Editorial: Damned if you do and damned if you don't

Choice, as the government is always glad to tell us, is very important. People need to be involved in decisions that affect their lives, such as where they go for outpatient appointments or when they see their GPs, while parents need choice over what hours they work.

However, not everyone is entitled to choice all of the time, and sometimes any available choice is between the proverbial rock and the equally uncomfortable hard place. GPs are facing the latter type of choice. They can opt for a contract change that shifts the emphasis away from evidence-based clinical targets to evening or weekend opening, regardless of whether it is appropriate for a specific practice's community.

Or they can say 'no' and face having less control over primary care delivery, an even greater shift away from clinical targets and increased competition from larger privately owned healthcare providers.

It is not much of a choice really. It is rather as if NICE had issued guidance that BP measurements could now only be taken with one hand tied behind your back. And because GPs did not like that approach, the alternative was with both hands tied.

The current contract impasse is definitely a case of damned if you do and damned if you don't. Vote to accept the DoH proposal and, many argue, you will leave yourself open to greater and potentially more damaging changes being imposed in the future.

Vote 'no' and you could face GPs being painted as the bad guys who don't really care about patients, and thus providing more general practice opportunities for the large private healthcare businesses.

As with previous contract rows, the spectre of mass resignation from the NHS has been raised to the usual media and political chorus of disapproval. And it could be argued that this is the option that moved the profession from hand tying to having the appendage lopped off.

At present it seems that GPs have only negative options to consider. What they actually need is a positive strategy that counters the bad press faced by the profession and moves the debate forward.

Rather than allowing GPs to seem a completely negative and intransigent body, the GPC needs to provide a positive stance for the profession to get behind.

One way would be to include the rejected GPC proposals (including extended hours) on the ballot. Or it could devise a compromise position, including the clinical quality changes originally agreed by the GPC and NHS Employers. GPs could then present themselves as proactive and regain some of the ground they risk losing as this battle for the hearts and minds of the public continues.

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