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We must keep right to limit list sizes

So far, it is only the draft of the new contract that I have had time to read, nevertheless it seems pretty clear to me that whatever provisos exist for resolving list size disputes between a PCO and its newly subordinate practices, all the advantage will lie with the PCO.

Given their retained powers of assignment, it will be open to PCOs to manipulate practice list sizes. A PCO that wished to see certain practices decommissioned could destabilise them directly by a forcing them to expand their list disproportionately.

The present right of practices to limit list size to protect the professional and personal lives of the GPs and the quality of the service they offer patients should not be surrendered – and it seems to me some practices may not survive if it is.

Nearly everything that has been agreed in the new contract, whether for good or ill, cannot now be altered.

But it is possible that a determined insistence by GPs could save this traditional right or at least ensure meaningful talks whenever renegotiation might recur.

Although individual GPs and practices standing alone would expect to achieve nothing, this demand could find effective expression among quorums of GPs in individual PCO areas – and from there (before anyone has signed anything) it might be expected to find its voice at national level. After that who knows?

Dr Alan Kelly



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