This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

My gut is certainly reacting to this new contract

Copperfield

copperfield duo 1500x1000px

copperfield duo 1500x1000px

There’s a lot to digest in the new contract, and there’s obviously more to come. So reactions at this early stage are going to be more emotional than rational. Then again, GPs are good at gut reaction, it serves us well in the day-job. And I have to say, contract-wise, my personal GI reflex is definitely dyspeptic.

Yes, there are some good bits. Though there is so much smoke and mirrors that, while I’m cautiously accepting some cash in one hand, I’m nervously checking my credit cards with the other.

But. In fact, lots of buts. So many, in fact, they will have to spill into other columns and blogs. And the biggest is that gut reaction. Frankly, for me, it’s a queasy mix of clear defeat and vague insult.

Defeat because there is nothing in the document about controlling workload, the single most significant issue facing GPs today. Remember those halcyon days when the GPC was going to negotiate some kind of tap on the torrent of endless tasks and appointments? This contract is a tacit admission that it simply cannot be done.

The other defeatist admission is that GPs can be conjured up in adequate numbers. Not now, maybe not ever. Instead, the solution is to throw other staff at us in an illusion of help – staff chosen because they’re available and will make pleasing headlines, and if you think I’m making that up, check out P11, 1.8, (i) and (iv).

And insult? Listen. I already belong to two proto-networks, both involving legal agreements, one employing a pharmacist and quite probably neither fulfilling the contract network criteria. So, for starters, we’ve got to unpick that little lot. Then we’re going to have to choose and agree new network partners, solve the Rubik’s cube of geography, define and agree the legalities, sign everyone up, decide who’ll get the funding and appoint a lead. By 15th May 2019.

This is a joke. I have a full time job. I’m busy. Too busy. Workload, remember? Setting an insane deadline shows that, not only has the workload issue been ignored, it’s still not taken seriously.

I feel defeated even before I’ve begun. And dyspepsia? Frankly, I need a bucket.

Related images

  • copperfield duo 1500x1000px

Readers' comments (12)

  • This contract is a tacit admission that it simply cannot be done.

    --- no, 'cannot' is the wrong word. Won't is more appropriate.

    Unsuitable or offensive? Report this comment

  • this is a can of worms. not just a normal sized can but a 'party seven' sized one. (does anyone under 50 understand that?)

    Unsuitable or offensive? Report this comment

  • There is another defeat - the fight against the paperwork. Previous QOF indicators, whilst not exactly the most popular thing in the world, at least involved patients.
    The new QI indicators turn out not to be Quite Interesting at all but look rather the old QP indicators dusted off and re-arranged by the RCGP.
    Each network will also require a clinical director working quarter time. That could be almost 400 WTE GPs managing the networks, not seeing patients. It also seems likely that the network itself will take some time from practices.
    The killer for me is the new services that the Networks will provide. Med reviews, nursing homes etc. There will be loads of new pharmacists and NHSE will chip in 70%.
    So I will be paying for 30% of these, which seems to be bloody generous of me. Presumably this is paid for by cutting other services in the practice.

    Unsuitable or offensive? Report this comment

  • Indeed Gavin Jamie - I reckon about £3 to £4 per patient is what we will be chipping in to fund the extra staff.

    Unsuitable or offensive? Report this comment

  • I thought I was just getting stupid [ having once done advanced maths], GP land was getting so complex, I was getting confused. I am delighted to see that even old Coppers [ astute as he is] is finding it smoke and mirrors.
    Thank goodness I am leaving, this is all too much for me.
    I hate having to find 30% for new staff for networks I must join. Why?
    But the BMA and RCGP think this is a good thing. So what are we missing, Copperfield ?

    Unsuitable or offensive? Report this comment

  • What you are missing is that neither RCGP or BMA are your friend, but have joined the darkside.

    Unsuitable or offensive? Report this comment

  • Let common sense prevail

    I love Copperfield and enjoy my regular dose of cynicism, but I have to say the comments are very negative. If we don't want the government to pay (most of) our indemnity, or to heavily subsidise staff who may save us some headaches, we only have to say 'No, thanks very much'.
    There are some positives in the renegotiated contract, indeed it is the first time that I have felt some positivity about the future of GP in a while.

    Unsuitable or offensive? Report this comment

  • Dr BG had government indemnity look what it they did to her.We still have no details' month till roll out and no details.Seems like the same kind of substandard incompetent management as the Brexit debacle.

    Unsuitable or offensive? Report this comment

  • The reality is that this is a Trojan horse, the Networks will take on more responsibility, massive bureaucracy, and untested staff at a cost to the practices whilst losing experienced Colleagues as Clinical Directors , nevermind the opportunity costs of navel gazing (peer review) meetings to negotiate between rival practices (network colleagues) and presumably CQC et all.It seems the Clinical Directors and ‘lead practices’ will take on former CCG roles.
    I think practices should think long and hard about staying outside the networks until they are fully resourced.
    As usual the GPC have let General Practice down

    Unsuitable or offensive? Report this comment

  • And what to make of the Balancing manoeuvre? I interpret that as high earning partners having money taken off them and redistributed to the "network" and lower achievers - that is, money taken off PERSONAL INCOME and given away. This apparently will improve public confidence. What it won't improve is me working hard to be a high earner- I'll employ any old twerp in any role, reduce my income and sit back while the rot spreads.

    Unsuitable or offensive? Report this comment

  • Agree with carfentanyl. i will work less to keep my income below the threshhold. don't want to be targeted by conmen.

    Unsuitable or offensive? Report this comment

  • Plus they snuck in banning private patients. Many practices have responded to falling nhs income by running a small private practice ( not for their eligible nhs patients- but others and fully separately run -in doctors own time).
    With less than 6 weeks to go before this is implemented “further details to follow”-
    This doesn’t apply to hospital doctors or Babylon ...
    how can they dictate what GPs do in their own time? “You have to choose either nhs or private not both”
    What do we dissolve our business now? Plus shoot your selves in the foot NHSE as my nhs runs at a loss that is covered by the private work... so I know which I’ll choose..... maybe that was their intention- drive more doctors out?!
    Before anyone judges.... I go over and above in my nhs work- 15 hour days trying to do everything for everyone....because I care for our patients... but not at this cost! And 25% of appts blocked for nhs111? Accessis shite as it is.... I can’t deal with more patient complaints about not being able to book routine appts?!

    Unsuitable or offensive? Report this comment

Have your say