Talks over the break-up of the UK-wide GP contract are to begin within three months after the Scottish Government tabled plans to break away from the rest of the UK on the majority of GMS negotiations.
Scottish health secretary Nicola Sturgeon wants around three quarters of the total GMS contract to be negotiated separately for Scotland, to allow greater focus on public health and integrating health and social care, marking a divergence from the ‘market driven’ model being pursued in England.
Ms Sturgeon said the move was designed to ‘repatriate’ rather than re-cast the contract, and had been prompted by a wish to ‘protect the founding principles’ of the NHS.
LMCs have repeatedly rejected calls for a separate Scottish contract, including at their annual conference this June, amid fears that a break-up of the four nation deal would weaken individual negotiating positions.
But the GPC has warned of increasing pressure to break up the UK-wide deal from across the four nations because of the divergence in health policy brought about by the Health and Social Care Bill in England.
The Scottish Government said it wished to increase the focus on public health challenges such as tackling alcohol consumption, and said the move would also ‘assist the efforts to integrate primary and secondary care and health and social care’.
Ms Sturgeon said: ‘The work contract for Scottish GPs is currently negotiated on a UK basis. Given the scale of the challenges we face, and the changes in England, the time is now right to ask ourselves whether that is still appropriate. I do not believe that it is.’
‘The NHS reforms in England – which we have no intention of emulating – are a threat to the contract’s ability to ensure Scottish patients receive quality care. I believe that we should protect the founding principles of the national health service. I do not think we should stand by and allow a vital part of our NHS system to be governed by a contract increasingly tailored to suit a market-driven model we do not share.’
She added: ‘My proposal is not to recast the structure of the contract but instead to repatriate aspects of the annual negotiation in order to introduce change in some important areas – in particular public health and the standards of care set out in the organisational indicators – and to leave on a UK basis the indicators for good clinical care.’
‘I intend to discuss the options over the next three months with the BMA and others and will be keen to hear the views of GPs from around the country.’
Dr Dean Marshall, chair of the Scottish GPC, said: ‘We are interested to hear the Cabinet Secretary’s views on how the GP contract could be improved.’
‘We remain committed to the framework of the UK contract which has delivered significant benefits to patients since its introduction in 2004. The current contract already includes a degree of flexibility which enables the contract to be tailored to the particular needs of general practice in Scotland.’
‘While we welcome the open dialogue with the Cabinet Secretary, it is vital that changes to the GP contract are evidence-based and are negotiated and agreed with us as representatives of the GP profession in Scotland.’
Fellow GPC negotiator Dr Richard Vautrey said it would be possible to add greater flexibility to the contract without removing the UK-wide deal: ‘It’s for the Scots to decide.’
‘We need to see more of the details, but the reality is there are already larger elements that are country specific. We would want to retain the UK-wide deal.’
‘The concern we do have is that the changes in England are forcing the Scottish Government to take this stance. From their perspective many of the recent chances in the contract are very dominated by the English system, such as the QIPP indicators in QOF.’