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If ever there was a time to fight…

It’s now more than a month since the Department of Health issued its ultimatum over the GP contract – and for many GPs, it has felt like a phoney war.

There is no doubt the proposed changes would have a huge impact on every practice, with the QOF changes in particular likely to ramp up workload, and the phasing out of MPIG and Carr-Hill adjustments set to radically reshape practice funding.

But since the initial announcement there’s been little movement. GPC negotiators have made it clear they oppose the changes. But they have held fire on any detailed response until after the publication of the Statement of Financial Entitlements – which was expected any day as Pulse went to press and would signal the start of the Government’s formal consultation ahead of a possible imposition.

The news that the BMA is planning roadshows around the country to discuss the changes in early 2013 suggests negotiators are digging in. It is unlikely to be all over by Christmas.

In the meantime, as we reveal today, behind the scenes both GPC members and LMCs are agitating for a robust response. The talk is of some kind of bureaucracy boycott, perhaps non-cooperation with revalidation or the CQC, or maybe working to rule. But it is the suggestion that GPs could be asked to withdraw from commissioning that is most likely to grab ministers’ attention, coming as it does at a delicate moment in the transition from PCTs to CCGs.

The elephant in whichever room GPs meet to discuss the profession’s response is, of course, the ‘Day of Action’ debacle. The BMA’s industrial action over pensions – which somehow managed to annoy patients and attract negative media coverage while having little practical impact – was an unmitigated failure.

But that must not inhibit GP leaders as they determine their response.

For a start, as many argued on pensions, action targeted at bureaucracy is a very different prospect from action explicitly designed to interrupt patient care. A boycott of commissioning would be uncharted territory, and there are arguments against, but withdrawing support from controversial reforms would play better with the public and the media than stopping appointments.

Then there’s the sheer scale of the changes under consideration – and the DH’s bully-boy tactics in threatening to impose them without negotiation. The full long-term ramifications on practice finances are yet to become apparent, but they will be profound.

Worryingly, after the last GPC meeting, chair Dr Laurence Buckman wrote to GPs promising to ‘deliver tools and guidance to help you understand what the changes will mean for your practice’. That’s useful, of course – but also sounds a little bit like the changes may be a fait accompli.

The GPC and LMCs’ primary function is to fight for GPs’ terms and conditions, and if ever there was a time to fight for them, it is now. The BMA must consider using every weapon in its arsenal – even if, post-pensions, that arsenal feels a little barer than GPs would like.

Steve Nowottny is the editor of Pulse.