On 03/21/98 09:39:12,  Ian Trimble <[log in to unmask]> wrote:

>The concerns which have been raised include the way in which groups
>will be formed, the (lack of) funding for developing groups, the
>responsibility for budgets and rationing, the risk to income from the
>linkage with cash-limited GMS (risk which is only carried by the GP
>members of the PCGs), the perceived lack of guidance and the time
>scales involved.

There *are* other concerns that you have ignored,  Trims:

1.  the issue of imposition
2.  the lack of choice and opt-outs
3.  the real threat to small practices
4.  the issue of 'it's our ass that's on the line'
5.  the lack of any supporting evidence that these things work
6.  the lack of any real consultation
7.  the absence of any real trials (I thought that this government
pledged to trial change before it is introduced.  That *was* in the
Manifesto before the elections)
8.  the issue of hijack by bigger and better GPFH practices who have
'some' experience
9. the issue of real training for doctors to take on budgets of several
million pounds

I can go on.  I am sorry, Trims,  but the concerns are not only
'procedural'.  There are 'fundamental principles' concerns.

Has everybody forgotten what 'fundamental principles' are??

>All of these concerns need to be addressed, and I can assure you that
>they get fed back to the centre.

By whom?
How do you know that?
Have you any feedback?
Have I any feedback?
Are 'The Shadows' back on the scene again?
Have they ever left the scene?

>The alternative to trying to argue our case would be some sort of work
>to rule followed by sanctions / conflict and an unknown outcome,
>perhaps an imposed national salaried contract, who knows?

Is that a good enough reason *not* to argue our case?  Fear of the
unknown now is legitimate reason for our crippled and inert profession?

Besides,  tell me any evidence and categorical assurance that,   you, 
or anybody else has,  that they will not impose a national salaried
service should they wish to.

If they wish to do so,  we would have given them the green light anyway
by being so 'docile'.

>Just what is the alternative on offer, Ahmad? 

1.  Assess the actual degree of support for this amongst all GPs
2.  That means organising an independent,  secret,  national ballot
3.  If there is support for it,  we engage in real negotiations from a
position of power rather than being on our backs
4.  If there is not support for it,  we say 'NO'

5.  When we say 'NO':

	a) replace our leadership with one that can fight
	b) allow those who want to work in groups to do so provided that
	there is 'natural affinity and synergy' between them
	c) allow those who wish to continue in an individual capacity to
	do so
	d) recognise that we put our money into general practice
	e) that means that any professional group wishing to 'collaborate'
	with us,  must do so too.  Money where your mouth is.
	f) recognise that irrespective of all the fancy jargon, 
	management-speak and 'politically-correct' talk that the bottom
	line is this:
		1) it is the doctors who ultimately decides because it
		is the doctors who have the ultimate responsibility (I
		mustqualify this by 'Principal GP' since we still have
		the travesty of carrying the can for non-principals!)
		2) patients,  on the whole,  still wish to be seen by a
		doctor
		3) we have a job to do.  We know how to do it.  We are
		obstructed all the way by endless arguments with those
		who do not understand how it works
		4) whatever happened to 'patients not paper'?  We are
		still drowning in paper.

6.  Offer this:

	a) GPs,  through their collective will and representation will
	'advise' the DoH on primary care matters
	b) those GPs who wish to 'manage' should do so full time and be
	trained for it,  but not speak for the profession
	c) strengthen our existing accountability mechanisms

7.  Negotiate a 'Better Deal' for all GPs.  That includes:

	a) end of 24 hours responsibility
	b) bring pay back to where it should be compared with other
	professions
	c) end the SFA system for paying GPs
	d) end the 'pool' system,  intended net average, review body etc
	e) negotiate directly and collectively with government on pay
	and conditions
	f) back that with real muscle and gumption up to and including
	strike action
	g) always derive your power from the grassroots

Do you have any problems with that?

I could go on.  These are just one man's thoughts.

>As the options come into focus I think the majority of our colleagues
>will agree that collaboration is preferable to conflict in this
>instance.

What is your evidence?  Where did this 'majority' come from?  Have you
asked them?  All of them?

>Listening to our GMSC leaders I just can't see a unified coherent
>response from general practice in favour of striking over this issue.

Da-da!  Hole in one,  Trims :-)

Of course,  you can't see it.  The leadership is on a different planet.

The words 'lions led by asses' spring to mind,  but that was in another
country and me thinks the wench is dead.

In summary:

1.  Provide coherent, strong and responsive leadership
2.  Ask the grassroots on this specific issue of PCGs *and* the wider
     issues of the 'State of the Profession'
3.  Get a mandate
4.  Go talk to government when you are upstanding
5.  Get a real and enjoyable life ;-)

Does anybody have problems with these 5 points?

Let me hear it.

Ahmad

-----------------------------------------------------------------------------
Dr Ahmad Risk
http://www.cybermedic.org
Chairman British Healthcare Internet Association <http://www.bhia.org>
Director Internet Healthcare Coalition - USA <http://www.ihc.net>

Home: +44 1273 724866/748198
Work: +44(1737)240022  Fax: +44 1737 244660


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