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Why contract has me thinking of emigration

As an experienced 37-year-old GP who is currently completing a period of mutual assessment for a partnership in semi-rural Nantwich, Cheshire, the new contract fills me with dismay. I voted against an unpriced contract and I am now coming to understand why.

Due to a vacant principal's position during the baseline period for the global sum equivalent we had assumed our earnings could only go up. Despite this vacancy we have found we will still require a minimum practice income guarantee, and it will be April 2006 before we match current earnings ­ which even with a full complement of partners are only 75 per cent of intended net remuneration.

The date of this anticipated financial milestone assumes that we hit our 899 aspiration/quality points ­ including the non-evidence-based advanced access bribe ­ but as we are being pushed in the direction of a clinical computer system that none of us are familiar with, even this income is not guaranteed.

We are three (formerly) enthusiastic,constantly learning,innovative partners (all in our 30s) who believe in skill mix, public health initiatives and delivering high-quality care. Unfortunately, we cannot work for the next 24 months in an atmosphere of financial siege.

Like many of our colleagues, our expectation from the contract was that in return for changing the way we work ­ I believe that the misused terms are modernising and quality ­ we would get a fair pay rise and a better work-life balance.

It now appears workload will stay the same ­ due to the time spent ensuring data is 'correctly' Read coded ­ but we will have less clinical freedom and suffer lower earnings.There is also no benefit from relinquishing out-of-hours as I am now lying awake due to sleepless nights worrying about earnings and will have no money to spend during my free time.I believe that, having stuck with the NHS, I deserved better than this.

When I leave, the patients of Nantwich will, once again, find that no practices are taking on patients, not that, under the small print, overwhelmed practices will be allowed to refuse allocations where most or all lists are closed.

I think the contract will do nothing for recruitment and retention and for improving morale, with the possible exception of making it easier to find locums. If devolution provides no solution I am thankful I am still young enough to emigrate.

What hope for general practice if a 37-year-old principal is feeling as manipulated and undervalued as I am?

DrKeith Malone



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