The countdown has begun on another year's negotiations on the GMS contract.
After two years of a pay freeze and minimal change to the quality framework most GPs are anxiously awaiting the outcome of both contract negotiations and the submissions to the Review Body.
However, if the DoH's written evidence to the Review Body this month is anything to go by then negotiations are unlikely to be smooth and stress free.
DoH calls for tougher targets
In its evidence the DoH stated that no uplift, even an inflationary one, should be considered for GPs unless they accepted tougher targets in the quality framework, promised to reinvest a greater proportion of their profits back into their surgeries, make efficiency gains or agree to movement on the issue of phasing out the MPIG.
Dr Laurence Buckman, chairman of the GPC, appeared unconcerned about such threats and pointed out that it was to be expected that the government's evidence would try to hurt GPs.
'These issues are not unresolvable,' he said. 'We are both agreed that any quality framework changes need to be evidence- based, we both agree the MPIG needs to be phased out it's just the timing and the how.'
However, if the DoH is unwilling to soften its stance then the question is whether GPs are willing to dig in and suffer another year's pay freeze.
Accountants expect GP profits in both 2006/7 and 2007/8 to be down by 7 per cent. A third freeze would risk 'a return to the disastrous pre-contract morale problems', the GPC claims.
Dr Buckman said: 'I think GPs would be very distressed to find another freeze for the next year but at the moment negotiations are progressing amicably.'
Dr Charles Zuckerman, medical secretary of Birmingham LMC, believed GPs would be prepared to suffer another pay freeze in order to maintain the current contract.
'What the government is asking GPs to do is, in effect, unpick a contract which it agreed to. It is saying the only way to get even an inflationary pay rise is to do a great deal of extra work. That will simply put us right back to where we were before the contract was negotiated,' he said.
'I'd be surprised if the negotiators were to sit back and let all their good negotiating efforts of 2003 go down the tube. I don't see how they could recommend to the profession to accept the dismantling of the contract for a few inflationary baubles.'
Dr Eric Rose, GPC member and GP in Milton Keynes, agreed.
'The whole point of the new contract was that it would let us control our workload,' he said. 'Any demand for extra work will have to depend on the size of the pay rise. It would have to be a realistic increase'.
While both sides seem unwilling to compromise, it may be that the current negotiations on the quality framework hold the key to successful resolution.
The expert group, set up to assess all new evidence and submissions for inclusions from various groups, has now sent its report to the GPC and NHS Employers sub-group on quality framework negotiations.
Dr Brian Dunn, GPC Northern Ireland chairman and member of the quality framework sub-group, refused to reveal any of the content, but said negotiations were progressing well and it was attempting to achieve an agreed framework.
'We are hoping that if we can come to an agreement on changes to the quality framework that this will make the government more understanding in its supplementary evidence to the Review Body,' he added.
It is perhaps the case that the quality framework is the one area that can rise above the entrenched positions of a government intent on efficiency and a medical workforce determined to protect its hard won gains.
The need for the framework to be evidence-based and ensure the greatest impact on health within primary care makes it an easy sell to clinicians, the government and the public.
However, using the quality framework as a negotiating tool is also fraught. Neither GPs nor public health experts were happy with the inclusion of an obesity register without any targets to reduce in the last round of changes.
It is believed negotiators are hoping to come to a resolution on the quality framework before the end of the year and preferably before both the DoH and the GPC will give oral evidence to the Review Body at the beginning of December.
The Review Bodies recommendations are expected to be made to ministers in February.
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