Interview: Keeping out England's NHS madness

GPC Northern Ireland chairman Dr Tom Black talks to Neil Roberts about NHS reform.

With the ink not yet dry on a second successful Northern Ireland GMS contract deal in as many years, Dr Tom Black could be forgiven for an air of triumphalism.

But there is nothing of the sort from the Derry GP and GPC Northern Ireland (GPCNI) chairman.

'I don't think you're ever a success,' he says. 'You simply deal with the detail as it comes through.

'It's like painting the Forth Bridge - a continual task of incremental improvement.'

But the 2013/14 deal was seen by many as a triumph. Facing what could have been the worst outcome of all the UK nations, Dr Black's team not only avoided the deal imposed in England, but secured arguably a better one than Wales and Scotland.

Success

Success is relative. Their success has been 'keeping out the madness' from England, says Dr Black, listing NHS 111, Darzi centres and PMS contracts among policies that Northern Ireland has avoided.

The fact that the 2014/15 English contract in effect mirrors much of the 2013/14 Northern Irish deal hints at GPCNI's success. 'They've got rid of the imposition and come back to our position,' he says.

The 2014/15 contract in Northern Ireland is still awaiting ministerial sign-off as we meet at BMA House in London. But headline agreements include 263 QOF points reinvested in the global sum and 13 indicator thresholds reduced.

Perhaps most significantly, plans to remove MPIG - already agreed in England and Wales - have been 'parked' for assessment by an 'equitable funding subgroup'.

The group will also examine seniority pay and locum superannuation funding - subject to controversial changes in England - alongside expanding population supplements (EPS) and contractor population index (CPI) reform.

Dr Black, conscious of the disaster of MPIG withdrawal unfolding elsewhere, but 'obliged' to discuss cuts in the UK deal, wants to neutralise the impact of funding redistribution by tying it to other reforms.

Without a 'rising tide' of funding for EPS and CPI, Dr Black insists he 'could not discuss MPIG'. The GPC can 'veto' MPIG withdrawal, he argues. 'What you have to establish is solidarity. Once you have solidarity and a single voice speaks for all GPs, what is there to argue about? That's not a red line, that's a veto,' he says.

Dr Black, who has spent his career at the urban practice his own family would have used in the republican heartland of the Bogside, Derry, insists the community benefits from the 'UK model of general practice'.

'My colleagues in the Republic of Ireland, two miles across the border from my practice, have to charge patients 50 euros a time. Then those patients have to spend 70 euros on their prescription.'

Northern Irish GPs, he says, are grateful for a seat at the negotiating table in London. 'If I was a member of the Irish Medical Organisation, I would be paid twice as much and not have to work as hard. But my patients wouldn't do as well. And that's the bottom line.'

He says Northern Irish GPs are better off as part of a UK deal, but suggests lessons could be learned from the Republic. Demand outstrips supply of primary care in the UK, he argues, but the 'obvious option' of charges would be politically unpalatable.

Where Northern Ireland could lead the UK, Dr Black agrees, is in developing GP federations.

Collaboration

Not-for-profit federations covering about 100,000 patients, Dr Black says, could ensure practices aren't 'dumped on', and help them collaborate on community nursing, prescribing, out-of-hours and outpatient services.

At the annual Northern Ireland LMCs conference this month, Dr Black expects to be 'challenged quite strongly' over plans for GPs to take back control of out-of-hours care.

GPCNI has agreed a basic deal and wants all services run by mutuals, with no return to individual or practice responsibility.

Out-of-hours care, says Dr Black, is an 'integral part' of general practice. 'So we should be responsible for delivery; we should be responsible for ensuring the quality standards; the service should be delivered by GPs.'

A key part of negotiations has been trying to prevent a replica of England's NHS 111 being imposed. 'We want a service delivered by professionals and funded to the level required,' says Dr Black. 'Funding should be £34m,' he says. 'It has decreased since 2004. It was £23m, it's now £21m, which is bonkers.'

'The two rules I try to live by,' he says, 'are: will this improve recruitment and retention, and will this improve care for patients?

'If you get terms and conditions right, so recruitment and retention is right - that's that sorted. If you get care for patients right, that's that sorted. Everything else is detail.'

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