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Independents' Day

'The 2004 contract has not kept up with general practice'

GPs want a simpler contract which will give them flexibility, argues NHS Alliance chair Dr Mike Dixon

The NHS reforms were meant to bring about a decentralised, primary care-focused NHS. But how can you be decentralised and primary care-focused if you have one standard, one-size-fits-all national contract?

There are a good few GPs who would like to go back to taking responsibility for out-off-hours services, and a few more who would like to go back to taking individual responsibility for patients. But the majority of GPs, I suspect, are sick of the red tape. They want to go back to a time when being a GP was more free. This is why GPs are so dissolutioned with the current contract, with half saying they would welcome a renegotiation.

Many GPs are looking for simpler contracts that will give them flexibility instead of hemming them in with tick boxes. The 2004 GP contract hasn’t kept up with general practice, and people quite rightly feel that the current system isn’t flexible enough. There are progressive practices who would like to offer more services, like in-house GUM clinics, or health advisory services in schools. The absolute priority must be to support these practices to take on more and to make it easy for them to do so.

I think the local contract is probably the best alternative. There would be a core contract, with core prices, that specifies the things that all GPs have to do - but there would also be a local contract which would prioritise local concerns and provide some flexibility for practices to extend and increase what they’re offering.

I don’t know what will happen in the immediate future, but it’s completely inevitable that the contract will go in the next 10 years. In a way, it’s happening already - look at Somerset, for example, who have said that they’re going to opt out of the QOF. It’s the beginning of the waters coming through the floodgates.

Dr Mike Dixon is a GP in Devon and chair of NHS Alliance

Readers' comments (9)

  • I agree a local contract that addresses the global issues and specifically covers local concerns and allows practices to be innovative and uncluttered to offer a high level of care .

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  • 'Many GPs are looking for simpler contracts that will give them flexibility instead of hemming them in with tick boxes. '
    Scrap 111 and all privately owned OOHs, £200 retainer/patient to us, £100 to our co-op, paid by HMG, £25 per consultation, £100 visit, indexed linked increases and Robert's my Mum's brother.

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  • It will never happen and any local negotiation eventually gets stamped on and stopped.
    The reason people go into politics is because they love meddling and telling everybody what to do. Such people always centralise control, because allowing local control is anathema to their desire to meddle and tell everybody what to do.
    That's why every new health secretary adds more and more demands, and despite saying the politically correct platitudes about giving local accountability PCGs then CCGs etc, actually does quite the reverse.
    General practice will never be free to improve as long as it is shackled to politicians and the state.

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  • The proposal of the 2004 contract was a core offer and local enhanced services to meet the needs of the population.
    It does contain the flexibilities Dr Dixon desires.
    what makes it currently unfit is the applicationof the contract:-
    a "GP will make more money" toxic Management attitude to LES being offered;
    the emergence of "super size" business with partnership profits touted in the Red tops as the norm for everyone;
    the political realisation that the taxpayer cannot afford an NHS 24/7 medical primary care system;
    inter professional politicking with NHS managers(disproportionately of a nursing background) favouring Nurse led initiatives on the basis of alleged equal performance and lower cost;
    A persisting lack of political vision as to whether a state health service addresses health Needs or Consumer wants;
    These are not going to be addressed by "new GP Contract" It serves only to further paint the GP as the cause of the failure of the NHS , not the pinch point of a failed pyramid banking model of state health care.

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  • Vinci Ho

    This kind of argument is only meaningful if the attitude and behaviour of the NHS local team and the CCG concerned , are 'different' (not the current fashion of being short sighted and passive). Somerset is perhaps one of this..........though I still worried some kind of retribution from the top because it is sticking up as the 'odd one out'.

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  • The days where a single payments - eat all you can buffet culture - where Primary care has to provide unlimited access to patient demands is unsustainable.

    There needs to be a retainer fee per patient - to allow for administration and some primary prevention work - ie immunisation and smear recall etc.

    After that - a fee per appointment system - which would force the DOH to launch a national advertising and education campaign to reduce demand.

    Why reinvent the wheel at every GP practice and CCG level - when a nationwide co-ordinated approach can lead to patient education and ramp back demand.

    Enhance service etc can pay for local and national programs required.

    This is what you need to implement Dr Dixon and BMA negotiators and resign if you fail to deliver this.

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  • I am sick of the time wasting in Primary care that comes from unlimited access.

    Care home ring for urgent visits for a drowsy not eating patient, who was up half the night, now is sleeping, and by time you see them they are awake and had lunch.

    Relatives who never see their parents - guilt ridden, and ringing to just go and check my mum is ok, and she is weak and not drinking. She isn't drinking as she needs a carer to give her fluids, and a relative or carer to look after them - however the family prefer to live 50 miles away and ring once a week.

    Any cr@p is the GPs job to sort out, from lonely patients to fill in pointless forms for other organisations that increase their own bureaucracy and expect GP letters for everything.

    A charge for a consultation may focus the mind - do I really need an appointment - if so welcome and we will try our best to look out for you, form filling and time wasting stops us from seeing the real sick patients in a timely manner, and prevents time for more proactive care.

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  • not a good idea.
    more cost
    more paperwork
    more confusion
    more division of the profession

    Not a good idea !!

    When are we going to act together with one voice ?

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  • It all depends on the local management. Our practice in Dorset was able to negotiate contracts with the Health Commission management for in house audiology & physiotherapy and we managed our own chiropody provided by the local NHS. The results were that we could fit a hearing aid in 2-4 weeks (local waiting time then was up to 18 months) at a lower cost than the NHS provider, physiotherapy waiting time was 1-3 days (NHS equivalent 6-8 weeks) and our chiropody service was able to provide regular supervision and treatment for all our vulnerable patients (diabetics, rheumatoid, PVD etc) and regular treatment up for existing patients every 6-8 weeks.

    Once the PCT took over we were bludgeoned to reduce services and increase waiting times in the name of "equity" (equity for whom I asked) by "managers" who seemed to have no understanding of general practice and no solution other than "waiting lists". Our hearing aid service had to fold when digital aids were adopted as the imposed requirements of the service required the use of software we were not allowed to use and the RNID would not approve our private audiology technician (who had been fitting digital aids for many years). After I left the practice the other services were discontinued no doubt as a result of further pressure to achieve equity (PCT speak for levelling down).

    The result - no savings and worse service for patients. Is this the New NHS?

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