Whilst the UK Government is consulting on the imposed changes to England’s GP contract, here in Scotland there have been reliable reports of ‘cooperation’ and even ‘working together’ between SGPC and the Scottish government. The result as we have seen at the contract roadshows is a ‘more Scottish contract within the UK contract’ for this coming year.
There seems to have been some common sense in the Scottish agreement. Some clinical QOF upper thresholds will increase, but they will be capped at 90%. Organisational domain points will be recycled, but 77 of these points will go directly into practices’ core funding stream. Anticipatory care planning, with a focus on electronic communications and polypharmacy, should improve care from out of hours services and hospitals for complex patients and those at higher risk of admissions. There will be support for the multi-disciplinary primary care team by incentivising regular meetings. There will also be a new focus on the patient safety programme that will be funded with 11 points from the organisational domain.
Those are just some of the changes that were agreed after just a four-week-long negotiation with SGPC and the Scottish government. The SGPC negotiating team of Dr Alan McDevitt, Dr Andrew Buist and Dr Collette Maule are to be commended for all their hard work and skill over those hectic weeks in November.
There is new work with this agreement and this will be challenging when GP practices are already at workload saturation. However, when compared with the imposed changes in England such as the forced phasing out of MPIG, the increasing of clinical indicators to upper quartile achievement over two years and the all new work in enhanced services to earn back most of the organisational indicators, it certainly feels that the general practice climate in Scotland is more warmer than England.
South of the border
There are always been a north-south divide in general practice even before the inception of the GMS contract in 2004. However the divide is now becoming a gulf. That gulf is made wider due to the apparent differences in attitude to general practice between Holyrood and Downing Street. Patients value GPs and our holistic and generalist approach providing continuity and high quality care.
But English GPs are seeing continuous erosion of NHS general practice through government bureaucracy, endless reorganisation and relentless commercialisation. The government in Scotland have shown that they are willing to work with GPs to create a framework that is good for patients, good for the NHS and good for practice stability.
I expect our government to be civil, fair and rational when it comes to negotiations with GP. This is a reasonable expectation but one that the Department of Health in London seems unwilling or unable to fulfil. Despite five months of talks with GPC, the UK government wants to force through changes which will punish GPs in England. The choice is between unsustainable workloads or significant slashing of GP incomes.
The belligerence of this imposition damages the Government, the health service and patient care, and contrasts sharply with the partnership approach of SGPC with the Scottish government.
Dr John Ip is one of the medical secretaries of Glasgow & Clyde LMC and a GP in Glasgow.