AK  <<Can you accept the statement that only 14% voted against then?>>

Yes, but....

AK <<the stale and useless argument >>

I agree with that.

AK <<  how many GPs were unable to vote, or prevented from voting, and had
they all
been able to vote and all been of exactly the same opinion on the matter,
what differences to the outcome could have been produced?>>  is the key
question.

I agree that is the key question and I am not sure how it can best be
answered. I think there was an element of battle fatigue by the time the
vote came round and there is no doubt whatsoever that our negotiators saw it
as their role to sell the deal to the profession. Thereby confusing their
roles as negotiators (performing a task on behalf of a larger group) with
their roles as representatives and role models. In short, they used the
respect and trust we had for them to encourage us to suspend our own
judgment on the proposed contract. I do not think this is an appropriate
method for professionals, whatever about the shop floor where the average
worker in the traditional manufacturing body is generally not au fait with
rules and regulations and accounting and all that sort of thing.
I think that a vote NOW would produce quite a different result.

I did not set out, over the last year or two, to go around N Ireland and
Scotland spouting on about the awfulness of nGMS nor did I even let it be
known (for quite a few months anyway) that I was seriously agin it.
I was frankly totally gobsmacked at the number of GPs in those two areas who
without prompting or encouragement expressed disapproval in very vigorous
terms.
As the amount of non-clinical work needed to survive financially under nGMS
became obvious to them, the language became even stronger. As yet, of the
several dozen GPs I have talked to in various parts of N Ireland and
Scotland, I cannot recall one saying he or she actually voted in favour.
Most recent conversations are on the utter awfulness of it all. I have heard
at least one extremely active GP in my neighbourhood (committees+++, patient
groups+++, CME+++) say, from his position on various BMA/LMC/GPC bodies,
that senior representatives are toeing the party line on nGMS, refusing to
accept any criticism of it, denying that there are unhappy GPs in N Ireland.
This is of course all anecdotal and circumstantial. But I am concerned for
the future of NHS GP in this western part of the province if what I hear
locally is a good reflection of general feeling in the west. I suspect that
it is. And as I said before, I suspect that many rural GPs here voted
against or abstained because they were unsure. And from my POV as a patient
with ongoing needs, I see damn all in nGMS that it likely to make the care I
receive any better, in any way. I accept of course that mental health got
the hind teat in nGMS negotiations and this reflects the general view in
society and the NHS in general that mental health does not need a lot more
funding so it is perhaps a bit unfair to use the lens of mental health care
to examine the pros and cons of nGMS. But only a bit unfair.

As for the future in general?  There is no point in exceptional GPs like
Adrian saying that nGMS does not bring more non-clinical work. Most GPs will
find it does. Just like there is no point in me saying GPs should inject
more joints and soft tissues when it is plain as a pike staff that many
don't have the skills and have other priorities.
I see, like many others, a future of GPs spending less time with their
patients, more time on paper work, more time on  appraisal/revalidation
(which will be shown to useless within a few years and the result will be a
doubling of the amount of information required to pass), more referrals to
hospital because of less clinical time and less willingness to tolerate
uncertainty, longer waiting lists while New Labour fantasises about choice
of hospital.  I really don't know where those with chronic illnesses who
need GP care will go in the future.
In short, going to hell in a handcart.
As for constructive criticism, what would I suggest and what system would I
put in place, the Canadian set up has a lot going for it. GPs have a lot of
respect from patients, managers and pols, they have a lot of power, better
access to all sorts of investigations and a high standard of living. Somehow
or other the Canadian system manages to pay for work done without anything
like nGMS.
Declan