The debate that has been raging about the new contract, out-of-hours and our relative drop in income has had us all running around like headless chickens.
These are all symptoms. In general practice we always look for the underlying cause or theme that will allow us to understand the problem. This is no different.
We need to ask ourselves why the DoH rolled over so easily for the new contract, especially out-of-hours changes. Was it completely outmanoeuvred by our negotiating team?
I would suggest not. I think that we became the unwitting participants in a long game. I’m not the first to think this but it seems to me that the government would like to control the health economy/community as much as it possibly can. One requirement for this is the fracturing of primary care: dual registration, APMS and walk-in centres all lend support to this view.
Out-of-hours was obviously going to cost more than £6,000 per GP per year. The DoH’s hope was that the population would lose faith in us. Our standing would fall and this would aid a plan to erode the long term therapeutic relationships that we have with our patients.
Yet, despite the problems with out-of-hours, GPs still have widespread support from the electorate.
So, plan B: we are the bad boys again, because we lined our pockets and don’t offer a routine service at night and at weekends.
In the end, the population will be too wise to fall for this spin, but we need to keep our professionalism to win this long game.
Dr Tim Ballard
GP in Marlborough, Wiltshire, and RCGP council member