It's the new year – and if the Christmas break has done its job, batteries will be recharged and resolve steeled. Let's hope so, because if 2011 was a difficult year for GPs, 2012 shows every signs of being a fractious one.
GPs have already received a survey from the BMA asking them whether they want to take industrial action over pensions, and both the BMA and RCGP are busy cranking up opposition to the health bill. But GPs are also battling on a third front, with practices facing their seventh straight year of funding freezes and austerity.
Partners have accepted successive reductions to their drawings, and practices snipped away at every possible slice of excess fat. Now, as our survey shows, practices have been left with nowhere else to go – but to cut jobs. Nurses, practice managers and salaried GPs are all entering the new year facing the bleak prospect of redundancy.
The assault on GP funding had its roots in the heady days of 2005 and 2006, when general practice received a hugely welcome injection of cash as a deliberate attempt to address its recruitment crisis. The Department of Health was pilloried by the media for the perceived generosity of that contract deal, and has been set on a clawback of GP pay ever since. But it has long since achieved that aim, with the proportion of NHS funding spent on general practice, and the proportion of practice funding taken by GPs in pay, both now below 2004 levels.
Practices have taken all the pain they can, and the latest funding squeezes amount to precisely the kind of cuts to front-line services ministers pledged to avoid. How can the loss of salaried GP positions, from practices overwhelmed with workload as it is, be seen as anything but a cut to patient care?
There is a danger, too, to the profession in these job losses. Simmering tensions between GP partners and salaried GPs will inevitably bubble up at practices where one group is making the other redundant. It would be tragically easy for the profession to turn on itself.
Yet practices have faced squeezes to their budgets since 2006, and Pulse has been surveying their responses ever since. They have reduced drawings, found efficiencies, eventually constrained staff pay and in some cases closed services – but it is only now, when they have no other choice, that they are resorting to the ultimate cost reduction.
Rather than division, this is a time for unity and solidarity. GP leaders must focus their fire on the Government, expose the lie that NHS austerity can be achieved without damaging patient care, and finally challenge the media orthodoxy that sees any increase in funding for general practice as a wad of notes in GPs' pockets.
It's time too for a fresh look at the profession's career structure. Nothing will fuel the desire among young GPs for partnerships more than the prospect that salaried positions could be made redundant. If the profession's leaders want a New Year resolution, they could do worse than to find a way to meet that demand.
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