At the heart of the problem lie the Darzi clinics: each PCT must set one up by December. These will be cheaper to run than existing practices because they can be staffed by salaried doctors from the EU for whom even our salaried rates are a great increase in remuneration.
Darzi clinics are required to have extended weekday opening times, and probably Saturday and Sunday surgeries as well.
Any practice in the immediate vicinity will face stiff competition if it doesn't match its opening times. It makes no sense for these practices to vote 'no' - they will have to open for longer in order to preserve their list sizes, and they might as well get paid for it. In turn, practices next to them will be forced into extended opening, for similar reasons.
GPs were once protected by the Medical Practices Committee which prevented too many GPs practising in any area: many Darzi clinics would have been disallowed.
Shorn of this restraint, the laws of supply and demand will operate inexorably. With cheap private providers increasingly threatening the profits (and the existence) of surrounding practices, while simultaneously offering lower salaries to employed GPs, average UK GP remuneration will drop precipitously. The more clinics are introduced the more dangerous the situation becomes. General practice will cease to be attractive to new UK graduates; the supply of registrars will dry up. GPs owning their own premises might find them harder to sell. Practices most at risk will be in the cities and suburbs.
The net effect of the Darzi clinics and the extended hours imposition is to take money from existing GPs and give it to the shareholders of the private providers, who will employ fewer GPs and at lower rates.
At the same time the personal GP-patient relationship with its high quality and continuity of care risks being lost. Voting 'no' means even more money being deducted from GP remuneration.
So after a lot of thought, I've changed my mind: I think we have to vote 'yes'. It won't stop the threat, but it will slow it down, giving time for the quality issues to surface.
Dr Lancelot is a GP from Lancashire.