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At the heart of general practice since 1960

You're about to make or break the NHS and BMA

As GPs enter the final few days of voting in the ballot,

LMCs executive Dr Brian Balmer summarises what he

considers to be the contract's strengths and weaknesses

Ps are making their individual decisions on the proposed new GMS contract, and their collective will has the potential to alter general practice for the foreseeable future, determine the long-term status of primary care, and possibly make or break both the NHS and the BMA.

This is an exercise in true democracy with implications that few of us will see again. Doctors will make their decisions based on the perceived advantages for their practices, patients, their income, personal lives and that of their families. Other influences will be the effect of the recent Carr Hill shambles, mistrust of the Government, and general confusion over an increasingly complex package.

I am not going to explore the technicalities of the allocation or pension deals on offer; this ballot is about our future in the NHS and a short-term narrow view is not appropriate. I would, however, like to offer a rapid summary of what I consider to be the good and bad points of the contract.

There will be a substantial increase in primary care funding if the contract goes ahead, although how much will reach GPs is uncertain. This investment is clearly at risk if GPs vote No. The loss of out-of-hours responsibility in December 2004 is long overdue and must be welcomed.

I have a slight concern that PCOs will struggle to organise a service and that it could prove to be a drain on future resources, but loss of out-of-hours is a real victory. Of course if you vote No to the contract you will sacrifice the chance to drop out-of-hours.

The attempt to divide workload into definable and therefore funded segments, with the introduction of enhanced services, could provide a solution to the decade-long debate on core services, but will again be a test for PCOs. The future arrangements for patient allocations are truly awful and GPs cannot control workload if there is no control of list size during a recruitment crisis.

There is no doubt that pensions will be greatly improved with the new deal, though how anyone can be precise in predicting future trends through a maze of uncertain variables is beyond me.

The development of practice-based quality-centred contracts is unarguably the future for primary care, but GPs will lose their monopoly provider status and will be competing in a new marketplace. The implementation of the contract, and commissioning and providing primary care amid increasingly aggressive acute foundation trusts, will be a test of PCO capacity.

The current configurations, with some notable exceptions, are unlikely to flourish. PCO reform will be an inevitable consequence of a Yes vote, and this alone should persuade some to vote positively.

Implementation of the contract will mean a massive improvement in practice management and IT, and probably an LMC-organised control of workload dependent on the availability of new resources.

'There is no money' must in future mean there is no contract and no expansion of primary care responsibilities.

A No vote will produce a drive to PMS with its short-term rewards and inevitable micro-management by PCOs within a shrinking unified budget. It will also bring a need for strong leadership from the BMA in an increasingly antagonistic NHS environment.

I do not believe the BMA currently has either the will or the capacity to conduct an industrial dispute. This is not necessarily a criticism, merely a statement of the facts, although a more overtly assertive stance, such as that shown by the special conference of LMCs, might have improved the present deal.

All GPs should take this opportunity to vote and therefore contribute to the shaping of our collective future. And I would urge everyone, when voting, to concentrate their minds not on the recent allocations disaster, nor on a dislike of the Department of Health and its unlovable boss, but on what they want for the future of general practice and primary care. The crucial thing when you vote is not to lose sight of the big picture.

Concentrate not

on recent negotiation disasters, nor a dislike of the Department of Health and its unlovable boss, but on what you want for the future of general practice and primary care~

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