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The new contract recognises the GP crisis – but it has a hidden agenda

Dr Kailash Chand

Dr Kailash Chand

Dr Kailash Chand BLOG_duo-3x2_LR

In the new five-year GP contract, general practice has finally received sufficient funding from the Government that, on the surface, claims to offer a solution to the incredible strain that has been undermining patient care for the best part of a decade.

Plans are laid out for an expanded workforce, for tackling the avalanche of paperwork and for rescuing practices that face collapse.

It also provides support for doctors buckling under this strain, with services to help address burnout and stress, and pledges to introduce a range of other professionals - such as pharmacists, physiotherapists and nurses - to the workforce, in a bid to help share the workload.

On the face of it, this is a credible vision, bringing together a number of different strategies in a genuine effort to help general practice.

This new contract is designed as an endgame – with the final stages seeing the GP workforce replaced with low-paid pharmacists, physiotherapists and nurses.

This new contract is designed as an endgame – with the GP workforce replaced with low-paid pharmacists, physiotherapists and nurses

It represents the first time in years the severity of the crisis has been recognised – and we should therefore welcome the additional investment and many of the measures agreed by the BMA and NHS England.

In particular, the pledge to fund indemnity for all GPs and general practice staff – something I have been pleading for, for a long time – is important.

But the big question is will these measures deliver what patients want: better access and sustainable services in their local practice? Will this lift the sinking morale of the profession?

I am old enough to recall when a new GP contract for GMS practices was agreed in 2004.

After the initial wave of happiness it didn’t take long for joy to turn to tears.

There was a gradual realisation that the political agenda was to break up the traditional model of general practice and move to a new business-like approach of providing primary care.

This model sacrificed GPs’ independent contract status, while killing off continuity of care.

I believe this new contract is a continuation of that ideology.

It is designed as an endgame – with the final stages seeing the GP workforce replaced with low-paid pharmacists, physiotherapists and nurses.

One of my bigger concerns is that all practices are being asked to join a network – designed on a business healthcare model, complete with clinical lead and governance processes – by July.

Large healthcare companies could step in and start running them, with GPs becoming salaried and terms and conditions being dictated by private providers.

With more than 100,000 full-time posts vacant across NHS hospitals, there is also the question of where the nurses and other clinical staff will be found to supplement GPs.

I hope I am wrong, but I believe that the new contract as it stands has a hidden agenda - and is not a panacea or saviour of general practice, despite all the pronouncements of its merits.

Dr Kailash Chand is a retired GP in Tameside

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Readers' comments (13)

  • Sadly hit the nail on the head.

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  • We all know what you say to be true. Public are sadly unaware.

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  • There will be no new money. Where are the new staff going to come from?

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  • The magic GP/paramedic/physio and pharmacy tree where they cost nothing.Whatever happened to physician assistants!!!!!That tree must have withered for primary care.(like the 5000 extra GPs).

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  • It’s a natural progression to extrapolate ‘killing off continuity of care’ to ‘killing off the more needy patients’.
    But isn’t that like MURDER BY ANOTHER NAME?

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  • Added to which the prohibition on providing private care alongside NHS services shows that entrepreneurial GPs are not wanted, only big corporations and wage slaves. From a profession to an assembly line in less than 20 years. People will not know what is denied to the many until it is gone. And the few that can access a real doctor: forget it unless you live in London - as the politicians do.

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  • I remember the Fradd Affair - getting out of nights and weekends was "a bit of a laugh" how the press loved that

    and the Emergency Break clause where the DOH could change any aspect of the contract at any time - the BMA negotiators trusted it would never be used except in national crises.... lambs leading lions

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  • precisely why i have at long last thrown in the towel, i cannot believe after nearly 30 years in the NHS without a break i will be able to sleep peacefully in my bed and not worry about reminding reception to recall joe for his renal function test the hospital requested before restarting his spironolactone. Thank the heavens above i am out I AM FREE before the NHS f's up my life any further. At least i can enjoy more of my life before i hit my 60s and not have any regrets. My children will see a happier dad and my wife will remember how how much fun it use to be in the old days, thats if the world itself does not implode before then!!!

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  • It seems to me that the main reason why the Government have agreed an indemnity solution is to progress their agenda to replace GPs
    They know that GPs would not take on the vast numbers of non doctors if GPs had to cover the costs of the mistakes etc that all these non doctors will make when they will be expected to make decisions!!!
    Sadly our colleagues do not understand the end game of “multidisciplinary teams” who are usually risk averse inefficient and “ GP informed “ clinicians!!!
    Ashok Rayani

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  • It will of course take time to produce the extra paraparamedical staff such as pharmacists and physios. In the meantime who will do the jobs that the delegated staff have been doing up until now?

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  • I also agree that further down the line networks will have to become one practice eventually and salaried . Bring it on because where will you find a salaried GP to work till 8 pm at night doing paperwork unpaid !
    It is also unrealistic time scales involved . Where am I to get medical indemnity. No one has said who to contact or register .

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  • Recent Pharmaceutical Journal article stated Southampton Uni pharmacy course closing due to lack of applicants.......!?!?

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  • This is not the end-game, the endgame as @9.17 points out is the formation of super-practices. Partnership will be reduced to John Lewis model. No autonomy, more patients, less continuity. And where will the GPs go? Out the door. There’s a reason why the GPs setting up the federations do little or no clinical work - they’ve created a monster they can’t handle. And those remaining will spend the next decade trying to go back to tradional sizes practices, in vain. The time to fight is now. This will be the death knell for general practice.

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