Opting out cost may increase

GPs fear the DoH will seek to increase the cost of opting out of 24-hour responsibility, after a former GPC negotiator said the deal secured in 2004 was far better than expected.

GP leaders have pledged to resist any attempt to reprice out-of-hours opt-outs, but they accept that the DoH could ultimately impose it.

GPC chairman Dr Hamish Meldrum said: ‘Anybody can try to unpick anything. We would resist it strongly — it would be another part of the contract the DoH was reneging on.’

Under the new GMS contract, practices’ global sums were cut by 6 per cent if they chose to opt out of out-of-hours work. PMS practices that opted out had baseline funding cut by the same percentage.

But last week, former GPC negotiator Dr Simon Fradd told the BBC that securing the end of 24-hour responsibility for this amount had stunned negotiations.

He admitted that the fact that GPs voted heavily in favour of the new contract suggested that the DoH ‘could have asked for a larger reduction’.

Dr Fradd later admitted his comments were ‘unfortunate’ and said that the new contract had rescued NHS general practice from a ‘state of crisis’.

But the comments have sparked fears that the DoH could seek to change the deal.

GPC member Dr Fay Wilson said: ‘Nothing is an eternal guarantee. The contract was supposed to be renegotiated in 2006 and it can still be renegotiated. If the DoH imposed a change in the price of out-of-hours opt-outs, there would be a strong reaction from GPs.’

Professor Alan Maynard, professor of health policy at the University of York, said the DoH was ‘obviously tempted’ to increase the levy for opting out and agreed this was possible.

However, he said: ‘There’s a political downside to annoying so many GPs. I think a stealthy pay squeeze over a couple of years is more likely.’

This week health secretary Patricia Hewitt confirmed that the DoH was seeking to impose a profit cap on GP earnings.

She told GP that she would ‘not propose capping (quality framework) payments and don’t think we should’.

‘But increased profit taken is another issue and that is something we are discussing with the BMA,’ she said.

A DoH spokesman added that ‘any future changes to the contract will be negotiated to ensure GPs invest in improving services for patients’.


  • 1 April 2004. First PCTs take over out-of-hours care from GPs.
  • 31 December 2004. All PCTs must cover out-of-hours unless GPs opt to retain them.
  • Opt-out fee is £6,000 per GP on average — 6 per cent of global sum.


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