A lot of people are using the phrase ‘contract creep’ in relation to the recent negotiations between the GPC and the Government. But I don’t think it’s fair to call Jeremy Hunt that. As he’s repeatedly pointed out, he loves us really.
It is true to say, though, that the contract is expanding into a monster that is threatening to eat us – and the GPC just seems to be standing by making menu recommendations.
Remember when the idea of the contract was to define what we do, and to ensure that anything bolted on was an enhanced service, which had to be paid for? Things have changed a bit since. What happens now is this. A new bit of work starts life as DES. Then, after a while, it magically transforms from ‘enhanced’ to ‘essential’. And so it’s absorbed into the contract and becomes ‘core’.
This happened last time with the Online Patient Access DES. It’s happened this time with the Patient Participation DES and the Alcohol DES. And who’s to say it won’t happen next time with the Unplanned Admissions DES?
It’s OK, we’re told. The money’s recycled into the global sum. Well, yeah, supposedly, but cash in hand feels a lot better, given the smoke and mirrors tactics beloved by the DH. Besides a) recycling dilutes out the amount, because it pays everyone, even those who didn’t previously participate and b) it removes our choice of deciding whether we have the capacity to add work onto what was our core contract. So it’s lose-lose.
That’s contract creep. That’s our contract sucking up everything in its path until we’re doing everything, for everyone, all the time, regardless of our inclination or capacity.
Back in the day, I went to a ‘new contract roadshow’, and I was specifically promised that the bad old times of the John Wayne, ‘A GP’s gotta do what a GP’s gotta do’ contract were behind us. Well they’re not. They’re here now, and they stretch before us ad infinitum. Time to act, I think. Otherwise, as the contract continues to creep in one direction, there will be a stampede of GPs in the other.
Dr Tony Copperfield is a GP in Essex
