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The great contract debate

Sorry to bang on about the new contract. But even NICE’s astounding new guidance on secondary prevention in patients who’ve had an MI – with its bold pronouncement that we no longer need to prescribe these patients fish oils – isn’t enough to shift the great contract debate from the top of the coffee-break agenda.

Now the dust is beginning to settle, it’s becoming clear to me that some of the less trumpeted contract changes represent missed opportunities. For example:

  • Abolition of practice boundaries. I think someone has accidentally done a “find ‘shrink’ and replace with ‘abolish’” on every draft contract reference to practice boundaries. Because the only realistic way to cope with what is expected of us now, and in the future, is to have a) Some control over our workload b) Fewer patients c) More time. And what this requires, apart from more GPs, is a smaller area of responsibility – if not philosophically, then geographically. Personally, I’d like my practice area to be reduced to roughly the size of my consulting room.
  • Publication of the full net income of GPs. You don’t need to be a conspiracy theorist to see where this one’s going ie straight into a certain tabloid newspaper’s front page headline. I’d like to suggest that, in the next round of contract negotiations, national newspapers are forced to publish, each year, the estimated number of lives we GPs have saved through monitoring blood pressure, dishing out statins, running the flu vaccination campaign and so on. Because if Jeremy Hunt wants the public to assess ‘value for money’, the punters need to know our worth as well as our pay.
  • Abolition of seniority payments. Thanks a bunch. But instead of these being tipped back into the pot – and, boy, will we be watching to make sure that happens – they perhaps should have been converted to Juniority Payments. Given the recruitment crisis and the fact that older GPs are perceived as the Fat Cats of the profession, it would have been a lovely gesture to provide an incentive to younger doctors to join general practice – far nicer than the two-fingered one they think we’re currently giving them.

Still, it’s not all bad news. At least we can forget about trying to spell ‘eicosapentaenoic acid’.

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