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Make-your-mind-up time on GP commissioning

By Steve Nowottny

Wrangling among GP groups reflects the wider uncertainty in the profession. But it is the GPC's response which will be critical, writes PulseToday editor By Steve Nowottny

Back in February, before the election, I wrote a blog post about GPs taking back responsibility for out-of-hours, under the title ‘Your move Mr Lansley'.

It was written just after GPC chair Dr Laurence Buckman had sent a ‘line-in-the-sand' letter to the profession, firmly pledging that he was ‘not about to renegotiate the GMS contract with anyone'.

Just six months on, things look very different. Mr Lansley has indeed made his move, and out-of-hours is but a small slice of the £80 billon pie GPs are being asked to take charge of.

We report today that a number of leading GP bodies have begun behind-the-scenes talks to try and formulate a united response to Mr Lansley's far-reaching plans. A whole host of senior figures from the RCGP, NHS Alliance, NAPC and Family Doctor Association are keen that on this most important of issues, the profession is seen to speak with one voice.

The BMA and the GPC are not part of the discussions, not yet. But shortly they will be taking the lead role in what are likely to be some exceedingly complex - if perhaps unaccustomedly cordial - negotiations.

And now it's Dr Buckman and his team of negotiators who face a dilemma.

So far the GPC's response to the commissioning plans has been noncommital but receptive, even positive. There is a feeling that GPs have been saying for donkey's years that they could run the NHS better – now, astonishingly, they're being given the opportunity to prove it.

But the GPC's constant mantra has also been ‘show us the detail', and as the detail emerges, it's become apparent it's not all good news. Provision of out-of-hours, even as provider of last resort, is a red flag for many GPs. Being lumbered with legacy contracts with consultants and private firms concerns others.

And for many it still hasn't quite sunk in yet that the quality premium for good commissioning will come out of existing resources – meaning the good practices will have to re-earn their money, and the less-good practices will lose some.

Now, in the normal run of things, negotiators would sit down with the Government and do their level best to negotiate each point. They'd win some, they'd lose some, they'd haggle their hardest and they'd aim to emerge with the best deal possible for the profession.

But this isn't the normal run of things – and while they'll still be aiming to get the best deal for GPs, the wider political context comes into play. Put simply, Mr Lansley has risked a lot of his personal political capital on a plan which places a lot of faith in GPs. Many non-GPs are sceptical about whether it can work – many, particularly PCT-types, hope that it won't.

And if it is to work, then GPs will not just need to be on board, they'll need to be seen to be on board. The scope for protracted haggling over the small print may be limited.

Much to ponder, then, as GPC negotiators prepare for the most significant round of contract talks since 2003-4, and quite possibly much longer. Do they stand their ground and insist on arguing every point, regardless of the political heat that generates? Or do they gamble that in the wider scheme of things the reforms are very much in GPs' favour – and do everything they can to support them?

Your move, Dr Buckman.

By Steve Nowottny is the editor of PulseToday.

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