Editorials

Passing the contractual buck

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7323.1199 (Published 24 November 2001) Cite this as: BMJ 2001;323:1199

Alan Milburn's move may help improve relations with the profession

  1. Dominique Florin, fellow,
  2. Steve Gillam, director
  1. Primary Care Programme, King's Fund 11–13 Cavendish Square, London W1G 0AN

    Negotiations for a new contract for British general practitioners have begun. Following an announcement in July by Alan Milburn, the secretary of state for health, ministers and civil servants of the department of health no longer negotiate the terms of the national contract directly with general practitioners.1 NHS managers, represented by the NHS Confederation, now have this role.

    This change took everyone in the general practice community by surprise, but it might just break the longstanding stalemate between the government and the medical profession. Currently, general practitioners are plumbing new depths of despair with their workload, with New Labour's consumerist vision for the NHS, and with the constant references to medical failures from Shipman to Bristol. While politicians assert sympathy with the position of health professionals, they have set up a host of new mechanisms to increase their control over doctors in the NHS. The lay press alternately paints a picture of special pleading by greedy doctors and exhausted caring professionals struggling to keep afloat in a system stretched to breaking point. In a pre-election ballot, over 80% of general practitioners who voted said they would be prepared to consider resigning from the NHS should the government fail to agree contractual changes with their leaders.2

    Reform of primary care is linked intimately to …

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