Journalists often feel pressure at this time of year to become hostages to fortune. Pulse perhaps rather prematurely bade ‘Bye Bye’ to the QOF last January and, although it has been replaced in some areas of England and is due to vanish in Scotland next year, most practices are still labouring under the framework.
Perhaps unwisely, I now venture an even more ambitious prediction: unless something drastic happens, 2016 will see the beginning of the end of the national GP contract. Yes, I forecast the once-fairytale marriage will fall apart by next December.
The honeymoon was short-lived. After a sizeable boost in take-home pay in 2004 and the lifting of out-of-hours responsibility, there was a sense of hope in the profession. Things were not perfect, but as a cub reporter, I wrote story after story about the shortage of GP partnerships and salaried GPs clamouring for each vacancy. How things have changed.
Fast-forward 12 years and we are in the throes of a breakdown. Many practices face a severe shortage of GPs and hardly anyone wants to be a partner. Funding has been cut progressively, leaving many practices fighting for survival. An exhausted workforce is drowning in a blizzard of paperwork, gratuitous regulation and patient demand. The GP contract has not caused all this – but it hasn’t helped.
The devolved nations have already gone their own way; Scotland is developing a ‘salaried lite’ contract north of the border for 2017.
In England, though, GPC insiders tell us there is little on the negotiating table for the 2016/17 contract to ease the pressure on GPs; instead, ministers are mooting a new DES to roll out seven-day access. Beyond that, there are signs that there will be little more than tinkering to a deal that is looking well past its ‘use-by’ date.
Of course this may change by April, but health secretary Jeremy Hunt has not hidden his distaste for Labour’s ‘disastrous’ GP contract – he even let it slip last year that GPs were being made to pay ‘penance’ for agreeing to it. It would be a huge coup for him to break up the national deal, and preparations are already being made for the first GPs to sign up to an alternative voluntary contract by the end of 2016.
GP practices in Manchester will lead the profession in this trial separation. They are preparing to dump their individual contracts from next November and merge into large ‘local care organisations’ that could buy up their premises and provide seven-day access and more specialist care in the community. And this will be a model for the rest of the country, as NHS England draws up its voluntary deal for practices as a way of driving forward the ‘new models of care’ in the Five Year Forward View in 2017.
I imagine few GPs retain any affection for the 2004 contract and the new voluntary deal is likely to come sexed-up with pledges of additional funding, the removal of the QOF and partnerships with secondary care.
Many will see this as a chance to realise the dream of a primary care-led NHS. However, the GPC has warned national collective bargaining will be lost and practices risk the same precarious fate as those who opted for the once-shiny PMS and APMS contracts.
But the GPC and its old contract are starting to lose their appeal – unless they can win back a disillusioned profession, we are heading for a messy divorce.
Nigel Praities is editor of Pulse