politicians of all colours, in fact, lost the plot and the death of a publically funded, affordable National health service became inevitable. Now it's kind of expected. No one will disagree with predictions of the destruction of the NHS as we know it. It's's what's happening...the country thinks it deserves more than it can afford...and so only those who,actually have the cash will get what everybody feels,they are entitled to...and the rest will make do with low grade 2nd world care..and be out raged all the same

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  • Thanks Nigel. I think that much is apparent.

    The real question is what the divorce settlement terms (read contract) looks like? And who will negotiate it? GPC have been tarred with the establishment brush of late, and will need to act fast to regain the faith of the profession.

    Some Options:
    1) A new contract model with a great negotiating job on the voluntary offer resulting from serious industrial action/public pressure (GPC led if they pull their finger out). This holds the risk of being a fudge and continuing the slow death.
    2) Co-pay/Insurance top-up model (GPC or anyone else who can achieve unilateral action)
    3) A full abandonment of the NHS model, and private practice only (Probably GP Feds led as they would give the scale to achieve this and survive)

    Unfortunately, I suspect we'll end up with a hotch-potch of the three, which will seriously damage our negotiating position. If we're smart, we'll all do one of them - at least for a region anyway, and this could be where Gp feds come in - to co-ordinate the choice of option and the execution of it.

    The other key question: What will the Juniors and Consultants decide to do? If we all jumped together, it might be very powerful. For example, the Juniors/Consultants could join with GPs to form chambers or some other novel contracting form.

    United we might just survive this.

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  • In 2005 I was telling people that I thought the NHS had 10 years left. In 2010 more friends agreed that it had 5 years. Now people are talking about April. I won't be sad to see it go as being an NHS GP is killing me - but I am scared scared scared that into the grave with the NHS will go the pension pot that Ive been paying into for 25 years. Who will be left to fight for it? I'm preparing for the biggest act of daylight robbery in history from the 'all in it together' austerity brigade.

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  • @ABOVE

    I feel for you with regards to the pension.... im not sure what would happen to previous contributions if the scheme did go belly up....... technically its backed by the govt but relies on the working bots to prop it up.....

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  • Anyone who thinks that a public sector pension will be there is in for a shock - just look at Greece. The governments of the west have been over-promising and under-investing. None of them has a plan for the baby-boomers hitting retirement, and now pensions, healthcare and welfare are all going to break. Time for plan B folks

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  • I am voting with my feet and quitting as a Partner early 2016.
    For me the rot started with the failure by politicians and the profession to recognise good things such as the GP co-op system for OOH care, demonstrating complete ignorance when they priced OOH cover at £6000 PA for a full time GP in the 2004 contract.
    The contractual requirements have made GP a miserable career with emphasis on processes. The proliferation of abbreviations for 'services' and everything else is a red flag indicating a chaotic service hiding behind soundbytes.
    When conducting consultations with patients began to be interfered with by QOF etc (enhanced services so say dreamed up by 'us' ie GP's who should be managers are no better), I knew the end was nearing.
    There is no time left for intelligent thinking, generating new ideas or actually doing teaching in a sensible way (what was wrong with the apprenticeship model?).
    I predict a salaried service as that is the only way GP's will be freed up to do what they are trained to do (we were once called 'experts in the consultation'). The managers can then get on with what they are good at and leave us to do our job, as well as the other jobs we have been given such as public health dr, social worker etc.

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  • Agree with all the comments which is why I too am voting with my feet and quitting as a Partner early 2016.

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  • Divorce and settlement?
    There will be none as there is no prenupt.
    And we created this situation ourselves :- with our leaders with no backbones, Infighting, Some sucking up to PCTs and helping themselves & also helping to close down practices
    In my CCG (PCT) Medical Director (not CQC) helped PCT to close down four practices to meet government agenda & lo behold two of the practices MD grabbed for himself. Outgoing GPs are so in fear of GMC that they can't even talk about this. When I questioned outgoing Chief Ecxevutive of PCT I was told in no uncertain terms "to keep out of it". Of course I am still writing to him to get some answers on these GPs behalf.
    Unless we do something fast, we as traditional GP species is a thing of the past

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