Chairman of the General Practitioners Committee
Dr John Chisholm
Tuesday 2 July
This year has been dominated by the negotiation of a radical new contract for general practitioners, that will change general practice more than any other contractual change since 1966 or perhaps since 1948. We have been negotiating with the NHS Confederation, acting as the Government's agents, and their involvement has proved of considerable benefit, bringing a clear understanding of the problems of general practice and of primary care.
The context for the negotiations was set by the National Survey of GP Opinion carried out by the GPC last year. The Survey showed a profession in poor heart, with family doctors paying an unacceptable personal price for their commitment to their patients. GPs said that too much is being asked of general practice, that they were experiencing excessive work-related stress, that their morale was low, that they were planning to retire early. Perhaps most horrifying of all, twenty-eight per cent were seriously contemplating a career change outside general practice. Is it any surprise that we continue to experience a dire recruitment and retention crisis - a crisis in which the net increase in the numbers of GPs in England between September 2000 and September 2001 was just eighteen whole time equivalent doctors?
The framework document for the new GP contract, Your contract, your future, was published on 19 April. The contract will be practice-based. It will be a UK contract with nationally negotiated terms and conditions of service but will allow appropriate local flexibility to address local needs and to enable practices to decide how services will be provided and resources used.
GPs will be better able to control and manage their workload through a variety of measures. Practice resources will be matched to the numbers and needs of patients. New work will only be introduced when new resources are provided. Doctors will be able to opt out of various services, including out-of-hours care. Allocation arrangements will be changed. Demand management initiatives will be introduced.
All GPs will be able to benefit from career development opportunities. GPs who wish will be able to work as salaried doctors, with nationally determined terms and conditions and pay rates.
The contract will be focused on quality and outcomes, with incentives and opportunities for continuous, evidence-based quality improvement. There will be substantial investment in practice infrastructure.
Since the publication of the framework, the GPC negotiators have toured the country and have attended some fifty roadshow meetings of general practitioners. They have now spoken to between twelve and fifteen thousand GPs at these meetings.
A ballot is currently under way, in which GPs are being asked whether they 'believe that the new GMS contractual framework is an acceptable basis on which to proceed to the next stage of detailed negotiations and the preparation of a priced contract, on which the profession will be balloted?'
If the profession wishes negotiations to continue, there will be a further ballot on a detailed and priced contract a few months later. The new consultant contract supplies an inevitable benchmark for the pricing of the new GP contract.
The pricing is absolutely crucial to the acceptability of the final package. This is the opportunity for the government to demonstrate its commitment to general practice. If it fails to do so, GPs will reject the contract in the second ballot - not because of greed bit because of the consequences for patient care. If it fails to do so, all the negotiations will have been for nothing. If it fails to do so, GPs will have been betrayed. The Government will have let both GPs and their patients down.
However, I believe that Government is now convinced of the need to invest in the NHS and in general practice. The budget settlement should deliver 43% real terms growth in NHS funding in the next five years. Investment in primary care will reduce pressure on the hospital service and produce better health outcomes. But perhaps the most persuasive argument of all is the Government's instinct for political survival. It wishes to be re-elected, and has irrevocably nailed its colours to the NHS masthead. Its plans for the NHS crucially depend on the contributions of GPs and of primary care teams. For once, the Government's political self-interest coincides with our profession's interest and our patients' interests.
Six months of work on the contract negotiations, some eighty meetings and the consideration of a thousand documents have required colossal work on the part of the GPC. The negotiations have involved a team of eighteen, and have imposed consequential burdens on everyone who works in the GPC office. I would like you to join me in thanking Bill Kent and the whole of the GPC secretariat, and also my phenomenally supportive negotiating team. I truly could not wish for a better team to work with.
I should also mention some other aspects of the GPC's work over the past year.
The publication of the Kennedy report has been a landmark in the NHS and should ensure that the health service becomes a safer, more open, more patient centred and more accountable. The GPC and the BMA are determined to encourage good practice; indeed, the new GP contract will assist in that encouragement. Nonetheless, doctors are human beings working under pressure; we all make mistakes some of the time. The NHS needs to develop a blame-free culture in which errors can be minimised and where individuals are not held responsible for the deficiencies of the system.
Appraisal has been introduced as a contractual requirement for GP principals in England.
Some progress has been made in negotiations designed to boost GP numbers and improve working lives in primary care. Much more remains to be done, in particular major investment in child care, but some important steps in the right direction have been taken.
The Government has implemented regulations which have the result of excluding the locum earnings of doctors who also work as assistants or principals from superannuation within the NHS scheme. This unfair and iniquitous disadvantage must be corrected at the earliest opportunity.
Family doctors and their staff are not being adequately protected against violent attacks. It is intolerable that GPs devoting themselves to the NHS do so in fear for their own safety and their staff's safety. The GPC has been striving to ensure that GPs have access to secure facilities, so that violent patients can receive the treatment they need without endangering GPs and their practice staff. I am pleased that, in response to persistent GPC pressure, the English Health Department is now writing to all Primary Care Trusts and Strategic Health Authorities, insisting that all PCTs have local action plans in place for tackling violence by 31 October.
The new contract framework can restore our faith in the future. It will fairly reward high quality work. It will allow GPs to undertake a manageable. It will deliver a better service for patients. It will help to cure the crisis in family doctor recruitment and retention, by making general practice a more attractive career. It will make a difference to the quality of life for doctors and the quality of care for patients. It has the potential to revitalise general practice and to rekindle GPs enthusiasm.
I want to see a better future for my profession. I look forward to a time when patients do not have to wait; when doctors are no longer worn out; when GPs work the hours they choose and have a life; when there are sufficient GPs to meet the needs of patients; when the real value of being a clinical generalist is recognised; when high quality care is available in each and every practice; when that quality is recognised, rewarded and resourced; and when GPs can give patients the time they need.
I know you share that vision of a better future for our profession and for our patients. I believe that the new GP contract can be the vehicle for achieving it. I and my team pledge ourselves to achieving the renaissance.