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GPs go forth

The mystery of paragraph 3.12


We need to talk about the elephant in the room. That being mysterious para 3.12 of the Network Contract Direct Enhanced Service Draft Outline Service Specifications, with which you are all now painfully familiar. Except with mysterious para 3.12, which, for some weird reason adding to the overall mystery, doesn’t seem to have registered.

It might be that we are self-consciously ignoring it, like most elephants-in-rooms. Or maybe, despite being an elephant, it has genuinely been overlooked, because the Draft Specification room is so overwhelming.

Whatever. Mysterious para 3.12 is in the ‘Enhanced Health in Care Homes section’, and this is what it says:

‘In future years we will consider whether and how to bring out of hours provision under the authority of PCNs, to ensure more effective and coordinated out of hours support for care homes.’

They’re going to need a bigger shovel

So, pick yourself up off the floor, get back in your chair and try to stay calm. But yes, mysterious para 3.12 does appear to suggest that PCNs might have to take back OOH care in residential homes, and there’s enough wriggle room ambiguity in the phrasing to suggest that this responsibility might extend to all OOH care. And that would put you and I just one doctor/noctor-off-sick away from having to do it ourselves.

I’m old enough to remember doing my own OOH work, and how the 2004 contract enabled us to opt out, transforming GP life overnight. An undisturbed one. Since then, OOH workload has increased horrifically, through the relentless rise in public expectation and via various Government demand-stoking initiatives. Taking it back would be unthinkable.

Except I’m thinking about it now, because of mysterious para 3.12. Which leads us to why mysterious para 3.12 is so mysterious. It’s because, while the whole para is about wanting GPs to take responsibility, nobody seems to want to take responsibility for para 3.12. Pulse has tried to establish what it means, exactly, and why it is there, but with absolutely no success. No one seems to be able to fathom how para 3.12 came to be, nor what its implications are, or, if they are, they’re not prepared to say.

It’s as if they are all holding their noses and averting their eyes as they step over or around a noxious steaming pile that has been dumped in the middle of their lovely specifications. Probably they blame the elephant.

The GPC can’t ignore it, though, as they try to clear up the specification mess. And I think they’re going to need a bigger shovel.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield

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Readers' comments (17)

  • Some might suggest that age has diminished your adventurous spirit!
    Mind you, the caution that comes with life experience does tend to modify the careless gallop into the unknown!

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  • Yup - spotted here. I'm also out spotting non Spec, non DES potholes as there is more to the 20/21 deal than just the rotten specs. There's the rest of the package including your pay award. And to my mind it all has to work, it has to support your core work, and your practice bottom lines - not just your top lines have to be in healthy surplus not deficit.

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  • Thanks for your diligence Michelle, we need you. Lets be fanciful for a moment and suppose that a keen new GP partner could be found to augment my straining maxed-out (And excellent) practice team: unless there is a significant rise in core funding this would just result in a substantial pay cut for me and the other partners with little impact on workload. I can achieve a big reduction in workload for the same loss of income by dropping to part time

    The paltry sum that General Practice receives through capitation for a patient is not even enough to buy a coffee once a week. Our negotiators need to get real! The hospital is paid as much for a single appointment as the GP gets for TWO YEARS unlimited contacts

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  • The whole contract is a bid steaming pile of excrement,and needs to be deposited where excrement belongs .How did the GPC let this one through unless they were full of it as well.Afraid non cooperation with what ever they come up with after they regurgitate it as well.YOU CAN’T POLISH A TURD however many times you polish it and serve it up.IT WILL ALWAYS BE A TURD.Bin the contract.Go back to the red book pay per process only, the block contract is finished.But so is GP land anyway.It all stinks.

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  • The GPC and BMA has failed us. The environment we practice in is no longer the same as it was 10-20 years ago. It is toxic.
    People will just quit if OOH is brought in.
    Once again, one sided contract changes. I think it is time to take us all private. Take us the dentist's way.
    The unlimited demand and block contract stinks.

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  • When some name is that long and contract unreadable, you know they want to con you.
    Smoke and mirrors. GPC's big fail.

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  • Cobblers

    TC Article 2/1/20. Pulse noted this then.

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  • David Banner

    The DOH would dearly love to dump OOH back on GPs.
    They bitterly regret giving us the choice to opt out in 2004, not realising that 99% of us would do so. They massively miscalculated, thinking most of us wouldn’t stump up the opt out fee, not realising that the fees we were already paying amounted to far more.
    So opt out and enjoy a pay rise, who would say no to that?
    Since then, demand has mushroomed, and the cost of running the service is ruinous (assuming you can find any doctors willing to take the shifts, which increasingly they won’t).
    Criticism mounts, but the DOH can’t get away with foisting it back on burnt out under-doctored practices.
    Which is the genius of PCNs.
    Force practices together to encourage working at scale, soften them up with the illusion of better funding, disorientate them with a deliberately unworkable DES, fake contrition by watering down the DES, then when they are in self congratulatory mode sneak in the OOH, initially for Care Homes, then everyone else.
    And many GPs are so spineless they might just get away with it too.
    Yes it will cause a mass exodus of older partners, but as we know, that’s what they secretly want.
    In 5-10 years you have a salaried service dancing to your tune, working around the clock, with no pesky partners blocking your grand plans.

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  • Just to wind everyone up more- Where I do GPSI sessions in dermatology a consultant service has come in to see 2ww patients (the easy ones). They see one every 12 minutes and refuse to see ANYTHING apart from the lesion referred. £80 a patient so £1280 for a morning. The biggest joke? On one session they referred all 16 patients for surgery. Our lack of value of ourselves is terrible. Time to go private

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  • DrRubbishBin

    The only rational way to work as a GP in the U.K. is to be a locum - if you have a formal written contract with anyone you are going to get screwed

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