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Ironing out the creases of the new GP contract

Lynn Young
Primary Healthcare Adviser for the RCN

It is important to admit that sometimes when events unfold I am proved to have been wrong, or to be a little kinder to myself, a touch misguided! The case in question is that of the proposed new GP contract, which continues to be a source of huge conflict and unhappiness among our GP colleagues. This is a huge disappointment, as the belief held by many (even by those GPs who disagree wildly with the detail of the new contract) is that the negotiators had the very best of intentions and worked ferociously hard to complete their challenging task.

The existing GP contract via the Red Book does not serve clinicians or patients adequately and needs to be adapted to meet the needs of the 21st-century healthcare system. The sadness is that, while driving to make matters better, conflict, tension and hostility prevail within the GP workforce. Such distrust comes at a time when general practice urgently requires an injection of new vigour for it to be fit for its purpose - a healthy workforce capable of delivering its part of The NHS Plan.

Delays have occurred, mostly because of the Carr Hill funding formulary and due to inner-city practices causing uproar as they believe that they would be impoverished by the proposed new funding system. However, despite vitriolic letters in the popular GP press and demands to have the Carr Hill formulary dumped, the vote has gone ahead and the result should be known by the time you read this article (GPs are voting as I write).

Ministers, GP negotiators and the NHS Confederation are keen to get a positive vote so that the legislation required for the new contract to be implemented can be included in the Health and Social Care Bill.

The best-laid plans and good ideas often go adrift, causing anxiety and dismay for many - particularly those who truly believe that the vision, once delivered, would bring benefits to all.

So, colleagues, the emergency meeting for GPs has been held, negotiators just about survived a vote of no confidence, anxious and angry GPs have had their questions answered (maybe not to their satisfaction) and the ballot went ahead. If we are to provide better patient care we must all travel forward, heal relationships, close the door and open new, more positive ones.

As an enlightened GP recently said to me, "With or without the new contract, the direction of travel for primary healthcare is pretty clear." The principles and themes underpinning modern primary healthcare are:

  • Strong and supportive teamwork.
  • A focus on who can, rather than who always has.
  • Workforce development for all, including the health- and social care support worker.
  • New points of access to the health service, including the development of the first-contact care nurse and the nurse with special interests.
  • Clinicians driving service development with the support of management.
  • Radical new approaches to commissioning that hold the key to the redesign of better services.
  • The implementation of Agenda for Change and the new skills and knowledge framework.
  • The development of a sound working environment that encourages the very best of talent to work in healthcare.

And so on and so forth …

If the ballot fails to get the support of the majority of GPs much of the above will still happen - this is truly the direction of travel. But a new GP contract could act as a helpful catalyst to this essential process. If the vote is no (like the consultant contract), the future could be one whereby within a very short space of time most general practices will operate within the Personal Medical Services pilot scheme rather than the more conventional and traditional means.