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Voting on the new contract ­ first we need to see Plan B

Dr Charles Simenoff says the GPC must urgently discuss alternative models for general practice so GPs can make an informed choice on the new contract

believe the time has come for the GPC to unveil Plan B ­ a secret list of alternative models of general practice GPs could operate if the contract is rejected ­ and I am disappointed to hear that they are refusing to bow to overwhelming popular demand over this.

Let us look at the background to the negotiations. In early 2001 we were informed by our GPC negotiators that they were having great difficulty in sorting out the many problems of NHS general practice. These included increasing workload, pension arrangements, the lack of GPs due to GPs leaving and few people entering the profession, and the unfair 'bribing' of GPs to go into PMS.

The profession was balloted on resigning from the NHS if a new GMS contract was not in place by April 2002 and if full GPC representation for PMS GPs was not met.

The profession voted 86 per cent in favour of resigning if these two conditions were not met and the GPC negotiators set to work to obtain a new GMS contract. The Government delegated its role to the NHS Confederation, the body representing NHS managers.

By April 2002 a new contract was not ready but the GPC negotiators had produced a contract framework. Again the profession was balloted and voted to continue through 2002 in order to produce a fully costed contract for implementation by April 1, 2003.

As we know, this timescale has again slipped and it is highly unlikely that our new GMS contract will be fully implemented before April 1, 2004, which incidentally is the very day the Government proposed when it published the NHS

10-year plan in July 2000.

We now hope to have our new contract in the next two to three weeks and we shall be voting on it in early April. By then it is expected that 40per cent of GPs in the UK will be working to a PMS contract.

Our negotiators have worked long and hard over the past two years to achieve a good GMS deal and they deserve our thanks for their efforts. However there is a great feeling of distrust among GPs that the Government and its PCT appointees do not have the interest of GPs at heart and that the promised resources will not get to practices over the next two to three years.

We have seen the Government act in bad faith over the past two years (see box) and we are therefore going into a ballot on our new GMS contract without knowing what the alternatives are or what could happen if the new contract is rejected. GPs across the country are fed-up and disillusioned. There is now a recruitment crisis with many vacancies unfilled and practices being allocated patients, even though they have closed their lists. New GPs are not committing themselves to an NHS contract that will still be open-ended with the Government being able to change it without consultation.

Our consultant colleagues rejected their new contract as it was felt they would lose clinical and management freedom even if they were paid more. GPs are concerned that this could happen to them. The GPC has had a strategy group looking at other options if the new contract is rejected.

We need to have these options, that is, the 'Plan B' before we vote. We would not buy a house or sign for a car without studying the alternatives, but we are being asked to vote for a new contract which will decide our working conditions and income without being able to look at any options.

Manchester LMC discussed the arrangements for the new contract at our last meeting in January and the overwhelming feeling was that the GPC should give us alternatives on February 21. Having spoken to colleagues in other LMCs in the north-west of England, I have heard similar views. It is only fair to assume that this view is held nationwide and has been expressed by many GPC colleagues.

So I can only repeat I am disappointed to hear the GPC negotiators are not listening to grass roots opinion and have no intention of publishing the alternatives along with the new GMS contract so that GPs can make an informed choice when voting.

How the Government has failed GPs recently

 · Failing to adequately fund appraisal

 · Failing to fund safe havens for seeing violent patients

 · Failing to fund occupational health schemes for general practice

 · Failing to fund pension arrangements for non-principals

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