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‘The 2004 contract has not kept up with general practice’

The NHS reforms were meant to bring about a decentralised, primary care-focused NHS. But how can you be decentralised and primary care-focused if you have one standard, one-size-fits-all national contract?

There are a good few GPs who would like to go back to taking responsibility for out-off-hours services, and a few more who would like to go back to taking individual responsibility for patients. But the majority of GPs, I suspect, are sick of the red tape. They want to go back to a time when being a GP was more free. This is why GPs are so dissolutioned with the current contract, with half saying they would welcome a renegotiation.

Many GPs are looking for simpler contracts that will give them flexibility instead of hemming them in with tick boxes. The 2004 GP contract hasn’t kept up with general practice, and people quite rightly feel that the current system isn’t flexible enough. There are progressive practices who would like to offer more services, like in-house GUM clinics, or health advisory services in schools. The absolute priority must be to support these practices to take on more and to make it easy for them to do so.

I think the local contract is probably the best alternative. There would be a core contract, with core prices, that specifies the things that all GPs have to do – but there would also be a local contract which would prioritise local concerns and provide some flexibility for practices to extend and increase what they’re offering.

I don’t know what will happen in the immediate future, but it’s completely inevitable that the contract will go in the next 10 years. In a way, it’s happening already – look at Somerset, for example, who have said that they’re going to opt out of the QOF. It’s the beginning of the waters coming through the floodgates.

Dr Mike Dixon is a GP in Devon and chair of NHS Alliance