General Practice

Dear Members

You have heard all the publicity recently about GPs and extended hours. I am the representative for East and West Sussex GPs on the BMA General Practitioners’ Committee (GPC) and am writing to you now to try to clarify the situation for some of you as best I can.

The main issues as I see them are:

1. The way the government is planning to change our contract without negotiation and by holding a gun to our heads.

2. Extended Hours

IIn mid December last year, GPC negotiators had agreed a package with NHS Employers on how we could deliver extended hours. Extended Hours are top of the government’s agenda, in spite of the fact that 84% of patients are satisfied with the current opening hours. However at the last minute, Gordon Brown and No 10 stepped in, tore up what had been agreed, and imposed much stricter conditions (Imposition A)*. If we do not accept Imposition A, much worse is threatened (Imposition B). We are now in the middle of a 13 week consultation period (up till 1 April when either A or B will be imposed).
See more details below.

3. The wider agenda – the involvement of private companies in general practice

For example
Virgin ‘Healthcare’ are already holding meetings for GPs all over the country. American companies like United Health have just won a bid to take over three practices in London, despite a bid from the incumbent GPs.

The implication of privatisation of services is that many more GPs will be salaried and the opportunities for newly trained GPs to get a partnership will be very much diminished.

Next week there will be a poll of all GPs in the UK, including partners, salaried doctors, GP locums, GP registrars.
It is very important that everyone fills in the questionnaire. Some people may not like the questions.

GPC issued a motion last week which has received a great deal of negative publicity.

MOTION

That the GPC has come to the conclusion that Option A is less damaging for general practice, because the alternative option will harm the underlying fabric of NHS general practice and patient care more quickly and more lastingly.

These are very momentous times for general practice, and the next year is very important. I know many GPs feel very unhappy with the way everything is going. As I said, GPC had agreed a reasonable option, a gun was then held to our heads, and 2 dreadful alternatives were presented to us. GPC feels very strongly that we must remain united.

Under Imposition B
- there will be a proliferation of commercial APMS (Alternate Provider Medical
Services) and Darzi centres
- partners will not be replaced
- danger of general practice going the way of NHS dentistry

I know many MWF members are salaried or locum doctors. There has been much in the GP press about exploitation of salaried doctors, and I see a very important role for MWF in supporting these doctors. We do not want Virgin, Tesco and United Health to be their only employers in the future.

Please email me on cdfabre@yahoo.co.uk with any comments. In the meantime, please vote in the poll and let GPC know your views.

With best wishes

Dr Clarissa Fabre

Vice President
MWF

*More details of Imposition A and B

Imposition A

Scrapping of Access and Choice and Booking Directed Enhanced Services (DESs)
Money from these DESs goes to an Extended Hours DES.
Des is voluntary.
Has to be a GP, not a nurse doing the extra surgeries.
2 GPs can’t work together to fulfil the hours (30 minutes per 1000 patients per week)
Hours must be additional to a normal day’s work.
If surgery shuts over lunchtime or for a half day, these hours will be added to the extended hours required.
Extended hours must be in 1.5 hour blocks in the evening (after 6.30pm) or Saturday mornings, or for 1 hour blocks in the morning (from 7-8am).

Imposition B

DESs scrapped as above
135 QOF points removed

BUT unlike A
Money from these DESs and scrapped QOF points goes to Primary Care Organisations (PCOs).
PCOs will use some money to arrange Extended Hours with their practices (Local Enhanced Services).
A LOT OF THE MONEY WILL GO TO FUND DARZI CENTRES AND PRIVATE COMPANIES SUCH AS VIRGIN AND UNITED HEALTH.
This money will never be returned to general practice.

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