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Letter of the week: Time to dig our heels in over the latest contract crisis



Despite grassroots GPs warning of the dangers of some aspects of the 2003 contract, the GPC did not take notice. As a result we are now at breaking point, with the Department of Health regularly threatening to change the GMS contract and shuffling around QOF points at every opportunity.

It is difficult to say what the GPC should do now to try and wrest back some control over GP workload and pay. Half-baked strikes are a waste of time. Perhaps the GPC needs to start talking openly about the likely ‘consequences’ of the planned imposition rather than industrial sanctions that might require a ballot (‘BMA refuses
to rule out ballot on strike over GP contract deal
’).

For example, tightening QOF indicators will lead to a vast increase in referral to secondary care. Similarly, if GPs are tied up with lots of new work they will have less time to deal with emergencies and are likely to direct ill patients to A&E.

There is only so much time in the day available for GPs to fit in their work. If many new duties are added, the result will be to divert a lot of existing work to secondary care, which will lead to a massive increase in costs. This isn’t industrial action on our part, but a predictable consequence of the Government’s ill-thought plans.

From Dr Kaiser Chaudhri, Preston

Haven’t we heard all this debate over the contract before? We had exactly the same headlines in 2004, and those of us with longer memories will recall 1990 as no different.

The politicians will set their battle lines, with miniscule carrots and threats about what will happen if we don’t comply. They will prime the Daily Mail, eager for ‘shock horror’ stories about greedy GPs. The GPC will huff and puff and hope to eke some morsel from the carnage, and present it to the profession as ‘the best deal under the circumstances’. Then we’ll get on with work as we always do, with less remuneration for more effort. Then the politicians will renege on the parts of the contract they don’t like because the ‘contract’ will have a clause in it that says they can basically do what they want, when they want. And then in a few years we’ll have a set of different politicians imposing yet another contract, and so on. It is as it has always been.

I have little confidence in our ability as a profession to change anything. The ‘day of action’ this year in support of GP pensions was a damp squib because most practices did not take part. Mine did, and had superb support from patients. What a wasted opportunity to be united and strong. Politicians know we are politically weak and take advantage of that. Unfortunately we get what we deserve.

Can I make a plea to all GPs to think hard about any contract they sign? Let’s not repeat the mistakes of 2004, when we were led like lambs to the slaughter. Politicians have tuition in how to be evasive and deceitful when answering questions. They have no interest in patient care unless it affects their electoral chances If they thought euthanasia was popular it would be part of QOF. Whatever they come up with is unlikely to be in the interests of patients or GPs, so why sign it? Because the GPC says we should? Or because everyone else is signing it? Not good enough. Think about it. If we all dig our heels in, are they going to sack us all? I think not.

From Dr Mike Ashcroft, Wigan