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The devil really is in the detail

If I might be allowed to indulge in a little smugness, I’d like to say ‘Told you so’ about the much trumpeted ‘Named GP’ contract upheaval. Told you so. It’s not so much a game-changer as a barely discernible extra bit of injury time.

Unlike the new DES on Unplanned Admissions. My reflex reaction to this was another ‘It’s what we do already’ moment. But reading what detail there is suggests it is, in fact – unlike other bolt-on, take-it-or-leave it DESs – a role-transforming contract within a contract. And if my back-of-a-fag-packet calculations are correct, the money attached isn’t enough to interest even the most excitable GP-bashing headline writer.

This new DES will corral us into the frustrating, time-consuming, medico-legally fraught and evidence-flimsy world of admission avoidance, far more so than we are already. And while I’m quite happy to wave a two-fingered goodbye to over a third of QOF tick-boxes, I’m not sure that justifies me selling my soul as a generalist so I can become a part-time vulnerabilist.

And this DES, too, acts as a smokescreen to other contract changes which seem to have snuck in pretty much under the radar.

Such as the abolition of practice boundaries, with all the already well-aired, bonkers implications. And the abolition of seniority payments, obviously in the hope that senior moments will mean those afflicted won’t even notice. And the abolition of financial privacy with the publication of our ‘salaries’. This latter innovation has been accompanied by the weakest medico-political justification I’ve ever heard, along the lines that it will let the public judge whether we GPs are ‘value for money’ – so it’s not really just a new stick for editors to beat us with, as if they needed one, it’s a prompt for concerned tax-payers to switch to a more cost effective GP, or, failing that, storm the barricades of the College.

My first at-a-glance view of the new contract read like a minor victory. The second filled me with doubts. And the third has left me feeling distinctly queasy. As the old saying goes, the devil’s in the detail. Yes, and quite possibly the Four Horsemen of the Apocalypse, too. Anyone feeling vulnerable?

Dr Tony Copperfield is a GP in Essex. You can email him at and follow him on Twitter @DocCopperfield.