Chris Lancelot on…the fight facing negotiators

The government’s constant publicity about GPs’ ‘excessive’ pay and reduced working hours is obviously intended to soften us up for something — probably the renegotiation of MPIG and/or PMS.

Our negotiators will soon have a fight on their hands, representing doctors who won’t go on strike, and with public support for GPs being systematically undermined. How can the negotiators strengthen their position?

Firstly, they need to look long and hard at the type and quality of people who advise them to avoid the elementary mistakes of the past five years. These started with the secretive Carr-Hill formula, which the negotiating team happily promoted. Yet they didn’t think to try it out on their own practices first: then they discovered to their horror that 90 per cent of practices suffered a pay drop. At the same time they repeatedly hyped our increase in pensions which have now been capped. Our negotiators say they always knew that ministers had the power to do this: why didn’t they remind us about this loudly and frequently before we voted, or alternatively negotiate out this possibility?

Next there were the quality framework rules. On the surface, these look sensible, but they are full of logical holes, chief of which are the crazy rules about empty registers: for example, if you have no patients on lithium because your local psychiatrists don’t use it, then you don’t qualify for any of the lithium-related points, even though you may possess a register.

As a double whammy, this drives down your holistic points. A competent systems analyst attached to the negotiating team would have spotted (and removed) all these anomalies at source.

Then there is the concept of a ‘contract’. Why are the agreements which are hammered out by our negotiators capable of variation on a whim by the secretary of state? After long and careful deliberation, GPs voted for a new contract which contained, among other things, MPIG in perpetuity and hours of availability between 8am and 6.30pm.

Suddenly we discover this new agreement isn’t a contract at all, but unilaterally changeable by the DoH. The contract we have now is not the one we voted for. Why did our negotiators not insist on a fixed contract, or alternatively frequently remind us before the vote how unfixed these agreements actually are? Whose side are they on?

Dr Lancelot is a GP from Lancashire. Email him at

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