A ‘score draw’, was how Dr Tom Black put it. And while the GPC negotiator was talking about a separate contract settlement in Northern Ireland – a settlement which incidentally seems to be the final nail in the coffin of a UK-wide contract – he could well have been talking about the deal in England as well.
Whenever there’s a wide-ranging revision to the GP contract – and the 2014 changes cover a lot of ground – it can be hard to see the wood for the trees. Even several weeks after the deal in England was announced, medical accountants are only just beginning to pick through the detail, crunch the numbers and calculate what the changes will mean in the round for different kinds of practices.
The initial reaction from GP leaders was enthusiastic; the verdict from the grassroots much less so. A snapshot poll conducted by Pulse in the immediate wake of the deal found almost two-thirds of GPs believe it was ‘poor’ or ‘very poor’ for the profession.
Such concern is understandable, given the raft of GP-bashing front-page articles in the national press that greeted the contract announcement. Publishing GPs’ earnings, scrapping seniority pay and removing practice boundaries are all hugely contentious; to commit to all three at once was bound to cause alarm.
But as the dust begins to settle, there are real grounds for optimism too. On closer inspection, many of the most ominous proposals turn out to be less scary than initially feared. Out-of-hours oversight will not mean answering the phone round the clock. Published pay figures will be aggregated across a practice, not linked to individuals. And for many, being a ‘named GP’ will mean little practical change.
Not all the new responsibilities can be dismissed as simply formalising what GPs already do. The new emergency admissions DES, while funded well, will be a lot of hard work. And the long-term implications of GP practices being given one of four Ofsted-style ratings by the CQC and forced to publish it, combined with the removal of practice boundaries, could be huge in terms of patient choice. Who wants to be registered with a practice labelled ‘requires improvement’?
But crucially, where concessions have been extracted, they have been extracted at a price – most significantly, the transfer of funding previously tied to QOF targets into the global sum. If there was plenty of give, there was plenty of take too.
That is, after all, the nature of a negotiation, and perhaps the most heartening thing for GPs after last year’s imposition is that there was negotiation at all. GPs have every right to be uneasy about certain elements of the deal. But taken as a whole, it’s hard to avoid the conclusion that the GPC negotiators have played a difficult hand rather deftly.
Yes, Jeremy Hunt has been handed the headlines he was chasing. But while he was busy trumpeting ‘the return of the family doctor’, the GPC has nimbly unpicked some of the most disastrous elements of this year’s contract imposition, side-stepping threats of the return of out-of-hours responsibility and scoring an increase in core funding to boot.
Not an outright victory by any means then, but if the outcome was a score draw, it feels like one the profession can build on. If nothing else, GPs can end 2013 a little more optimistically than they started it.
