Contract Special - Negotiations could end national GMS contract

The UK countries look to be going their separate ways in GMS negotiations.

NI GPs to see £2.7 million invested in clinical DES
GPs in Northern Ireland (NI) look poised to reach a deal on a new GMS contract, after GPC Northern Ireland voted unanimously in favour of proposals from the NI executive.

Dr Brian Dunn, chairman of the GPCNI, said: 'It's important to get the details right, and we still plan to poll our members.

'But we hope to be able to advise them to vote for the contract.'

The NI Executive proposes using £1.3 million from the £4 million directed enhanced service (DES) for access to fund aspiration payments to help GP practices set up improved access services.

The remaining £2.7 million will be used to pay for a new clinical DES, in an area to be chosen at a meeting being held this week.

But the offer does not include the 1.5 per cent guaranteed funding increase proposed in England.

Dr Dunn said that, despite widespread support for the plan, some GPCNI members had proposed voting against the offer in solidarity with GPs in England.

However, Dr Dunn added: 'We've benefited from the UK contract, and we want to retain it for as long as we can.'

Contract will not be imposed on Scotland
A contract will not be imposed upon GPs in Scotland if they reject the government's offer, despite hard-line rhetoric from Westminster.

Dr Dean Marshall, chairman of GPC Scotland, wrote to all GPs last week to say he has received 'assurances that further negotiations would take place between GPC Scotland and the Scottish government' if the profession rejects the proposed contract.

Such a move could be politically embarrassing for Westminster ministers.

GPC negotiator Dr Peter Holden said: 'Number 10 is petrified that Scotland might yet do its own thing, and there'd no longer be a national health service.'

The GPC is considering its next move in the event that a deal is agreed in only some parts of the UK.

The contract on offer in Scotland is almost identical to the one proposed in England, but with an extra £9.5 million to pay for extended hours.

The Scottish Executive has taken a softer line on the question of what happens if a deal is not agreed. A spokeswoman for the Scottish Executive said: 'We've been involved in constructive discussions with the GPC Scotland. We haven't talked about an imposition at all at this stage, and want to avoid going down that track.'

An GPC Scotland spokeswoman said it is happy to discuss more flexible ways in which a DES could fund extended hours, such as extra surgeries within current contract hours.

'Extended hours not a priority' says GPC Wales
GPC Wales still hopes to reach a deal on extended hours acceptable to both GPs and the Welsh Assembly Government.

Dr David Bailey, GPC Wales chairman, said that discussions were focusing on how to design a new DES 'so that as many GPs as possible take it up'.

'There's no point having a DES that no one wants to do,' he added.

Extended hours are not seen as a priority in Wales because most people work close to home, making it easier to attend an appointment during the day.

Dr Bailey said GPC Wales was meeting the assembly to discuss more flexible ways of achieving the DES.

These may include extending surgeries times by fewer hours, but on more days.

Dr Bailey also said he thought the Welsh Assembly Government was unlikely to impose a deal.

'I suspect they won't want to cut off all lines of communications if the offer is rejected, and will want to talk to us,' he said.

DoH attempts to bypass BMA with appeals to GPs
The DoH is trying to bypass BMA objections, and persuade England's GPs to accept the proposed contract.

If GPs in England reject the proposal, the DoH will impose a tougher contract, handing over 135 quality points and the choice and access DESs to PCTs to fund extended hours.

Health secretary Alan Johnson has written to every GP in England explaining the DoH proposal to use £158 million DES money to pay for practices to open an extra 30 minutes per week for every 1,000 patients.

The deal will also use 60 'redundant' quality points to improve access and give a guaranteed 1.5 per cent increased investment.

Mr Johnson said he was 'disappointed' by BMA suggestions that these proposals would damage care for older patients.

He claimed the imposed deal 'would enable the NHS to work locally with GP practices to make better use of resources'.

Health minister Ben Bradshaw said the letter reflected the government's view that the BMA's leaders 'don't really speak for the profession at large'.

GPC deputy chairman Dr Richard Vautrey said: 'The mood we reflect is consistent with the mood of the GPs we've seen.'

In a second letter, Mark Britnell, NHS director-general of commissioning, advised SHA bosses to prepare PCTs for extended hours by auditing current hours and drafting local enhanced services agreements in case no national deal can be agreed.

The letter implies practices must open from 8am to 6.30pm before extra hours would count towards an extended hours DES.

Extra hours cannot be divided between two GPs working at the same time.

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