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NEWS: Lynn Eaton BMA rejects government proposals for longer hours for GPs BMJ 2008; 336: 14-b [Full text]

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The milk was spilled some time back.

Hendrik J Beerstecher   (9 January 2008)

Re: The milk was spilled some time back.

Trefor J Roscoe   (15 January 2008)

memory lane

Hendrik J Beerstecher   (17 January 2008)

Gordon Brown can't be trusted

Mary Church   (22 January 2008)

Politicians can be trusted

Hendrik J Beerstecher   (24 January 2008)

Fiddling while Rome burns?

Dr D H Wilson   (4 February 2008)

Rest assured

Hendrik J Beerstecher   (6 February 2008)

The milk was spilled some time back. 9 January 2008
Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA Send response to journal: Re: The milk was spilled some time back.	Dear editor, It seems odd that the BMA is now crying foul with regards to the proposed changes in the GMS contract. It was the BMA that recommended voting for the new GMS contract in 2004, which included 1) the option for unilateral change of terms and conditions 2) no agreement about the scope or purpose of the QOF 3) no safeguards to inflation-proof the contract. The contract was accepted by 80% of the GPs and it seems the BMA is reneging on the agreement of 2004. Surely memories cannot be this short? Competing interests: None declared
Re: The milk was spilled some time back. 15 January 2008
Trefor J Roscoe, GP Sothall Medical Centre Sheffield S20 5JX Send response to journal: Re: Re: The milk was spilled some time back.	I am sorry but Dr Beerstecher is far too simplistic in his analysis. I was an outspoken critic of the nGMS contract at the time but the BMA did not recommended voting for the new GMS contract in 2004, they put it to the profession as the best they could get given the Governments position. He forgets that the ability to stop doing out of hours was a huge incentive to vote yes, perhaps outweighing other considerations. The option for unilateral change of terms and conditions has been part of the GP contract since 1948, although I am sure it was not envisioned that it could be used as a weapon of spite by a Government who were not getting their own way. To say there was no agreement about the scope or purpose of the QOF is ludicrous. It was design to stimulate better care and provide a performance related bonus for those GPs who were providing it. The Government interfered with it and are now dismantling it, despite the fact they said they would never do this when it was first negotiated. I agree that there were no safeguards to inflation-proof the contract, but I am not aware of an agreement between any employee and employer, especially in the public sector, where this is the case. The Government is responsible for cutting our pay over the last few years, it is nothing to do with perceived deficiencies in the contract. The contract was accepted by 80% of the GPs but it is not the BMA who is reneging on the agreement of 2004, it is the Government I hope that Dr Beerstecher will join the current GPC in helping to fight this iniquitous imposition that will ruin English Primary Care. Dr Trefor Roscoe GPC Representative for S Yorks. Competing interests: On the GPC - but only since 2004
memory lane 17 January 2008
Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA Send response to journal: Re: memory lane	I copied the poster of the BMA stating: "more pay" (tick) "less work" (tick) "better pension" (tick) "vote today" This is an odd way of not recommending something. An option for unilateral change is part of all employment contracts. The problem is that the GMS 'contract' is not an employment contract. Contractors do not enjoy the protection of tribunals afforded to employees. Therefore any change should normally be agreed by both parties and should be reflected in consideration. This is why the clause for unilateral change had to be specifically included; without it changes in terms and conditions could be challenged. Contractors are not employees, they do not receive pay, nor any of the benefits afforded to employees (holiday entitlement, working hours directive, pension contributions, maternity and sickness benefits etc). The contractors are wholly dependent on the profitability of the business for their income. Normally, if overhead costs go up, you would expect a service to increase their charges. However this has not happened in the last year, nor is there any provision in the contract to effect this. We sold the option to fiddle with the QOF, payment system, hours of availability and everything else to the government in 2004. Shock horror - they are using what we gave them! And I always thought they wanted these concessions in order not to use them. Competing interests: None declared
Gordon Brown can't be trusted 22 January 2008
Mary Church, GP Victoria Medical Practice, Health Centre, Victoria St, Blantyre G72 0BS Send response to journal: Re: Gordon Brown can't be trusted	Negotiators assume each side sticks to the contract agreed. The following was agreed between the BMA and the government for nGMS in 2004: 1 The hours of work ie 8am until 6.30 on weekdays, excluding public holidays. 2. Any other work done outside these hours if needed by the PCO area could be provided and resourced through a locally negotiated LES 3. QOF would only include areas with a sound clinical base We are dealing with a prime minister who cannot be trusted to keep his side of a deal. Should patients trust him with the future of their healthcare or should they trust their family doctor? Competing interests: None declared
Politicians can be trusted 24 January 2008
Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA Send response to journal: Re: Politicians can be trusted	The primary obligation of a politician is to himself or herself. You do not get to the top of the political ladder unless you use all accessible tools for your own self-interest. I suppose one could argue that therefore - by definition - the wrong person gets elected as our leader, but the right people are unelectable. Therefore you can always trust a politician to do what is in their self-interest. What better self-promotion than creating more and better services for the electorate without it costing a penny? Competing interests: None declared
Fiddling while Rome burns? 4 February 2008
Dr D H Wilson, G P principal Rotherham, S.Yorks Send response to journal: Re: Fiddling while Rome burns?	It is disheartening to read Dr. Beerstecher's gallows humour and "I- told-you-so" attitude on the subject of the 2004 contract. It matters little now because NHS General Practice is about to be dealt a mortal blow, and the cold wind of creeping privatisation is blowing under the surgery door. Perhaps that won't be too much of a problem in the South East, where any GP worth his salt will be able to maintain a living from private care, and their patients will be able to afford it. Not really the same for somewhat less privileged areas of the country where commuter belt health care styles don't really fit with the needs nor desires of the populace. As for politicians, self-interest may be a great asset, but I for one feel a little uncomfortable in embracing the urban cynicism that makes it appear acceptable. Honesty, integrity and a desire to serve were possibly motivation for public service once upon a time - politicians may have abandoned those notions, but should GPs follow suit? Competing interests: None declared
Rest assured 6 February 2008
Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA Send response to journal: Re: Rest assured	Dear editor, I can reassure Dr Wilson on a number of issues. Firstly, the threats of privatisation are hollow. When companies or PCTs run practices they cost on average about twice as much. Not even a politician is dim enough to wholesale replace GMS and double the cost of primary care overnight. Secondly, we are only talking about £5k per partner in lost income, not a mortal blow. The PCTs need this money to fund out of hours because, guess what, since the PCTs have taken over OOH it costs about twice as much. Thirdly, this money transfer from office hours to fund out of hours will be taken from small practices. The terms and conditions are such that a practice closing lunchtime or a half-day will not qualify for providing additional hours. This will also result in smaller practices appearing to offer less quality as the money is taken partly from QOF, grist on the mill of the DH. Larger practices and those with more income (PMS) have less to fear than small GMS practices. Fourthly, privatisation does not mean patient charges. If it did, my practice would certainly not be viable. Privatisation simply means that companies will be sweating their assets (GPs and their NHS pensions) in order to pay the directors or shareholders. In the end it will come down to this: Will GPs take the fiver, or take a position of integrity? Past performance may not predict future performance, but it is foolhardy to ignore it. I tried stamping my feet, bashing the ground and screaming loudly so I thought I’d turn my hand to fiddling. Competing interests: None declared