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Gold, incentives and meh

If ever there was a time to fight...

It’s now more than a month since the Department of Health issued its ultimatum over the GP contract – and for many GPs, it has felt like a phoney war.

There is no doubt the proposed changes would have a huge impact on every practice, with the QOF changes in particular likely to ramp up workload, and the phasing out of MPIG and Carr-Hill adjustments set to radically reshape practice funding.

But since the initial announcement there’s been little movement. GPC negotiators have made it clear they oppose the changes. But they have held fire on any detailed response until after the publication of the Statement of Financial Entitlements – which was expected any day as Pulse went to press and would signal the start of the Government’s formal consultation ahead of a possible imposition.

The news that the BMA is planning roadshows around the country to discuss the changes in early 2013 suggests negotiators are digging in. It is unlikely to be all over by Christmas.

In the meantime, as we reveal today, behind the scenes both GPC members and LMCs are agitating for a robust response. The talk is of some kind of bureaucracy boycott, perhaps non-cooperation with revalidation or the CQC, or maybe working to rule. But it is the suggestion that GPs could be asked to withdraw from commissioning that is most likely to grab ministers’ attention, coming as it does at a delicate moment in the transition from PCTs to CCGs.

The elephant in whichever room GPs meet to discuss the profession’s response is, of course, the ‘Day of Action’ debacle. The BMA’s industrial action over pensions – which somehow managed to annoy patients and attract negative media coverage while having little practical impact – was an unmitigated failure.

But that must not inhibit GP leaders as they determine their response.

For a start, as many argued on pensions, action targeted at bureaucracy is a very different prospect from action explicitly designed to interrupt patient care. A boycott of commissioning would be uncharted territory, and there are arguments against, but withdrawing support from controversial reforms would play better with the public and the media than stopping appointments.

Then there’s the sheer scale of the changes under consideration – and the DH’s bully-boy tactics in threatening to impose them without negotiation. The full long-term ramifications on practice finances are yet to become apparent, but they will be profound.

Worryingly, after the last GPC meeting, chair Dr Laurence Buckman wrote to GPs promising to ‘deliver tools and guidance to help you understand what the changes will mean for your practice’. That’s useful, of course – but also sounds a little bit like the changes may be a fait accompli.

The GPC and LMCs’ primary function is to fight for GPs’ terms and conditions, and if ever there was a time to fight for them, it is now. The BMA must consider using every weapon in its arsenal – even if, post-pensions, that arsenal feels a little barer than GPs would like.

Steve Nowottny is the editor of Pulse.

Readers' comments (8)

  • Tools - KY jelly.
    Guidance - bend over

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  • already given up hope NI GP

    At this stage i think its was all poor Laurence could do because lets face it,this government can after aperiod of "consultation" (ha ha )do what it wants.Boycotting commisioning is our only really credible tool left.and as you say quite rightly we would be doing this on ethical grounds as well as self preservation

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  • Boycotting commissioning is a powerful tool, and should be considered after an initial salvo of a total and countrywide boycott of any CQC related activity..another intervention that would not harm patient care in any way. To suggest, as some have, that boycotting commissioning would somehow reduce our influence is clearly wrong..we obviously have no influence over anything that matters to our profession now, and any new body tasked with delivering it would still need the support of all its GPs

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  • I agree we should boycott EVERYTHING to do with commissioning CQC revalidation, the lot. Only direct patient care should continue. We may have got it wrong over pensions but that could lull the government into a false sense of complacency over further industrial action on this issue, and as long as the punters can get in front of a doc, it won't matter as much what the Daily Blah says either. go with the mandate guys, and hold your nerve this time - no stopping until they back down!

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  • Commissioning activity could have been boycotted weeks ago. The problem the profession now has is the a significant minority who now have a vested interest and commitment to making CCGs work. The government has implemented a policy of divide et impere (divide and rule) via the back door and the profession will now find it very difficult to lobby in with a unified voice.

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  • Lets face it, getting practices to agree has never been easy at the best of times. Unless you get complete uniform rejection of whatever you are boycotting, people will falter and fear that their income will be at risk. Herding cats springs to mind.

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  • The DOH plans to introduce massive QOF changes at the very time that CCGs are due to go live.

    Faced with potentially massive and costly QOF changes all GPs can legitimately state that they are temporarily too busy with practice matters to participate in significant CCG activity. CCG Board Members, of which I am one, simply write to their Board stating that their partners have temporarily withdrawn their support for them being out of the Practice and that therefore they will have to have a leave of absence.

    Any GP who stepped up to replace their colleagues would have a tough job justifying their action.

    The duration of the temporary absence will of course be determined by the willingness of the DOH to stop dicking around.

    CCG Board Members will of course temporarily lose their CCG funding but given tax and superann deductions this is frankly not an issue.


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  • Drachula

    I want to fight, fight for getting it right for patients. There are a great number of contradictions and poor practice that we have to inflict on patients due to QOF (points mean prizes) already, and we are just going to get more. NICE is by and large irrelevant to GP populations and doesn't have enough ordinary GPs developing guidelines.
    What if I boycott the CCG? Who will do it instead? A locum? Certainly not someone who represents us. Then what? We lose income from QOF QIPP, but would we benefit enough from not needing to put the hours in? We do the work because it makes sense for practice income, and that is about it, because it doesn't always make sense for our patients.

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