Londonwide LMCs medical director Dr Tony Grewal spoke out strongly against the contract deal. He warned that the 0.5% funding increase agreed by negotiators was 'an effective pay cut' with rises in expenses far outstripping the uplift.
He added that plans to ask practices to negotiate 'inner and outer' boundaries within which they would agree to continue to see patients could be unworkable.
'It's self-evident nonsense,' he argued. 'There are thousands of practices in London - does each one have to negotiate an inner and outer boundary with a non-existent PCT? In London the PCTs have disappeared.'
He warned: 'The goodwill of general practice is limited and it is near overdraft levels. If you keep treating GPs like dung they will eventually give up and start acting like dung.'
But other GPs acknowledged that securing the 0.5% funding increase was an achievement for GPC negotiators, although they raised concerns about the contract allowing commuters to 'bend' practice boundaries and linking GP income to emergency admissions, and stressed the need to consider the needs of non English-speaking patients in deprived areas.
Funding uplift
Essex LMC chairman Dr Brian Balmer believes that the GPC negotiators have done a good job in the circumstances.
‘These days any increase in an achievement,’ he said. ‘Having achieved at least a recognition that expenses are going up is an achievement.’
Dr Ron Singer, chairman of the Medical Practitioners Union, said the GPC had ‘rescued the best deal it can from awfulness.’
‘This is a negotiated settlement rather than an imposition,’ he said. ‘It must have been one of the hardest negotiating atmospheres so the team have done quite well.’
He added: ‘The DoH believes GPs are paid too much; there is no sympathy in the department to uplift practices to keep up with inflation,’ he said.
RCGP chairwoman Dr Clare Gerada welcomed the contract agreement. 'This is a very sensible contract, not only in view of the financial situation facing GPs across the board, but also in that it reflects the central role of the GP in the NHS,' she said.
Practice boundaries
Dr Singer does not support allowing patients who commute to work to register with another practice as well as their own on a temporary residents basis. ‘To have patients registered at two practices is illogical and dangerous,’ he said.
He said the only way the scheme would work was with a ‘live system’ so that the practices could communicate. But this would raise data protection and confidentiality issues, he said.
Dr Singer added that it was ‘strange’ that in a time when general practice was moving to local commissioning that patients would be allowed to register in two different areas.
Dr Gerada said that the changes to practice boundaries were similar to those proposed by the RCGP.
She said they would 'allow GPs to make the sensible decision on a need-by-need, case-by-case basis, to continue to provide care for patients who move slightly outside of a catchment area'.
'Many GPs already work hard to accommodate commuters working in their areas so we will await the results of the pilot wth interest,' she said.
Emergency admissions
In the 2012/13 contract, QOF will link GP pay to reducing avoidable local hospital admissions. Dr Prakash Chandra, chairman of Newham LMC in east London, believes practices in areas with a large migrant population would be disadvantaged in this move.
‘Patients in this part of London include immigrants coming from eastern Europe, he said. 'The only thing they know is hospital. They have no knowledge of primary or secondary care.'
Encouraging people in these areas to visit their GP instead of presenting to A&E is therefore ‘very difficult’ for some practices, he said. But hospitals can also more easily accommodate patients who do not speak English than practices, he said.
Educating all these patients on how best to use the NHS requires input and resources from the PCT. ‘Without that, practices will struggle,’ he warned.
Deprivation
Dr Singer welcomed the agreement to explore how the Carr-Hill formula might be adjusted from 2013/14 onwards to give greater weighting to deprivation factors.
He said that deprivation was ‘a very big issue’ for many inner-city practices and it was important for the Carr-Hill formula to take that into account.
Dr Singer said it was important to recognise the additional burden created for practices with non-English speaking patients from deprived areas.
He said non-English speaking patients often took up more GP time due as they often needed 30-40 minute consultations with an interpreter. Dr Singer said the Carr-Hill formula needed to be adjusted to take these factors into account.
‘The current system doesn’t really cover dealing with patients whose first language isn’t English who take up the time of two English-speaking patients,’ he said.
