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Bob Senior: The new contract provides some certainty but could give unwelcome results



My initial reaction, obviously we can’t put hard numbers on it, is that there’s one or two bits that are interesting but it does make me question how it is going to work.

For example the named GP for all patients sounds good in theory until you think we have an increasingly part-time profession, with a high proportion of salaried doctors who come and go. So a patient could surely have an accountable GP almost changing with the wind?

I think it’s a shame that they’ve only chosen to continue the unplanned admissions enhanced service for another year. Practices are putting a lot of time and resource into that, and there’s still uncertainty about whether they’ll pull the plug a year down the line.

They also said they were going to re-examine the Carr-Hill formula to make it ‘better reflect deprivation.’ The challenge with that is, what sort of area? How big a geographic location are they looking at?

Picking a city at random: Oxford, most people think it’s all Inspector Morse, gleaming towers and old jags, etc. But there are pockets in Oxford which have very high levels of deprivation, so if you look at it as a whole it could present a completely different picture to certain wards within that area.

So the simple statement ‘it will better reflect deprivation’ is a bit of a misnomer, we need to know how fair and accurate it will be in truth.

The money from PMS reviews being invested in primary medical services is good, because there was a lot of concern about the lack of clarity over that. So at least we have some certainty there – quite how it will be invested remains to be seen.

Guaranteeing maternity and paternity pay, again it provides certainty, and it’s a step in the right direction, even if the amounts they’re funding are perhaps not as adequate as they need to be. It’s certainly a lot less than it’s going to cost to back fill a locum in the modern climate – if you can find a locum that is.

And I think there are bits in the contract which are ill-conceived – in particular the bit about publishing GP income which could give some very unwelcome results.

Because there’s a very unequal market out there, and very little transparency about earnings. So you could now have a doctor in a difficult part of the country, on a salaried job, look at this and say “darling, where’s Wiltshire? Is it nice? Do they have good schools? Why am I working here for this, when I can go and work there for a lot more?”

I’ve said to the Government before, that they should be very careful with what they wish for because it might not give them what they expect.

Bob Senior is chair of the Association of Independent Specialist Medical Accountants and head of medical services at Baker Tilly.