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Welsh GPs win deal on contract losses

The new contract and its implications were hotly debated by GPs at the Welsh LMC conference – Ian Cameron reports

The Welsh Assembly has agreed to cover any shortfall in income suffered by GPs in Wales as a result of using national disease prevalence data to determine their income.

GPC Wales chair Dr Andrew Dearden said the assembly agreed the deal after recognising that using country-specific data was an anomaly in a UK contract. He told the conference of Welsh LMCs: 'If there is a financial loss, it will be redistributed to GPs and compensation will be paid.

'We feel country prevalence does disadvantage Welsh GPs. Any shortfall will be made up but it would have been nice not to need a review.'

Disease prevalence data will be used to calculate the amount GPs are paid for each quality point.

GPs at the conference had condemned the use of national data on prevalence, voting unanimously on a motion stating the English Department of Health's decision not to use UK-wide information was 'manifestly unfair'.

GPs argued practices in Wales, which has higher levels of disease, would have to work harder than their counterparts with the same number of patients in England to get the same money.

LMC representatives said the move could singlehandedly scupper recruitment and

retention of GPs in Wales.

Dr Gareth Hayes, medical secretary of Bro Taf LMC, told the conference: 'Recruitment is going to suffer. If we have 100 patients with diabetes and are getting less than a GP in south-east England GPs are not going to want to come to Wales.'

Dr Phil White, chair of North Wales LMC, said the use of national data suggested there was a 'serious calculation problem'. He added: 'There's been no great change in GP

numbers or the size of the population so there's no change in disease prevalence either.'

Dr David Roberts, chair of Dyfed Powys LMC, said he 'deplored' the neglect of the people of Wales which was inherent in the decision.

No more contract votes

LMCs unanimously rejected a call for GPs to be able vote again on the contract because it bears 'little resemblance' to the deal they originally accepted.

GPC Wales chair Dr Andrew Dearden described the motion as the most important of the day.

In his opening speech to the conference, Dr Dearden acknowledged there had been 'some winners and some losers' under the new contract but said action was under way to correct the problems.

The BMA's Health Policy and Economic Research Unit is to investigate the financing of the global sum in Wales following the rise in the number of practices requiring MPIG correction factors.

Dr Dearden said: 'Global sums have dropped from what they were. We need to be sure that everything has been kosher and that it's a redistribution.'

He added: 'We recognise the contract is not perfect. We knew there would be areas that would be difficult, and not all areas have been solved.'

Opt out by September call

Every practice in Wales should be allowed to opt out of out-of-hours by the end of September to ensure new systems can cope in time for winter pressures, Welsh LMCs argue.

GPs said they feared services would be inadequate to cope with demand and practices and A&E departments would have to cover the gaps if health boards waited until the final opt-out date of December 31.

Dr Satish Narang, a member of Gwent LMC, said: 'The question is how much local health boards understand about out-of-hours. It's complex and needs to change.'

'LHBs are new bodies and have a lot on their plates and the service could fail if started in November or December.'

Dr Terry Stuart, a member of Bro Taf LMC, which also called for health boards to take over responsibility by October 1, said patients will think any failures will be GPs' fault because it is they who are opting out. 'We should stop talking about opting out and just say the Welsh Assembly is putting in a new system.'

Small practices' anger

GPs condemned ministers for removing economies of scale factors from the Carr-Hill formula that would have helped small practices.

Welsh LMC representatives accused the Government of trying to discourage singlehanded practice.

Dr Heather Evans, medical secretary of Dyfed Powys LMC, said her 1.5 whole-time equivalent practice had the same number of staff as a neighbouring four-partner surgery.

'Despite the fact we have fewer patients we still need those staff,' she said. 'Small practices are small by need of their geography. We were told that Carr-Hill would recognise rurality but every single practice in Powys – the most rural county – requires a correction factor.'

Dr Tony Calland, a member of Gwent LMC, said small practices were a victim of the Government's 'sausage machine'.

'It was ministers who took this out because they did not want to encourage continuation of singlehanded practice,' he said.

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