Changes to the GP contract are supposed to be the result of considered negotiation. Of late, despite intense funding pressures, the process has been remarkably smooth. But, two weeks ago, months of relatively positive contract talks – the GPC even claims a deal was close – came to a shuddering halt.
Instead of negotiation, the new health secretary issued a series of diktats. QOF thresholds would be raised and up to a quarter of indicators withdrawn. The MPIG would be phased out, the Carr-Hill formula adjusted. The only negotiation ministers appeared willing to countenance was over whether the GPC would accept this imposed deal or reject it in favour of one that will probably be worse.
GPC chair Dr Laurence Buckman hit back, claiming GPs were ‘stunned and angered’, and has since mounted a PR offensive decrying ‘draconian’ changes. But, while the GPC’s bark has been ample, its capacity to bite is unclear. We report this week it will wait for the DDRB’s recommendations on GP pay in February, rather than accept the deal on the table. The hope is that in the meantime something – no one can say quite what – will alter the Government’s approach.
It is understandable that the GPC does not wish to capitulate, and important that it has time to crunch the numbers. But it must engage the wider profession in decisions that affect every practice in the country.
Negotiators have always been secretive about contract negotiations, even with their own membership, while talks are under way. But continuing to be so once talks have broken down is harder to justify.
In his letter to the profession, Dr Buckman hinted darkly about the possible effect of the changes on GPs’ ability to engage with commissioning, but he refuses to be drawn on exactly what that might mean. The GPC has refused even to confirm how it will formulate its response, and, crucially, whether grassroots GPs will be consulted.
Meanwhile, it is making important executive decisions. Rejecting the Government’s deal out of hand, while likely to be popular, is not without risk, given that ministers could end up imposing the deal anyway but without the modest 1.5% funding uplift. Nor will there be universal support for the GPC resisting a plan to phase out the MPIG. There will be winners as well as losers from a revision of global sum funding.
The truth is the GPC has few options. The 2008 extended hours dispute proved contractual changes can be imposed. Winning over public opinion on anything to do with GP pay is a real challenge. And the BMA’s flawed opposition to pension reforms – over which, again, many grassroots GPs feel they were not adequately consulted – means ministers probably consider the threat of industrial action an empty one.
What the GPC does next is crucial, not only in terms of practice funding, but in determining the balance of power between GPs and ministers in future contract deliberations. It is a decision the whole profession should have a say in.