On 4th October, speaking on the Andrew Marr Show, the Prime Minister, David Cameron, announced that the Government would be publishing a ‘new’ GP contract.
He suggested that the new contract would get rid of box-ticking and form filling. Instead, it would focus on “making sure people can get access to a GP on a seven day a week basis between 8:00 am and 8:00 pm”.
He then proposed that the contract would be ‘voluntary’ not compulsory, and offered to practices or federations of practices, covering at least 30,000 patients.
A Department of Health press statement suggested that “the new contract will be offered to GPs on a phased basis, starting with those groups of GPs that are most ready to work in this new way, and will build on the success of the pioneering Prime Minister’s Challenge Fund for GP access and the NHS Vanguards.”
Simon Stevens, NHS England Chief Executive, has since also gone on record saying that NHS England would work with GPs to develop a new ‘voluntary’ contract by April 2017. A contract that would enable practices to work in bigger groupings, much as the Vanguard projects, which are providing a range of secondary and community services.
He also stated that the Vanguard sites were asking NHS England for a new contract option – one which would combine core general practice with wider primary and community health services, for those serving larger populations.
Does this chime with your reasoning and thinking of how general practice would best operate in the future? Can you see how it would benefit you and your practice going forward?
You might also remember that in July NHS England said that GPs would be offered ‘simple and attractive’ conditions to encourage them away from the national contract, and instead, join the new models of care that are being tested across the country.
The BMA’s reply to the announcement was one of shock – suggesting that they had not been approached about the ideas raised or been invited at any time for in-depth discussions around the suitability and/or timeliness of the suggested contract changes, or the announcement there of!
The GPC Chair, Dr Chaand Nagpaul, confirmed that the contract had not been discussed with the BMA, and added that the proposals did nothing to address the root causes of pressures on general practice. He suggested that the Government should learn from its own pilot schemes, including the most recent - weekend appointments, which had seen little or no take up by patients in many areas.
He called for proper levels of investment in GP services and funding for more GPs and staff to keep up with the sheer number of patients coming through general practices doors - suggesting that any potential new contract should centre round the fundamentals of healthcare - safe delivery and quality care.
Cheshire LMC response
The proposed ‘new contract’ announcement featured at the top of the agenda of our October LMC meeting. As you might image, the conversation was lively and encouraged much debate and heated challenge around the table.
The discussions continued as I took the opportunity to advise the Committee that I’d had several enlightening discussions with CCG colleagues in recent weeks around the initial contract announcement. These clearly suggest to me that there are gaps and disconnects in the way that central thinking is developing and the under funded operational realities facing our CCGs. To exclude our national negotiating mechanisms is a clear recipe for conflict. Overall there just does not seem to be any consensus of opinion as to the direction of travel or thought about how unintended consequences that might arise out on implementation.
It feels like the usual political railroad – similar to the junior doctor’s debacle – sound bites followed by implementation without any proper thought or detailed discussion with those at the heart of the subject i.e. those groups that it will ultimately impact upon.
Clearly it is imperative that we as your LMC support you, and keep pushing for opportunities to aid the contract discussions locally, to try and provide a balanced, insightful and grounded perspective into them.
That said, what are your thoughts on the proposed new contract? What support and advice do you want from your LMC and what would you like us to impart on CCG and NHS England colleagues on your collective behalf? This is a chance to shape your future!
William Greenwood, CEO