Family doctors are being mugged

Viewpoint: The new contract was a sleight of hand that misled GPs, believes Laurence Slavin.

When John Hutton was health minister, he proclaimed the GMS contract 'must be about a relationship based on mutual trust, respect and support' in his December 2003 foreword to 'Delivering Investment in General Practice'. He said 'the investment underpinning the new contract will see extra resources going into primary care'.

For good measure, he also wrote that 'the new contract is above all a strategic tool ... to revitalise general practice and make it a more attractive and family friendly place to work'.

What is the reality? I have been working closely with GPs for 20 years and feel I should voice my concerns.

I think the environment GPs are working in does not reflect the statements above. This is despite being only three and a half years into the new contract, in what can still be thought of as the honeymoon period.

Falling profits
Practices are facing falling profits, additional superannuation expenses, aggressive list cleaning, low or no pay rise and restrictions on enhanced services.


At the same time GPs are expected to fund increasing costs such as the switch to disposable instruments out of their existing income and are also expected to provide extra services. What is next?

GMS practices are facing the loss of the MPIG. Do we really believe the loss will be made up in the global sum or by the creation of a new stream of income? I doubt it.

What about PMS GPs? Not only is their growth funding under attack, but some PCTs are also proposing a maximum income stream for PMS practices. They want to impose a budget and working within a budget is absolutely not the same as running an income- led GP practice. Ask any GP who worked in a PMS-run salaried pilot.

Forced into GMS
We are also seeing policies that if a partner in a two-partner PMS practice wants to take 24-hour retirement the PCT treats this as a change in the contract's nature so the practice is forced back into GMS, you lose your growth money and get a global sum without the support of the MPIG.


But the GP is retiring for 24 hours over a weekend - this is hardly a reason for destroying their contract.

I think the new GMS contract was a sleight of hand. Look at promises in the Statement of Financial Entitlements and the Premises Cost Directions. How many have been delivered?

How many GPs have got the PCT to pay off their mortgage redemption penalties as part of a move to better premises? Not many, I bet.

But the promise exists. The truth is that GPs signed away their right to non-cash limited sources of income in return for a few 'good' years of higher pay.

GPs' earnings are continually misrepresented. Politicians blame GPs for the ills of the health service while the foundations that have long underpinned the provision of primary care are under attack. I think the time for complaining in LMC and GPC committee meetings is over.

Wake up guys, you are being mugged.

What is your view

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