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The new contract is a declaration of war

The new contract is a declaration of war

Dr Copperfield is not impressed with NHSE’s new GP contract letter, which he says imposes unsafe workload levels in general practice

I think we’re all aware by now that any missive from NHSE where the opening para appears to be a ‘Thanks sooooo much for all your hard work/dedication/effort blah blah’ bouquet has in store for us, a few paras later, a massive punch in the face.

And so it is with NHSE’s new contract letter. Not only does its obsession with access confirm that the politicians don’t understand or believe that every available drop of blood has already been squeezed from the GP stone, it offers only a few quasi carrots, with a very real and extremely threatening stick.

The ‘incentives’ involve a rejig of IIF to ensure that financial rewards are almost exclusively focused on improving patient access. Look, don’t they even read my blog? I’ve explained ad nauseam about demand, capacity, physics and maths. I’m not going through it all again. At least the Impact and Investment Fund is optional, which means, despite the financial hit, we can at least tell it to pIIF off.

Way more troubling is the contractual waffle, which they helpfully condense into the very stark, ‘Practices will no longer be able to request that patients contact the practice at a later time.’ This is a declaration of war.

After all, in the last few years, we GPs have, with increasing desperation, begged for some feasible way of capping workload. Because of the Government’s miserable failure to solve the GP person-power crisis, putting some sort of lid on demand is the only way to stay sane. The best anyone has come up with is the General Practice Alert State, which, deployed in primary care, involves me screaming ‘help’ and stabbing myself repeatedly in the eye with a fork, which does actually help a bit.

This means that GPs have been boxed into a corner whereby the only way to cope is by informally defining our own ways of keeping workload safe and sustainable. Which, in desperate times, might mean declaring that appointments are full, try again later/tomorrow. It’s not like there aren’t other options. What else can we do?

Well, we can’t even do that, apparently, because we’ll now be in breach. So we’ve campaigned for safe workload limits and NHSE has responded by explicitly imposing the opposite. Thanks for the split lip.

At least I can contact my GP, and I know they’ll have to see me. Assuming they pick up the phone.

Dr Copperfield is a GP in Essex. Read more of his blogs here



Please note, only GPs are permitted to add comments to articles

Albert Barcellos 8 March, 2023 11:22 am

I fear for my colleagues , using locums to fill sick doctors slots etc GPs have done their best . And imposing contracts is set for failure in small excellent practices. The big ones will used nurses etc

Dr N 8 March, 2023 1:05 pm

I started my GP partnership career with five minute appointments – looks like I will end my career doing the same.

Mike Baverstock 8 March, 2023 1:11 pm

Me too
In the days when I wrote – ‘Tonsillitis – Pen V’ or ‘Chesty cough – Amoxil’. I think my record was 44 in one day – no booked appts then – just turn up and wait. Turn up they did, starting an hour before surgery started – whatever the weather!
Computers put paid to decent time keeping. Too many boxes to tick on too many templates.

Richard Brown 8 March, 2023 1:24 pm

I feel for my colleagues in England. We don’t have this, yet, in Wales. The political naivety & ignorance across the UK is collapsing Primary Care & it’s hard to see how we can go on very much longer. Following the path the dentists took would help clinicians but be terrible for patients.

Peter Griffin 8 March, 2023 1:28 pm

There is a legal requirement upon employers to protect the health, safety and welfare of employees. This is set out in the Health and Safety at Work etc Act 1974. The Management of Health and Safety at Work Regulations 1999 flesh out how this must be done. Employers must carry out risk assessments in relation to workplace hazards, including stress. The Health and Safety Executive sets out a simple five steps approach to assessing risk

Step 1: Identify hazards, i.e. anything that may cause harm
Step 2: Decide who may be harmed, and how.
Step 3: Assess the risks and take action.
Step 4: Make a record of the findings.
Step 5: Review the risk assessment.

Where are those with occupational health qualifications who should be following this up with NHSE?

Richard Greenway 8 March, 2023 2:16 pm

Why would DH do this? Junior Docs are about to go on strike, Consultants about to follow.
Why choose to stick another knife into GP?
They could monitor less and allow us to make our own decisions and be professionals. It would cost them and us less money, and everyone would be happier.

Decorum Est 8 March, 2023 3:43 pm

‘Why would DH do this?’
It’s either particularly stupid or a cynical plan!
Take your pick!…….. (suppose it might be both)

Truth Finder 8 March, 2023 4:36 pm

It is a declaration of war. If we are going to breach the contract we might as well not take the contract as it cannot be done. 3 weeks to a unilateral contract imposition. Even if the staff exist (which they don’t), a new appointment to a post will take 4 to 12weeks minimum. It just shows how out of touch this government is.

Rogue 1 8 March, 2023 5:08 pm

Yes Mike I think you are right, we are heading back to the days of 5min appointments and 3 word notes.
That really is progress for the NHS!

David jenkins 9 March, 2023 1:06 am

Richard Brown

………yet… wales !!

you’re absolutely right. and when it does come in – GET OUT !

do what i did in 2007, and come to locumland where all is much rosier !

i am not on strike next week, but i have turned down work for every single day next week to support the juniors. i shall be spending my week rewiring my morris marina, and welding my 1939 wolseley – both of which should be on the road for “national drive it day” on april 23rd.

but…………..the week after next i shall be back in work in a surgery near you, at the age of 73 !

Adam Crowther 9 March, 2023 6:36 am

Fortunately the silver lining is the enforced “cloud”. you are number 100 in the queue and the current wait for your call to be answered is 10 hours. So everyone will fill in a triaged online consult and wait for their appointment to be appropriated. Interestingly with our cloud we can see that 50% of callers (circa 700 per day total) give up after they have been waiting for 4 minutes on average!!!!!

John Evans 10 March, 2023 6:29 am

It was a choice for the govt – take on the profession or fight their way out of a wet paper bag ….
They went it hit the easy option.

Dylan Summers 10 March, 2023 11:34 am

@Peter Griffin

In this scenario the partners are the employers. This could be considered an argument in favour of a move to 100% salaried service.

Alice Hodkinson 11 March, 2023 6:40 pm

So. I’ve had a brief flirt back in partnership, which is what I would still prefer to do. But back as a locum atm.
Given this imposition I think I’m best staying out.
I might be a bit late to get a job in Oz tho – I expect they are already full of UK doctors

Carpe Vinum 13 March, 2023 12:57 pm

The European Union of General Practitioners and BMA have recommended a safe level of patient contacts per day in order for a GP to deliver safe care at not more than 25 contacts per day.
No ability to offer callback? Easy – simple problems, signpost to 111, urgent need, signpost to A&E.
If every practice did this after 25 “contacts” the whole system would implode within a week

Anthony Gould 13 March, 2023 7:16 pm

I well remember the open surgeries
In the 80s I routinely saw 60 to 90 patients a day 4.5 days a week as well as on call and alternate Saturday mornings- oh and up to 13 visits a day!
Once I saw over 70 patients in a morning surgery but finished by mid day (flu epidemic and GP partner on leave)
Quality of practice probably sun optimal
Simply unsafe now as we have an older population. legible detailed notes and complex treatments.
Let’s not try to regress I doubt I could see that many patient ever again in a session
Only place for such quick and sub optimal care is in a crisis such as an epidemic and possibly not even then ( or for very limited time)
Let’s get real and let GPs all be salaried or we will never be funded adequately

Dr No 13 March, 2023 11:06 pm

We opted for 35 contacts per day a few years ago to stay safe and sane. Now even this feels punishing. Good medical practice cannot be done in 10 minute, one-problem consults. The term “moral injury” seems to have some traction in recent times. Forcing caring clinicians to deliver more and shorter consults is frankly abusive and the contract needs rejecting outright.

John Evans 14 March, 2023 10:53 am

Not employed but independent contractors so Health and Safety at work will rest with partnerships.

The ‘more money’ argument will be easily countered.

The only viable option is the ‘safety argument’ demanding appropriate time deliver consultations / results / correspondence safely.

If successful the true cost of delivering the service will lead to increased profits so perhaps recruit additional staff / use company structures employing yourself or some other option to avoid the inevitable “GPs cashing” in headlines.

Politics of envy have ruled the UK and been used by the gutter press to sell their ‘product’. The aim should be better work-life balance rather than absolute profit.

Valerie Jane Philip 24 December, 2023 8:42 am

Fund GP Practices properly, taking into account rising staff and premises and other costs.
Invest in ‘crumbling estate’ be it privately owned or NHS Properties.
Fund practices sufficiently to be able to employ the staff that best suit their population needs and optimise their staff mix themselves.
ARR, with some exceptions, have not been the answer as the supervision burden, if done properly, is a huge drain on GP time and deployment is often patchy and unfair.
Get rid of PCNs or at least reduce their level of funding and control over practices.
Get rid of QOF IIF.
Get rid of some of the less useful ‘statutory mandatory’ training.
Then you might make GP an attractive career again for young newly qualified GPs now heading for ‘aesthetics’, locums, antipodes or quitting altogether.
Or, you could go for an entirely salaried service! Who would take responsibility for access and continuity then!
Maybe memory fails me but 20 years ago GP was a great job with higher levels of patient satisfaction.
It has gone so wrong because of govermnent neglect and meddling.
Shame on them!

Valerie Jane Philip 24 December, 2023 9:19 am

Not that I’d blame anyone for doing aesthetics, locums or antipodes, especially with £60-100k student debt (which I never had, qualifying in 1976!) but the fact that the balance has shifted so far away from commitment to a practice, and its population, should speak volumes to NHSE