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GPs in Scotland have been waiting a long time to learn details of their new contract with the NHS. Their leaders have kept them in the wilderness for a while waiting on a Promised Land where the profession would be made attractive again. They finally arrived today.
And at first glance, there is much milk and honey. The 70-page document marks the most radical redrawing of general practice anywhere in the UK since 2004, with GP partners promised a guaranteed minimum income of at least £80k; direct reimbursement of expenses, longer consultations with more complex patients and the transfer of workload to the NHS with no loss of funding.
But it is perhaps the whole theme of the document that is refreshing. The reassertion of the GP role as the ‘expert medical generalist’; the citation of Barbara Starfield’s ‘four Cs’ (contact, comprehensiveness, continuity and coordination) as ‘guiding principles’ and the whole emphasis on reducing workload and risk. It all makes the GP Forward View in England look rather cold and mechanistic, rather like a Haynes manual put next to a glossy brochure for a new car.
But I have no doubt there will be many GPs concerned about how this all will play out in the real world. The aspiration of all GPs giving up their premises by 2043 would mark probably the biggest nationalisation of healthcare estate seen since 1948, and for individual partners surely the point of no return in terms of their relationship with the NHS.
Also, as GPC chair Dr Alan McDevitt, hinted at when speaking at Pulse Live earlier this month, the whole package ‘is not intended to give GPs a large pay rise’. No practice will lose funding, but there will be little opportunity to increase it either, with what amounts effectively to a freeze in new local enhanced services.
There will be a sizable injection into the GMS contract next year – an average of £24k per practice, although it will be those in deprived areas and those with more elderly populations who will benefit most – but it is not clear how this relates to the rest of £250m that is planned ‘in support for general practice’ by 2020. Will that simply be siphoned off by the rest of the NHS?
The BMA claims that they have retained ‘independent contractor status’ for the profession, but looking at the package as a whole, it looks rather like it has traded a big chunk of the profession’s autonomy for guarantees on income stability and workload. Now this is perhaps a fair trade, considering the pressures on GPs and their practices at the moment. The alternative is the direction of travel in England, where only the stronger practices survive and a small group of super-partners reap all the benefits of a ‘bigger is better’ system that employs an army of salaried GPs. Or Northern Ireland, which is heading out of the NHS entirely. But I can’t help but wonder how all this will be perceived by a profession that has traditionally fiercely defended its independence at all costs.
And I wonder about the immediacy of it all. With one in four practices with at least one vacant position for a GP, and nearly three quarters of them open for more than six months, how will this all help right now?
These are exciting times for Scottish GPs. They have been offered a genuine alternative, with many things to recommend in it. But we will find out next month if they choose it over the status quo.
Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities