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Coalition plans for GPs to shatter UK-wide contract

By Ian Quinn

Exclusive: The Government's plans to make GPs take greater responsibility for commissioning are set to drive a break-up of the UK-wide contract, with GPs in England to take on responsibility for out-of-hours while those in Scotland look set to escape it.

In an exclusive interview with Pulse, Scottish health secretary Nicola Sturgeon said policies north and south of the border were increasingly going their separate ways, and that contract negotiations would need to reflect that.

And GPC Scotland chair Dr Dean Marshall said the coalition Government's plans on commissioning and out-of-hours would place a fatal strain on the UK-wide contract, because of huge policy clashes between the Scottish and UK governments.

Ms Sturgeon told Pulse's guest editor competition winner Dr Georgina Brown: ‘Our first objective is to make sure the GP contract reflects Scottish priorities. Up until now we've chosen to negotiate on a UK-wide basis and that's served us reasonably well. But we'll continue to make judgments about that depending on how things develop.'

‘There's no doubt the models of delivery for healthcare north and south of the border are diverging. They look very different and we have to make sure the arrangements we have in place in Scotland reflect that.'

Dr Marshall said: ‘There is a view among politicians in Scotland that the GMS contract doesn't suit Scotland well. It's very difficult to see how the UK-wide contract would work on such big issues as commissioning and out-of-hours.'

‘If there are wholesale changes and if the Tories renegotiate the contract as they've said they want to, I think these areas are too big a difference.'

Dr Marshall added that losing the UK-wide contract would be a big blow to the GPC, which he believed had been stronger because of its make-up from different countries.

He said some GPs in Scotland were frustrated at not having the same opportunities set to be offered to their English colleagues, but added: ‘They don't have the threats either.'

Commissioning out-of-hours care is seen as one of those threats. Ms Sturgeon showed little enthusiasm for following England's lead, saying: ‘When responsibility for out-of-hours was handed to health boards, provision did go through a very shaky period. That has settled. Patient satisfaction with out-of-hours is actually very high.'

The BMA in Wales, which has scrapped the commissioner-provider split, said it was awaiting guidance from the coalition over the impact of the contract.

But Dr Brian Dunn, chair of GPC Northern Ireland, said GPs there were enthusiastic about commissioning responsibility. He said talks had been held with the DH about plans for groups of GPs to take on commissioning for areas covering between 50,000 and 100,000 patients.

How the UK-wide contract is fragmenting

England: DH planning new contracts for practices with independent NHS board, including commissioning responsibility and out-of-hours

Scotland: Scottish Government firmly against GP commissioning, use of private sector and plans to give out-of-hours responsibility back to GPs

Northern Ireland: GPC says it is enthusiastic about plans to take on more commissioning, with discussions over new commissioning bodies covering up to 100,000 patients

Wales: BMA says it is waiting to hear from coalition on possible impact

Scottish health secretary Nicola Sturgeon: will watch DH plans closely Guest editor