As there were a number of inaccuracies in yesterday's media coverage, we are
circulating to GPs a copy of the BMA press release (see below) which briefly
sets out the resolution of the General Practitioners Committee on the two
options the Government has given GPs regarding changes to their contract,
and the reasons for that decision.
Later this month a poll will be sent to all GPs in the UK to seek the views
of the profession on the governments' proposals. Details of the proposals
in all four countries will be clarified and sent out with the poll
documents. The GPC will continue to work with NHS Employers to clarify the
details of the options and the wording of the extended access DES and
continue to seek improvements to the DES.
The GPC debated and passed the following 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 more quickly and more lastingly. "
A brief outline of option A and option B is given at the end of the press
release below.
The GPC continues to have serious concerns about Option A and that GPs are
having to select from two options, both of which it considers unacceptable.
However, it was decided that the committee should take a view on the options
as many GPs were asking for the GPC's opinion in advance of the poll.
The GPC reached its view after an assessment that, whilst both options were
highly undesirable, Option B would remove significant amounts of funding
from the contract, particularly through the permanent removal of 135 QOF
points, and would not guarantee that the governments would not try to do the
same next year. The negotiators believe future negotiations would be more
difficult if Option B was to be the final outcome and would not result in
the Department re-opening negotiations. It was felt this was not the ideal
battleground on which to engage and the public debate needs to be focused
more widely on the threats from the increased privatisation agenda and the
implementation of the Darzi proposals, rather than on extended hours.
Of particular concern with Option A is the rigidity of the DES for extended
hours and the way the Government is approaching the whole issue. The
negotiators will continue to push for changes to the DES because, as it
stands, it is believed few practices would be able or willing to do it.
There will be increased efforts to convince MPs and patients that Government
plans are misguided and that attempts to micromanage practices from
Westminster are a recipe for increased patient dissatisfaction.
Next week further details will be sent electronically to GPs in a letter to
the profession from the GPC chairman analysing the options and their
implications prior to the start of the poll. Further information is
available on the BMA website at http://www.bma.org.uk
At approximately 8.35 this morning, Dr Hamish Meldrum, chairman of BMA
Council, was interviewed on Radio 4's Today programme on this issue - if you
missed the interview, you can listen to it using the following link:
http://www.bbc.co.uk/radio4/today/listenagain/
BMA press release:
For immediate release: Friday 8th February 2008
Government has put GPs in an impossible position, says BMA
The BMA’s GP Committee (GPC) met yesterday to discuss the two options the
government has given GPs regarding changes to their contract and passed the
following resolution:
“The GPC has come to the conclusion that Option A 1 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.”
Commenting on the resolution, Dr Laurence Buckman, Chairman of the BMA’s GPs
Committee said:
“GPs have been put in an impossible position and will have to choose between
two unacceptable alternatives. We have been asked which of these two is
less bad and we have responded to GP demand that we do that. We are not
recommending any course of action and GPs are free to come to their own
decision on how to vote. This is neither a climb down nor a U turn but a
recognition that between two bad alternatives, one is worse than the other.
“The two deals on the table from the government haven’t been negotiated,
they are inflexible and do not take into account the differing needs of
populations around the UK. It’s this method of ‘negotiation’ that has
angered GPs and it’s why we felt we couldn’t accept anything without first
consulting the profession. We have been studying the detail of the two
impositions and have provided GPs with our analysis. We still have huge
concerns that patients will get neither a meaningful service in extended
hours nor will the quality be of a level they deserve.
“We believe the impositions as they stand will be unsafe for doctors as they
will have to work on their own late at night. Patients also won’t get the
full range of services. GPs are willing to do extended hours, we put
forward our own proposal in December – we just don’t think the government’s
plans as they stand at the moment will be good for general practice or
patient care.”
The BMA’s GP Committee will be polling the entire profession in
mid-February.
Note to Editors:
1 Option A refers to the government deal put to the GPC on December 20
2007. On December 21 the GPC received first details of the imposition.
Since then the GPC had been conducting a detailed analysis of both options.
The GPC meeting yesterday was the first time the committee had met to
discuss this analysis. The details are as follows:
The following details are for England are as follows:
Option A:
The government's proposals:
£158 million of funding recycled from the 2007/08 Access and Choice and
Booking DESs (in England) would be reinvested in extended opening as a DES
including £2.80 per patient per annum for providing extended access
58.5 QOF points (38.5 from the holistic and organisation domains, plus 20
points from the patient experience domain) would be reallocated to support
access arrangements
Extended opening would be for 30 minutes per week per 1000 registered
patients - this would need to be in blocks of 1.5 hours after 6.30pm or for
one hour prior to 8.00am or on Saturday morning and would depend on
agreement between the practice and the PCO reflecting local patients’
wishes. This would be provided through a nationally agreed Directed Enhanced
Service (DES), and practice participation would be voluntary
Part of the funding available for access (35p per patient) would be
dependent on the results of access questions contained in the QOF patient
survey. This would include targets for 24/48 hours access and booking
There would be 1.5% uplift in the contract value, although it is unclear how
this would be allocated and what additional work on top of the DES further
practices would have to do to achieve this.
If the profession did not agree with Option A, the government has said that
Option B would be imposed, details are as follows:
Extended opening funded via £158m from the 2007/08 Access and Choice and
Booking DESs but locally agreed arrangements
There would be 135 points permanently removed from QOF including clinical
areas such as influenza vaccination and management areas such as computer
security. The overall impact would be a QOF with only 865 points instead of
the current 1000.
All lower QOF thresholds would be uniformly raised to 50%. The upper
threshold would be raised to the national achieved average. In general,
practices will lose money as the range gets narrower unless they are scoring
above the higher threshold for that indicator
There will be no QOF achievement payment until the end of the first quarter
The funding, as described above, would be allocated to PCTs for them to
agree local contracts for extended opening with any practices – including
those newly set up private APMS practices. Experience has shown that it is
likely that only a proportion of the funding would end up with any general
practices if allocated to PCTs.
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