New GMS: an opportunity lost?

BMA-DoH relations have hit an all-time low. Rachel Liddle looks at how new GMS has turned sour.

How have we got to the point where differences of opinion between MPs and doctors' leaders has become a very public slanging match?

Signalling an all-time low in relations since new GMS was introduced, health minister Ben Bradshaw and BMA leader Dr Hamish Meldrum exchanged angry letters this month. Each blamed the other for 'inaccuracies and misleading statements'.

Majority vote
The 2003 GMS contract agreement was drawn up amid much discord. But despite misgivings from many grassroots GPs, an unexpected 80 per cent voted to back the new contract.

Dr Andrew Dearden, a GPC negotiator at the time, said: 'The relationships through the negotiating times were, I think, quite reasonable.'

But three months after the vote, GPs became wary as the DoH delayed preparatory payments to practices, and funding for enhanced services disappeared.

One year in
Despite concerns, the GMS contract came into force in April 2004. And GPs performed well. In the first year, the average score from the quality framework was 958.7 out of the possible 1,050 points on offer.

Both the DoH and GPC were upbeat about the outcome - with the DoH using it to show investment in primary care had paid off and the GPC that the negotiated contract worked well. GPs saw a 32.8 per cent salary increase in just one year.

Pay freezes
But the honeymoon period for the GMS contract was soon over. Despite the DoH telling the BMA it was pleased with the contract outcomes in 2006/7, a few weeks later it asked GPs to do more for the money.

'From that time, the relationship disintegrated quite rapidly,' said Dr Dearden.

That year, GPs saw the first of three pay freezes, as NHS Employers sought below-inflation pay rises.

Negotiation breakdown
But the real mud slinging began six months ago.

Negotiations for the latest draft of the GMS contract led to a stand-off so strong that GPC chairman Dr Laurence Buckman rejected the offer.

Speaking of the 'draconian' contract at the time, he said it would 'destabilise and harm general practice services for patients'.

The BMA felt the DoH push for extended hours was taking priority over clinical care. The DoH argued that it wanted to improve access.

After a poll of GPs, the BMA reluctantly went with what was generally seen as the lesser of two evils, but still an imposition, that accepted the inclusion of access points over clinical care in the quality framework.

Tied up with the unrest has been the Darzi review of the NHS, telling PCTs to open polyclinics or GP-led health centres. This adds to the threat of private firms competing with GPs to provide NHS services.

And so to the present situation. Infuriated by what some see as political bullying, the BMA embarked on its ongoing 'Support NHS General Practice' campaign. Three weeks in, and coinciding with the UK LMCs conference, Dr Buckman delivered over 1.2 million signatures to 10 Downing Street.

But health minister Ben Bradshaw dismissed the petition, claiming the high number of signatures was due to practices pressuring patients to sign.

Asked about the current tensions, a DoH spokeswoman said: 'We are committed to maintaining a productive relationship, with this important doctors' union. We acknowledge that the BMA has not agreed with us over GP-led health centres.

'However, we look forward to working closely with the BMA,' she added.

But Dr Dearden said: 'I hope the BMA will not give way.'

It seems the public can expect more sparring, as the real fight may just be getting under way.

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