The Department of Health’s GP contract imposition forces GPs to choose between maintaining funding levels and ensuring patient safety, GP leaders have warned.
The imposition, announced on Monday, made few concessions to GPs, pressing ahead with plans to introduce higher QOF thresholds, new QOF indicators and four new directed enhanced services. The Government will also continue with plans to phase out the Minimum Practice Income Guarantee (MPIG) over seven years from April 2014.
The GPC said that practices will not be able to ‘chase every single demand placed upon them’, compromising patient care in the process.
It also warned that these changes will reduce patient access and staffing levels.
GPC negotiator Dr Chaand Nagpaul said: ‘The important message to practices is that they need to start to develop strategies to ensure that they are prioritising their workloads in the most effective way for patients and within safe limits.
‘What practices must not do is try to chase every single demand placed upon them, and in the process unwittingly compromise patient care.’
GPC chair Dr Laurence Buckman warned that the final contract terms will ‘divert valuable clinical time and resources towards box ticking and administrative work’ and will make it difficult for practices to maintain services at a time when many are already struggling under a rising workload within shrinking resources.
He said ministers have ‘completely failed to take on board the concerns of thousands of GPs’ about the impact of the imposed terms.
Dr Buckman said: ‘A BMA survey that drew nearly 8,000 responses demonstrated that the impact of these changes would result in GPs considering reducing patient access and staffing hours.
‘It is unacceptable that the Government has ignored this weight of opinion and ploughed ahead with so many ill thought out proposals that run the risk of destabilising patient care.’
Dr John Hughes, honorary secretary of Manchester LMC and a GP in Crumpsall, Manchester, reiterated the warning to doctors.
He said: ‘I am disappointed that they are imposing things that don’t have any evidence base such as the dementia screening. We actually don’t have services to refer people in to. There is a lot of talk about how this will improve care by early referral but there is no point in making us do it until there are services in place, nationwide.
‘I am also very concerned about the raising of thresholds on the clinical QOF. They are demonstrating ignorance. It will result in overtreatment of hypertension patients which may result in increased falls, fractured neck and femur and serious consequences.
‘It will be up to the individual practitioner to decide whether they chase the extra points or whether they act in the best interest of the patient, in which case you wouldn’t. But the problem is that we are having huge amounts of money taken away.’
Dr Nigel Watson, chair of Wessex LMCs, added: ‘We will have to look at what is achievable. Practices will need to look at what they doing if there are things here that are a priority, then maybe need to stop doing other things to achieve it.’
Meanwhile, GPC negotiator Dr Peter Holden warned that the imposition will result in a GP workforce crisis, as the Government cannot continue to get away with asking GPs to ‘subsidise the NHS’.
He said: ‘The Government will rue this day. You cannot keep financially abusing GPs. The thing that really annoys GPs more than anything else is the duplicitous way in which they have negotiated – they had no intention of coming to a deal, none whatsoever – and the fact that they are not even paying the expenses of the NHS.
‘Because the Government controls entry to medicine, it controls the value of the contract. It controls everything, in other words we are utterly ripe for exploitation.’
He added: ‘GPs are in shortage and under normal market forces that would push a pay rise and that would make the job attractive and market forces would correct it. The Government is trying to buck the market because it suits them, but a lot of GPs will turn around and say “why should we bother”. But we need the workforce crisis, because the only way we have ever managed to pull off decent contracts is in times of workforce crisis.’
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