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Give English GPs as good a deal as in Scotland, GPC urges

Exclusive The GPC has urged the UK Government to stop ‘discriminating’ against GPs in England and give them similar arrangements to those in Scotland or risk overloading practices.

Speaking to Pulse, GPC negotiator Dr Chaand Nagpaul implored the English Government to follow in the footsteps of Scotland and retract its contract imposition, or face the responsibility of creating new health inequalities in the UK.

The GPC intervention comes as the union surveys GPs on whether the proposed contract changes could make them leave the NHS, as it prepares to draw up its response to the Government’s official consultation ahead of a possible imposition from April.

The GP contract deal in Scotland differs from England in that all retired QOF points are recycled within the QOF – rather than assigned to new DESs – certain ‘unworkable’ QOF indicators have been removed and upper thresholds will not be allowed to go over 90% (see box, below)

Dr Nagpaul said the ‘stark difference’ between the deals would mean patients suffer in England due to ‘significant additional’ GP workload.

He said: ‘We would very much hope, even at this stage, that the Government will show English GPs the same respect as Scottish GPs have been afforded.

‘We find it very hard to understand why GPs in England are being discriminated against [when] there is a deal that is acceptable north of the border, which is not an imposition.’

Urging the Government to return to negotiations, he said the GPC accepts the phase-out of MPIG in England, where there are significant funding variations – unlike GPs in Scotland and Wales – as long as it is carried out in a sensible manner.

He said: ‘Our objection is around the removing of a huge quantum of funding from the QOF and then adding a huge quantum of work to DESs which are driven by political ideology.

‘This will lead to GPs immediately having money taken away and being asked to earn it back, to significant additional workload, as well as the QOF itself having imposed upon it excessive and unrealistic indicators.

‘Scotland has agreed to take on the risk-profiling [DES] as part of the QOF, and in fact, when we were negotiating we felt this was one way to make risk-profiling workload neutral. We proposed to replace one set of QP indicators with this because in that way you would replace one set of workload for another.’

Pulse revealed last week that more than three quarters of GP partners expect to slash their drawings and nearly half expect to cut extra services offered to patients if the Government’s proposed contract changes come into force.

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Dr Nagpaul added that it was ‘inexplicable’ the UK should have such inequalities between countries in the provision of general practice.

He said: ‘There is no doubt that the English imposition will not just disadvantage GPs but also patients. GPs will be overstretched an unable to manage their workload properly, and they will also be diverted from primary care into other Government initiatives thought the DESs.

‘The Scottish Government will get greater productivity from GPs, because it is actually trying to work with the workforce and expressing sensitivity to the GP workforce’s perspective. The [UK] Government said in its own imposition letter that it still believes that there is scope for a negotiated agreement to bypass the imposition.

‘I very much implore the Government to look to the Scottish approach and sensibly retract their imposition so that English GPs can have similar arrangements to those in Scotland.’

Dr Nagpaul also asked GPs to make their voices heard through the BMA survey, He said: ‘This is a crucial time when the Government needs to hear what GPs actually feel, because it is really the profession that the Government will rely on to implement much of its healthcare aspirations and policies. This is not just another survey.’

A DH spokesperson said: ‘We are consulting on our proposed changes and remain happy to return to negotiations. So far the GPC have refused to negotiate.’

Dr Tony Grewal, medical director at Londonwide LMCs and a GP in London, said: ‘The [UK] Government is acting most unwisely, especially as GPs are the ones who are going to keep this show together.

‘I would advise that if they value us and treat us with respect they will be surprised with how much we will deliver. My advice to English GPs would be to move to Scotland.’

The Scottish GP contract deal for 2013/14

  • The organisational domain of the QOF will be scrapped in Scotland, as in England, but instead of the points going into new enhanced services the points will be reused within QOF.
  • A substantial portion of points’ achievement from the QOF organisational domain will be transferred to the core funding element of the contract.
  • A further 17 points will be transferred to a new public health domain, 33 points will remain for patient experience but no longer within the organisational domain, while 23 points will be transferred to a new medicines management domain
  • No new DESs, but new indicators on ‘anticipatory care planning activity’ will replace quality and productivity QOF indicators on A&E and emergency pathways, instead of the risk-profiling DES created in England.
  • The majority of NICE’s QOF proposals for 2013/14 will be included, but there are concessions on the proposals branded ‘unworkable’ by the UK GPC, with some of them not being introduced at all while others will see agreements for wider exception reporting. The indicators that are not being implemented frees up 11 points which will be used to introduce a new patient safety programme in general practice.
  • Scottish GPs will also avoid the full extent of QOF threshold hikes proposed in the UK consultation, where some may be raised to 100%, as no Scottish thresholds are to be set above 90%.
  • While English GPs will see the MPIG in England phased out over seven years, the Scottish GPC has agreed that the parties will look at the variablity in funding in Scotland, but not have a wholesale removal of the MPIG.