Editorial: The new GMS contract has a sting in its tail

Six years ago general practice was a profession in crisis.

Few doctors wanted to become GPs because the pay was poor compared with other specialties and the hours, quite frankly, were horrendous.

The new GMS contract, introduced in 2004, has done much to address these problems. However, the contract has had something of a sting in its tail. It has been the catalyst for a whole new set of problems that threaten to undo its achievements on recruitment and retention.

Income is now no longer tied to the number of doctors in a practice, it is based on workload. This seems fairer but the unintended consequence is that, because the government decided to freeze GP income for three years, the number of partners is in freefall. In 2007/8 a third of GPs were salaried, compared with just 12 per cent in 2004/5.

BMA chairman Dr Hamish Meldrum last week called for a re-think, saying income should be linked to the number of GPs. When one of the architects of the contract says there is a problem, it should be taken seriously.

Grassroots GPs also want this addressed. Among the motions submitted by LMCs for their national conference in June, worries about the erosion of partnership opportunities and working conditions for salaried GPs feature prominently.

GPs are concerned that the shift towards a salaried profession, coupled with the government's backing for APMS and private providers, threatens the future of independent contractor status. Last week, GP revealed just 20 per cent of GPs feel independent status will survive the next decade.

The profession faces some real problems. But there seems to be a lack of solutions - or, as GP has pointed out before, a vision for where general practice should be heading and how to get there.

Addressing the partnership problem is key. Unless more partnerships are created general practice will remain a 'two-tier' profession and we could be heading back to pre-2004 conditions; where becoming a GP is a less appealing than a career elsewhere in medicine. That truly would be a crisis.

More opinion online
Read more opinion from the GP editorial team in the editor's blog at www.healthcarerepublic.com/blogs. This is what the team had to say this week:

  • "Impact of the budget It seems more likely managers will meet the targets by slashing spending on any area where people might not notice for a while, such as public health. The result could be an NHS packed with angry staff and secret rationing."
  • "Obesity damages environment There is an endless list of statistics like this because everything we do damages the planet. But it's becoming clear that many of the ways in which we damage our health have repercussions for everyone."

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