Under DH plans to overhaul the GMS contract, funding for GMS and PMS practices will be equalised, MPIG top-ups to core pay will be axed and new QOF indicators and raised achievement targets will be imposed.

Addressing GPs on Tuesday at England's first BMA roadshow on GMS contract reform, GPC negotiator Dr Peter Holden told GPs they needed to ‘learn when to say no’.

Over 140 partners, locums and salaried GPs from both GMS and PMS practices attended the event in Worcester, led by Dr Holden.

Dr Holden said there was a ‘stunned silence’ among the audience when he explained the government's plan for the GMS contract.

‘They are very angry with the government,’ he said.

Dr Holden said GPs had asked a range of questions about changes to the GMS contract, but most were interested in how they should handle the problems the reforms presented at a practice level.

Dr Holden said that a change in GPs’ attitude was vital if they wanted to survive the contract reforms.

‘GPs understood the content of the contract, what is needed is an attitude change for GPs. They need to stop saying "the PCT or the CCG told me to do it". They’ve got to think: "Is this economically viable? Is this worth the effort? Is this clinically appropriate?"’

Dr Holden said elements of planned changes to the QOF were economically not worth doing. ‘You might as well stand on a street corner ripping up 20 pound notes,’ he said.

Dr Holden said GPs at the meeting discussed new ways of working to maintain income levels, including forming federations to provide services for CCGs under the government's 'any qualified provider' policy.

‘People can’t assume that we’re going to carry on with the Dr Finlay model for ever,’ he warned.