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What do you think so far? New contract timetable.

With the die now finally cast on

the new contract timetable,

Dr Brian Balmer wonders about GPs' current thinking

he situation is now clear: the contract will be presented to the GPC on February 20, and to the LMC conference in London on the following day. GPs will be balloted on the issue on March 20, with a closing date of April 11. Should negotiations be incomplete, or if they fail for any reason, GPs will be presented with possible alternatives to NHS primary care on February 21.

The situation represents a final deadline for this protracted saga.

It has relevance to all GPs as this may be the opportunity we need to redefine general practice and to restore some pride to the profession.

Here is the good news. The quality framework has been simplified to a single cumulative points score, allowing progress in all areas to be rewarded. There are five 'management', one 'patient experience', and 11 'clinical' categories, and it is not anticipated that GPs will have to alter their normal working patterns to achieve substantial rewards. The recording of specific data will become essential, and management and IT support will need to increase for many practices. Those who think this is too complex should record the number of decisions they make in an average surgery. They will rediscover how complex is the work they do!

New resources will be available from April 2003, particularly for IT (via the modernisation fund) and for locally enhanced services.

These may not be accessible as 'practice' allocations until legislative changes later in the year, but imaginative PCOs will be able to use existing routes to move funds to GPs and start investing in the service.

Control over workload

Less certain is GP control over workload, which can only come from a clear definition of the boundaries of primary care, and that might be difficult in the presence of secondary care dumping and the growth of GPs with specialist interests.

Private work will still be possible but I doubt if this will herald anything earth shattering, and I am unconvinced by talk of PCO staffed in-hours visiting. There will be an opportunity to opt-out of out-of-hours, but no timetable is available.

Good PCOs will recognise this as an opportunity to address recruitment and retention and will move rapidly to give GPs this option.

I am very concerned that allocations, 24/48-hour access, and pensions remain unresolved. It is probable that a reasonable pension deal will be forthcoming, and it has been agreed that all NHS work will be superannuable.

My view is we should trade

24/48-hour access for an end to forced allocations. That way we control workload and they get a political victory that is not difficult for us to deliver, and one that will soon tarnish in a wave of patient irritation at altered appointment procedures.

Will the average GP be better off financially under the new deal? I don't know, but suspect that for anyone hitting reasonable quality points the answer will be affirmative. I think this will still be the case when out-of-hours is dropped, as the nationally agreed loss of income will be much less than the current costs for many practices, and the future costs for all.

My greatest anxiety is the formula to be used in allocating the global sum. This will decide the basic income of all practices and no such system has ever been tried, let alone tested, over such a wide range of practices. It will be very complex, but how many will lose out under its spell, and how easily will it adapt to shifts in populations?

The contract will introduce a new form of commissioning within primary care, and traditional practices will be joined by PCO-provided services, and private sector franchises. The GP monopoly will end, but well-run practices will flourish, and no GP worthy of the name should be short of work in the immediate future. If this deal is good we should grab it and run with it, but it is essential that GPs vote in the ballot, whatever their views.

The GP monopoly will end but well-run practices will flourish ­ it is essential that GPs vote, whatever their views~

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