Will GPs swallow Labours latest pill

3 May 01
GPs are angry that much is evident. The actions of those who on May Day closed their surgeries to all but emergency cases led family doctors to be mentioned in the same breath as the militant anti-capitalists and eco-warriors also protesting that day.

04 May 2001

The doctors' union, the British Medical Association, which refused to support the action, says it will ballot its members in the next few weeks on a mass resignation.

But why are these unusual suspects creating such a fuss? After all, last week the Department of Health outlined plans to give GP-led primary care trusts (PCTs) control over three-quarters of NHS spending in England by 2004. GPs will no longer be hospital consultants' poor relations they will effectively control what consultants do.

The reason for the disquiet lies in the implementation of the NHS Plan. Although family doctors largely agree with the modernisation programme, they are frustrated by the amount of paperwork they are asked to complete. They claim this means they can only spend about five minutes with each patient, instead of the ten to 15 minutes they believe they need. Lack of GP recruits is creating a vicious circle, further lowering morale and prompting ever more to seek early retirement.

It is too early to say which way family doctors will vote. Whitley Bay GP George Rae, for example, says doctors are angry but few in his local area would vote for resignation.

The BMA probably hopes the government will offer a suitable olive branch that would enable it to claim victory and postpone the resignation ballot.

The government's response so far has been to praise GPs' professionalism and, last week, to dangle control of most health care spending before them. These proposals will have wide-ranging consequences. Health authorities will be reduced from 99 to 30 and PCTs will be given many of their current functions. Doctors and managers welcome the move away from the Department of Health's `command and control' tendency.

BMA chairman Ian Bogle says: `Decision-making in the provision of health care should rest as closely as possible to the consulting room. For too long the health service has been centrally driven and this central control culture has held back progress.'

But he adds that the reforms could make workload problems worse by taking GPs away from their patients for longer.

This claim is dismissed by Stephen Thornton, chief executive of the NHS Confederation. `The proposals do not give any more responsibilities to PCTs. These responsibilities were heralded when The New NHS white paper was published in 1997 and the role it defined for PCTs will now come to pass,' he says.

`GPs will not be taken away from patients to do an admin job, and I don't see how they will be spending more time on administration. There will be managers and administrative support for the doctors involved. The trick is to get the GP input at the right level, so their time is used efficiently.'

Thornton insists that the resources freed from the reduction in health authorities will have to be spent on PCTs. `Health authority staff must be moved to PCTs this is not about cutting management overhead costs,' he says. `The NHS Plan requires good management, and that costs money.'

While the debate over GPs' workloads rages, it is no coincidence that the BMA and the Department of Health are negotiating a new contract for GPs. Nor is it a fluke that the results of the resignation vote will be announced possibly days before Tony Blair asks the electorate to re-elect his government.

There is no doubt that the BMA is concerned about the quality of care that patients receive and the welfare of its members, but it is also trying to strengthen its own negotiating position.

Cutting red tape is not the only issue in the contract negotiations. The government wants to change the way GPs' pay is calculated. In future, this will be based on outcomes rather than the number of patients they see or have on their lists. The BMA will want to ensure this does not hit GPs in their pockets.

The union also wants to maintain its national clout. It fears the new contract will allow some pay to be based on the achievement of locally negotiated targets and the BMA will wish to limit this.

But the ultimate prize will be to win a further increase in GP numbers. The NHS Plan promised an extra 2,000 GPs by 2010 but the BMA believes 10,000 are needed. A compromise figure would stop the proposed mass resignation.

But the BMA would also be able to argue that to recruit and retain the necessary numbers, pay will have to be increased. That, it would say, is the ideal prescription in the search for a cure for GPs' longstanding ills.


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