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A compelling argument – but has the BMA done enough to win contract concessions?

As analyses go, it was nothing if not comprehensive. The BMA had promised to respond to the Department of Health’s consultation on proposed changes to the GP contract in detail, and detail is exactly what we got.

In compiling its submission, the BMA drew on survey responses from nearly 8,000 GPs, while more than 2,000 turned out in person at its contract roadshows. In total, the submission ran to 31 pages of small type – densely-packed argument demolishing the Government’s threatened imposition line by line.

The survey findings around which much of the response hung were not in themselves surprising. They were very similar, in fact, to the findings of Pulse’s survey two months ago, albeit with a much more robust sample size. GPs reported that the proposed changes were likely to hit access, reduce the services offered to patients and make practices less able to offer good quality care. There were also widespread fears over workload and the effect on GP morale, while a significant minority raised the prospect of making administrative and clinical staff redundant.

Beyond the numbers, the BMA’s submission forensically examined each of the contract changes in turn. The four new DESs proposed in England, for example, were taken apart one by one, with the paper outlining why dementia screening could generate a large number of false positives, and why there are still huge questions over what the commitment to allow patients online access to their GP will actually entail in practice.

The submission, then, is well worth reading in full – and one can only hope that Richard Armstrong, head of primary care at the DH and the man to whom it was sent, will read and inwardly digest every page and then encourage the health secretary to do likewise.

But there was one thing missing from the BMA’s submission: any hint or mention of an ‘or else’.  

The context of the BMA’s response, of course, was that in the wake of the pensions debacle last year it has very few options. No one was expecting the BMA to man the barricades. But while negotiators have clearly ruled out leading any kind of commissioning boycott, they had been hinting darkly that GPs struggling to keep their practices going in the wake of the contract imposition might simply have no time to deal with CCGs. As GPC deputy chair Dr Richard Vautrey put it in January: ‘GPs will find it much more difficult to take part in CCG meetings and activity. The knock-on effect will speak for itself.’

Yet one finding of the BMA’s survey, which understandably didn’t make the press release, was that in actual fact the impact on CCG work will be limited.

Just 25% of the 6,600 partners and salaried GPs who responded said that they expect to reduce their involvement in CCGs if the Government’s proposals are implemented in their entirety.

That’s not an insignificant proportion, of course, and it may be that many GPs already feel disengaged with CCGs, or that those who are most involved are unlikely to be dissuaded by contractual changes. But either way, it’s a finding which casts doubt on any prospect of commissioning collapsing as a result of the contract row.

With the contract consultation ending today, GPs will be fervently hoping that ministers listen to the arguments the BMA have made, engage with the concerns raised and amend the planned imposition accordingly. They may yet to do so.

But ultimately, as GPC chair Dr Laurence Buckman put it so honestly in January, the uncomfortable truth is that the Government holds all the cards. What remains to be seen is how they will play them.