Now is not the time for local contracts

What do penicillin and deep-fried Mars bars have in common? Alongside golf, marmalade, the steam engine, bicycle, telephone and television, they are all Scottish inventions.

Readers of this week's interview with Scotland's new health secretary on page 17 might wonder how long it will be before there is another Scottish invention to add to that list - the Scottish version of the new GMS contract.

Nicola Sturgeon was quick to point out that she cannot see that just yet, but she would not rule it out. What is certain is that the foundations for it have already been laid.

The SNP has been in power in Scotland since May and already its NHS is looking markedly different to the Labour version across the border in England. So are local contracts a bad thing?

It's a debate likely to occupy negotiators in the coming months. The House of Commons Health Select Committee believes the government should allow quality framework targets to be negotiated at a local level to address local priorities (GP, 30 March).

NHS Employers believes primary care organisations should be handed greater powers to define elements of the GMS contract locally, including allocating quality points (GP, 27 April).

Meanwhile, the idea of focusing cash incentives in areas where there is greater need than elsewhere in the UK has merits for politicians, patients and practices, but would they outweigh the pitfalls? The GPC argues enhanced services already provide such flexibility.

So what do GPs think? A GP survey recently found that 79 per cent of GPs backed retaining a UK-wide contract.

And at a time when the DoH urges 'giving notice' to local PMS contracts as a cost-cutting option - Suffolk PMS GPs are in the middle of a test case - strength in numbers of practices on the same contract would seem advantageous.

So how desirable would GPs regard the invention of a Scotland-only GMS contract? Perhaps more deep-fried Mars bar than penicillin.

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