It was classic Cameron. An announcement that he will develop a new GP contract was made on the Andrew Marr show yesterday on the eve of Conservative Party conference.
For this most political of leaders has made GP practices the main battleground of his ambitions for the NHS.
The announcement of an alternative GP contract to rid practices of ‘box ticking and form-filling’ is not a massive surprise – it was hinted at in NHS England documents earlier on this year, but it is still a bold move.
The implication is that the nationally negotiated contract will be held in aspic whilst GP practices are tempted with a shiny new deal. Baubles could include the abolition of QOF payments and the prospect of premises improvements and, presumably, higher funding per patient too.
While PMS funding is being slashed and burned around the country, on the premise of ‘fairer funding’ for GP practices, the Government has come up with the idea of PMS 2.0 – a turbo-charged package to bind GP practices with hospitals and community services.
But the price of opting out of the national contract could be very high. The PM’s obsession – seven-day access – has already been mentioned and I would not be surprised if practices suddenly find themselves tied into new ‘efficiency’ targets, such as reducing emergency admissions and hospital referrals – that have to be met. Smaller GP practices will have to join a larger grouping covering at least 30,000 patients. Continuity of care, finished.
And the whole thing looks very much designed to marginalise the role of the GPC. The chair Dr Chaand Nagpaul told me in August that his strategy in negotiations this year was injecting some ‘stability’ into the national GP contract.
I predict he will be given his wish. But it could mark the start of the fossilisation of the national deal and expect pay freezes for years to come to tempt practices to the other side.
It may be voluntary, but for practices who are struggling to survive this new contract may become a Hobson’s choice. The Government has played its hand very well. All eyes are now on the GPC.
Nigel Praities is editor of Pulse
