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Opposing the GP contract imposition was a gamble. Was it worth it?



So now, at last, we know what the GMS contract will look like from 1 April, and in terms of practice finance, the real work is just beginning. GPs across the country will be taking a long hard look at their balance sheet for the coming year, with accountants forecasting a cut in partner drawings of up to 4%.

The mood of the profession seems to be hovering somewhere between grim resignation and fatalistic despondency at the moment, with the whole contract imposition process having acquired an air of apparent inevitability. But as the dust settles, it’s worth a quick glance back at what might have been.

Cast your mind back to October, when ministers first laid their contract changes on the table and offered them alongside a 1.5% funding uplift. GPC negotiators rejected the deal, and said they preferred to wait on the recommendation of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB).

It was a move which was, as expected, popular with the profession. But as Pulse pointed out at the time, it was also a gamble, given that ministers had not promised to abide by the DDRB’s recommendations (and had no track record of doing so), and given that they had warned they would take the 1.5% offer off the table.

How did that gamble pan out? Well, the DDRB did indeed recommend a greater funding uplift – 2.29% – but ministers cheerfully ignored this and without any real explanation downgraded their original offer of a funding uplift, to just 1.32%.

That’s worth repeating: the GPC’s decision to reject the Government’s offer cost every GP practice in England in cash terms – a small but significant 0.18% uplift, to be precise.

So what concessions were the GPC able to win?

At first glance, the amendments to the original deal which were unveiled yesterday appear limited, to say the least. Two NICE-recommended indicators for referral to cardiac and pulmonary rehabilitation services deferred. Some phasing in of the new DESs. A welcome clarification that locum superannuation reimbursement will at least be paid through global sum equivalent.

Certainly the GPC weren’t celebrating victory. In fact, GPC chair Dr Laurence Buckman was unequivocal: ministers had ‘completely failed to take on board the concerns of thousands of GPs’, he said.  

So, with the benefit of hindsight, should the GPC have swallowed its pride and taken the deal back at the end of October? Well, no – they would have been castigated for capitulating, and rightly so. It was bad enough for ministers to unilaterally dictate changes to a negotiated contract. If the GPC had signed up to the deal, that would have added insult to injury – and set a disastrous precedent for future contract negotiations, which will from next year be handled by the NHS Commissioning Board.

But it’s worth being clear, too, that the handful of amendments the Government made yesterday were at the price of a further cut to the already insufficient funding uplift first put on the table.

At the end of a decidedly one-sided contract fight, one final kick.

Steve Nowottny is the editor of Pulse. You can follow him on Twitter @stevenowottny.