Health secretary Jeremy Hunt has listened to the concerns of the profession and seeks to reverse the adverse impact of last year’s contract changes, which resulted in the introduction of unnecessary targets and excessive paperwork, or box ticking.
The new GP contract if successfully implemented, will reduce bureaucracy, will improve patient care and restore professionalism. GPC chairman Dr Chaand Nagpaul in his letter to the profession, honestly and candidly states: ‘The greatest benefit to GPs and their patients is that 238 QOF points have been removed and transferred into core GP budgets.’ He adds: ‘These changes allow all GPs to be freer to be doctors, exercising clinical judgment caring for patients, and resurrecting a sense of professionalism.’
In all the upheaval of the NHS reform, putting the GP at the heart was the right thing to do, even if the issues of GP responsibility, resources, workloads have not been addressed. The time has come now to do this, and Dr Nagpaul’s discussions with Mr Hunt are already bearing fruit.
What is not clear at present is how the ambitions of a better GP contract can be matched with improving quality of care, access, and safety of patients without additional money or resources. This fact should be uppermost in everyone's minds, because as anyone in the NHS knows, shifting resources around is like turning a huge tanker. Also, while Mr Hunt has captured the imaginations of many by his desire to improve the physical, mental health and social care of the over 75s, he must surely realise that having a named GP is not only unnecessary in the majority of cases, but that it is an impossible ambition to achieve. It introduces yet another target, and it ignores the social welfare which is beyond the control of the GP. The needs of the elderly and vulnerable are complex and need more than a named GP.
I have one further concern. The removal of QOF targets whilst being desirable, needs to make sure that the changes to QOF and other enhanced services free up enough GP time to concentrate on patient care. How this might be monitored in the future requires further thought.
We need a planned strategy for investment and development in general practice to meet the future challenges that it faces in the coming years. The GP contract should aim to balance the needs of their patients with what the GP can deliver within a shrinking financial envelope. The new GP contract means new responsibilities, but no new resources.
Mr Hunt must not politicise the GP contract and try to achieve the principles within the 2004 contract, of rewarding GPs for the work they do, and achieving excellence of care for all patients. Now is the time for real debate on how to restore the ‘jewel in crown of the NHS’ status back to general practice. Otherwise the Emperor shall continue to walk the kingdom without any clothes.
* Dr Chand is BMA deputy chairman but is writing in a personal capacity.
