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A year of living dangerously

How much more can general practice take? As we enter what looks set to be an acutely difficult year, that’s the unspoken question GPs are asking as they batten down the hatches.

A revamped contract, a mountain of QOF work, commissioning, revalidation, rationing and more; 2013 is shaping up to be the perfect storm.

A squeeze on practice funding is nothing new of course. But in England and Wales at least, the looming contract imposition – an imposition the GPC now admits it has no prospect of stopping – feels like a game-changer.

For the first time, practices are openly discussing what QOF work they will no longer be able to afford to do. For many, the four new DESs don’t look worth the effort. And with accountants predicting a sharp drop in overall practice funding, patient care will undoubtedly suffer.

There is no doubt GP partners will, as ever, bear the brunt. But this time even a 5% or 10% reduction in take-home pay may not be enough. GPs are talking of cutting chronic disease management work and minor surgery, and relying more on nurses and healthcare assistants to triage patients. It seems inevitable, as LMCs are warning, that ‘some patients will slip through the net’.

For many GPs then it will be a year of living dangerously, of anxious number crunching and tough decisions. But ministers, flushed with the success of outmanoeuvring the BMA, must take the longer view.

It now seems unlikely the contract changes will meet with any formal opposition. Industrial action is just not viable, and – despite support from a majority of GPs polled by Pulse – the GPC has also ruled out any kind of commissioning boycott.

But the fact remains that the Government is forcing through potentially devastating changes at exactly the moment when it is heavily reliant on GPs to lead its commissioning revolution. And even without any kind of formal protest, the impact on the NHS reforms may be severe. Practices will not officially withdraw from CCGs, but some will necessarily turn in on themselves. Many rank-and-file, apolitical GPs who might have shown a cautious interest in commissioning will now have neither the time nor the inclination to get involved.

Ultimately, as GPC chair Dr Laurence Buckman says in our Big Interview this month, the Government holds all the cards. But, with one eye on the bigger picture, health secretary Jeremy Hunt should listen to GPs’ concerns and offer meaningful concessions, even if he doesn’t have to. Otherwise goodwill from GPs at a critical juncture for the NHS will be in very short supply indeed.

The new-look Pulse
This is the first issue of our new-look monthly magazine, and we hope you like what you’ve seen so far. But we can now include in print only a small fraction of our news, analysis, business advice and clinical education. So if you’re a regular reader and you’re not already signed up, please go to to make sure you receive the best of our content on a daily basis. Please do let me know what you think of the magazine’s redesign at

Steve Nowottny is the editor of Pulse

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