• Extract from : http://tinyurl.com/yszddz

Details of the poll - 12 February 2008

Dear Colleague
Further to my letters of 21 December 2007 and 8 January 2008, the General Practitioners Committee (GPC) negotiators and the GPC have been considering their strategy and the implications of accepting or rejecting the governments’ offer.

The profession faces three levels of challenge over the next three years:

(i) The immediate issue of pay and conditions across the UK that affects all GPs of whatever contractual status

(ii) The short-medium term (1-2 years) impact of Lord Darzi’s ‘NHS Next Stage Review’ in England and changes in the other countries

(iii) The longer term impact on the UK, of government health policy in England – the emphasis on instant access over quality and continuity of care , the increased fragmentation of primary care, the potential for vertical integration between primary and secondary care, deprofessionalisation, and the commercialisation/privatisation of the NHS.

This letter concentrates on the first although none can be viewed in isolation from the others. The GPC will be seeking the views of the entire profession, via a poll taking place between the beginning of the week commencing Monday 18 – Friday 29 February, about their contractual options for 2008/09 and their opinion about the current state of the NHS and it is vitally important that all GPs respond. To help you fully understand the issues, I would recommend that you contact your GPC representative, through your Local Medical Committee (LMC), and, where possible, attend a local meeting to discuss these implications further before you respond to the poll. Whatever your contractual status, it is important that you express your views in this poll. Please do not abstain.

The appendix of this letter contains information on the following subjects which you should read before responding to the poll:

(i) Background information on the negotiating process (Download in PDF format 31k)

(ii) Up-to-date details of the governments’ offer (option A) and the alternatives (option B) in all four countries of the UK (Download in PDF format 41k)

(iii) Details of the poll (Download in PDF format 28k)

(iv) GPC analysis of the implications of the government’s offer (Download in PDF format 52k)

(v) The situation in the devolved nations (Download in PDF format 30k)

(vi) Longer term strategies and wider issues to consider (Download in PDF format 26k)

(vii) What you can do (Download in PDF format 29k)

It is my view that GPs have been put in an impossible position and will have to choose between two unacceptable options. The GPC has been asked repeatedly which of these two is less bad and at its meeting on 7 February the GPC 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 and patient care more quickly and more lastingly.” This does not mean that the GPC does not have serious concerns about Option A and the way the Government has approached this issue, but that it considers Option A to be less damaging to general practice than Option B. Contrary to some very misleading press comment, this is neither a climb down nor a U-turn but a recognition that between two bad alternatives, one is even worse than the other. The GPC is not recommending any particular course of action and GPs should make their own decision on how to respond on all the questions in the poll.

The options proposed by government have not been negotiated – although we have tried to clarify them and persuade the government to see sense in their implementation. In general, in England, the proposals for extended opening hours are inflexible and do not take into account the differing needs of populations, although the Scottish Government is discussing with the Scottish GPC how they can be made more flexible for Scotland. It is this method of ‘negotiation’ that has angered GPs and it is why we felt we could not accept anything without first consulting the profession. We studied the detail of the two options and have provided GPs with our analysis. We still have huge concerns that the quality and breadth of service in extended hours will not match the high quality of care within our usual hours.

The GPC believes the extended hours proposals as they stand will be unsafe for doctors as they will have to work on their own late at night. Patients are unlikely to receive a full range of services – neither within their practices, such as those provided by nursing and other key healthcare professionals, nor outside their practices, from support services such as routine pathology, imaging, or rapid outpatient opinions. Yet our own GP opinion survey confirmed that many GPs are willing to provide extended hours and, in the spirit of principled negotiation, the GPC worked with the NHS Employers on our own ideas for this in November; ideas which were subsequently over-ridden by the government. The GPC does not believe that the government’s plans as they stand will be good for general practice or patient care.

It is important to note that there has been some divergence between the four countries in their offers to GPs and the alternative proposals. It is vitally important that you make sure you are clear on the exact details of the offer and alternative proposals that apply in the country in which you practise before responding to the poll. Details of the options in all four countries can be found in appendix (ii) of this letter.

I fully accept that neither option is likely to be welcomed by the generality of the profession. Moreover, I must emphasise that this is not a dispute over pay, extended hours or how the UK government treats your negotiators. The GPC is prepared for a longer and sustained struggle over the future of general practice, and our tactics on this issue reflect that key objective. For now, you will have to consider which of the government options is less worse for your practice, your patients, and the future of general practice. To help you make this difficult choice, please take advantage of every opportunity offered to meet or make contact with your GPC or LMC representatives in order to address any concerns you may have.

With best wishes

Dr Laurence Buckman