An increasingly confusing GP contract

Those who believe that a contract is an agreement between two or more named parties should take a look at the state of GPs’ various contracts.

While PCTs seem to be able unilaterally to 'renegotiate' PMS contracts - like ‘contract' this word would seem to have a subtly different meaning in primary care - the situation regarding the GMS contract is increasingly muddied.

Imagine explaining the GMS contract to a lay person: as subcontractors providing NHS services, GMS practices have a nationally agreed contract with the NHS overseen by the DoH. Practice income derives from various nationally agreed streams, some of which are varied at a regional or local level. Changes to this contract are negotiated with NHS Employers, the DoH's proxy. Except that NHS Employers don't have the authority to negotiate on all parts of the contract (GP, 20 April). And now PCTs want a say in the negotiations too.When you write it down like that, the absurdity of the situation becomes crystal clear - unlike the negotiating process.

Is it any surprise that talks break down when we are faced with such an arcane negotiating system? Imagine if you took the same approach to staff contracts - you'd have empty treatment rooms.

Among GPs there is overwhelming support for retaining a national GP contract, not least because we have a ‘national' health service and it makes sense that GP services are provided and funded in the same way whether a patient is in Aberdeen, Anglesey, Antrim or Aylesbury.

If there is a need for more local involvement in contract negotiations this should not be done on an ad hoc basis but should prompt a review of the contract to decide how local decisions would affect national agreements.

Looking at the current situation, a review of negotiating arrangements is clearly overdue. Ministers should provide their proxies with clear mandates. Otherwise the current piecemeal approach will never lead to those objects of DoH desire - efficiency savings and service reconfiguration.

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