Healthcare Republic revealed last week that managers are calling for a new GP contract to incorporate changes including 'strengthening contractual levers to deal with poor or unresponsive services'.
Other aims in the NHS Confederation wish list include a QOF adaptable to local needs.
But it's not all bad news because the 11 points include incentives for taking greater responsibility for out-of-hours care and patients' use of emergency care services, as well as working federally, allowing for integration with social, community and specialist care.
Equally, the insertion of a six-month notice period into PMS contracts might not necessarily be the unwelcome threat it first appears. The National Association of Primary Care has backed the protection this could offer.
This week, GP reports that one idea floated for discussion by The King's Fund and The Nuffield Trust is for 'time-limited' GP contracts as opposed to the current arrangements described as 'contracts for life' by managers. Both organisations forecast 'forceful' opposition to this.
The NHS Confederation prefaced its wish list with a plea for everyone to recognise the financial position that the NHS finds itself in.
It's a similar rallying call to the one made to GP a fortnight ago by RCGP chairman Professor Steve Field.
The NHS Confederation calls on clinicians and managers to focus on 'rooting out inefficiencies in the system, reducing costs and redesigning services'.
With the government overruling the DDRB this month and effectively imposing a 1 per cent pay cut on GPs, its hardball attitude is now unquestionable.
How should GP leaders respond? Ideas to tackle problems, a willingness to negotiate and a readiness to give as well as take would be a good place to start.