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A dystopian view of general practice

Recently, NHS England has been pushing practices to federate citing the expense (and hassle) of contracting with thousands of individual practices. Jeremy Hunt’s new ’voluntary contract’ will only be available to federations. The little guy won’t get a look in. Escalating CQC fees (and the costs associated with becoming compliant) also mean that single handed practices are increasingly financially unsustainable.

But we all know the new contract won’t really be voluntary and the new contract is only going to be the beginning. All future enhanced services originating from the Department of Health will be designed to require the scale of federations to be successful.

If this is the case, how long will independent contractors be able to persist offering their current GMS or PMS services? There will be a progressive defunding of the current contracts, with wads of cash being thrown at those practices which are willing to sign up to the Government’s counterproductive seven day 8-8 agenda. All the lucrative enhanced services will be inaccessible to those GPs who resist the changes. The drive of ‘PMS reviews’ will charge forward, ensuring no PMS practices remain. No one will be able to afford to stay on GMS contracts.

The dystopian future of general practice has arrived by stealth and cunning

Slowly but surely every practice will have no other choice but to form federations. The RCGP and BMA are passionate about federations, and will help to convince reluctant GPs that it’s their only hope to survive. Federations will drive down administration costs and drive up quality while allowing the independent contractor model to continue. But that’s not why the Government is so keen on them.

After the Government has convinced us that the only way to pay our staff and continue to care for our patients is to sign up to the new ‘voluntary’ contract, the Government announces that the annual GP contract will be no more. They’ll cite GPs’ frustrations at changing KPIs every year and the necessary readcodes being released well into the financial year. They’re doing us a favour and GPs across the country will rejoice!

But only then will the final destination of all these changes be visible. We’ve been subtly nudged towards this target. The journey started a long time ago and all governments of all colours have joined the effort to ensure the safe passage of primary care to its next incarnation. With a 5-10 year contract awarded to patient populations of 50,000 or more, finally the Government will inform us that, sadly, a new interpretation of EU competition law means that they will have to put out all GP contracts to tender. They’re terribly sorry about it, of course, but the 3,000 page tendering application requires that you are a large multinational corporation.

And there we have it: the dystopian future of general practice has arrived by stealth and cunning.

Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative