Having just returned from a very rough but very fast and exhilarating
passage to the Channel Islands I find nearly 500 messages to wade through.
My request to suspend mail did not register! Back to face storms of a
different kind!
You are mistaken. I am not against PCGs. I am against the way they are being
imposed, and the threat they now represent to our personal incomes. If our
concerns re ring fencing of GMS income, proper payment, clarity of structure
including membership and democratic accountability,erradication of deficits,
proper financing, etc. are dealt with, then the PCG experiment might have
some interesting possibilities.
 I do have  fundamental personal concerns which relate to the whole concept
of the internal market and cost domination of the  NHS, with inequity of
access to care, be it from one PCG to another, or between fund holding and
non-fundholding practices. Rationing by post code is objectionable. I  did
not go into general practice to become a manager, and I am worried that the
whole concept will put most "thinking" young doctors off general practice as
a career, at a time when there is a frightening manpower crisis developing.
( Most GPs are never-the-less very good at management. They run very
efficient small businesses, and they do demonstrably have higher IQs than
most NHS managers!)The break-neck speed of introduction for PCGs is a
deliberate tactic to wrong-foot the profession. The government will
undoubtedly talk terms if GMSC calls a halt to GP involvement pro tem! The
first step is for the profession to give an unequivocal steer to GMSC at the
LMC Conference. A close vote will be disastrous. Hence you must keep up the
pressure. I can understand the worries of GMSC negotiators having witnessed
the woolly indecision and the divisions in the profession at recent
conferences. I can predict their speeches already. They will sound so
convincing - and representatives will yet again waver! It is down to you to
make sure representatives are briefed with the majority view.
 Look at the whole thing from the point of the civil servants who were
obviously politcally briefed to come up with a scheme to replace
fundholding. They would be bound to anticipate some resistance from the
medical profession, especially to fixed prescribing budgets. Their prime
objective has to be to get the PCGs up and running at minimal cost
utilising fund holders' undoubted management skills to establish locality
commissioning, and to cap prescribing budgets at local level. Now if I were
in the situation of those civil servants I would deliberately throw in a few
very controversial extras. It wouldn't matter that they were obviously
unfair and unacceptable. How about suggesting PCGs should have to absorb the
HAs existing  funding deficits, and then perhaps add a half concealed threat
to GPs personal incomes by chucking  currently ring-fenced GMS monies into
the general underfunded pot along with prescibing budgets and secondary care
money? These aspects  would be deliberately put there so that they could
"reluctantly" be conceded in negotiation, leaving the GMSC and profession
feeling smug with a negotiating victory, and leaving all real government
objectives intact. The White Paper didn't just happen. Tactics have been
planned with military precision. We are not dealing with fools( at least on
the Government side!). Only fools would presume that they could have things
entirely their own way with such controversial proposals! The DoH must think
Christmas has come early! What the civil servants had understandably not
reckoned on was the lack of any serious resistance from GMSC!!!!  Pathetic
isn't it? What we are now about to accede  to is a move to have GPs work
their butts off to pull a bankrupt NHS into the black, in their own time,
with at best token payment, and with the threat that if they fail they
suffer massive loss of income, and if they succeed they, and not the
politicians, get the blame for rationing essential services.
 And, yes I did outline my views last year for an acceptable national
salaried service, and also a framework for mass resignation. Both are
possible. Both are realistic options, with their own attractions and also
their own problems. If we pushed for a national salaried service on our
terms, backed by serious threat of resignation, then I think the government
would be in some difficulty refusing us. The probable expense of such a
salaried service would doubtless act as a spur for the politicians to make
our independent contractor contract much more attractive.
Unless we have clear thinking on our possible options how the hell can we
negotiate effectively?
I would on balance still prefer a better deal on our current contract, but
it would have to be a much better deal! The paper which I wrote on an
improved independent contractor contract  was presented to GMSC along with
many others when we had a think- tank day to look at our contractual options
( for all the good it did!!!). It was also published in GP Newspaper.
I will give medical politics a bit longer, but frankly if GMSC lies down to
have it's tummy tickled just once more, then I will feel inclined to spend
my time working to improve my own lot rather than trying to improve the lot
of general practice. I am having to do GMSC work in my own time.
More time to go sailing is becoming appealing!

                                              Peter Fellows.



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