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General Practitioners Committee Annual Report 2007

March 2007

Foreword
It has now been four years since the introduction of the new general medical services (GMS) contract. In my foreword last year I was pleased to report that GPs had risen admirably to the challenges of the contract and had gained clear improvements in their working lives as well as a long-overdue rise in their incomes. Overall, as most GPs, ministers and people involved in the original negotiations would agree, the new contract gave GPs a much needed boost in morale, aiding recruitment and retention in addition to improving the services we are able to offer our patients.

Sadly, the past year has seen a number of unwelcome developments that threaten to erode the hard-earned benefits of the new contract. We have all had to grapple with an unprecedented volume of media stories about GP pay and opening hours at the same time that the GPC was challenging the government’s intention to cap GP pensions retrospectively and striving against the odds to win an inflationary uplift to the contract.

During the second part of last year, negotiations started on stage 2 of the contract review. Despite consideration of a number of possible offers for 2007/08, we were unable to reach a negotiated settlement; not least because the local medical committee (LMC) conference in June last year made it quite clear that the type of offer under discussion – which attempted to introduce new work without sufficient additional funding – is wholly unacceptable to the profession. We remain deeply disappointed that the government is not honouring its agreement that value-for-money issues were dealt with by the 2006/07 negotiations. In accordance with our usual practice, we submitted evidence to the Doctors and Dentists Review Body (DDRB), asking it to recommend an across the board increase in GP pay.

GPs must have been profoundly let down by the news that the DDRB recommended a zero percent increase for GPs this year – effectively a pay cut. I consider this to be a grievous insult to GPs, who, despite their fantastic achievements under the new contract, will for the second year running receive nothing to keep up with the cost of living, but will still have to meet all the increased costs of running their practices, including staff pay rises. At the time of writing, the General Practitioners Committee (GPC) was about to meet to consider what action to take in the light of this huge slap in the face. Whatever else, GPs will want to think carefully whether or not they are still prepared to deliver crucial elements of the government’s agenda in the face of this massive slight to the profession.

The DDRB recommendation to cut the supplement for new GP registrars is also extremely disappointing and potentially disastrous for recruitment to general practice.

Despite this, GPs and the GPC should be proud of the spirit they have shown during the changes and challenges of the past year. The GPC and LMCs have helped to guide GPs through a revised Quality and Outcomes Framework (QOF) and several new Directed Enhanced Services (DES), introduced from April 2006 as part of stage 1 of the contract review. Simultaneously, LMCs, the GPC and the BMA have worked hard to promote general practice and to defend it from hostile government policy and media spin. GPs throughout the country have responded vigorously to anti-GP stories in the press and on the television and radio. I would like to express my thanks for all these efforts and for the tireless work of the BMA’s press and parliamentary divisions.

The Secretary of State’s decision to renege on the government’s deal with GPs and cap GP pension dynamisation retrospectively has been another of the year’s low points. GPs are justifiably angry and we are determined to seek a successful conclusion to the matter. We have already initiated a legal challenge to the government’s action and will consider every means open to us to resolve this dispute.

In the background to these particular negotiating landmarks and policy announcements, GPs are operating in a perpetually shifting environment. In England, the private sector is playing an increasing role in both primary and secondary care and many doctors are having to adapt to new referral pathways, complex tendering requirements and ambitious commissioning targets. There is much in current policy to make doctors suspicious and frustrated. However, while the GPC and BMA cannot always prevent unpopular policy developments, they have a clear duty to equip members with the tools necessary to function in the current environment. In the past year the GPC has produced guidance on Alternative Provider Medical Services (APMS) and has continued to publish detailed documents to enable GPs to reap the benefits, where possible, of practice based commissioning. With the wider BMA, the GPC is currently reviewing its services to members with a view to providing the most relevant assistance and advice possible.

Devolution issues mean that it is increasingly difficult to maintain the UK nature of the contract and the results of the up-coming elections in Scotland and Wales may well increase these problems.

Although it seems a long time since its publication, 2006 will also be remembered for the Chief Medical Officer's (CMO’s) report on medical regulation Good doctors, safer patients. The report particularly focused on general practice and the GPC worked closely with the wider BMA to craft a detailed response to the subsequent consultation. We are studying the detail of the government’s response to evaluate the likely impact on GPs, and will be briefing politicians, the media and others to press home our views.

In another key document, the Formula Review Group has recently released for consultation its report Review of the General Medical Services global sum formula. I would encourage GPs and LMCs to take the time to respond to its recommendations, bearing in mind the fact that any change in the formula would affect practices’ relative incomes and that implementation of a new formula without adequate additional funding would create new winners and losers. The results of this consultation will inform negotiations on how, when, or if at all, the recommendations of the review group should be taken forward.

As I said in the letter I wrote to all GPs in January, I believe general practice is judged, above all, by what we do and the way we treat our patients. Although we are working in a difficult environment,

I am confident that GPs will rise above the current problems and that the core values of consideration, dedication and compassion will remain as strong as ever.


Hamish Meldrum
Chairman, General Practitioners Committee