GPs get a new contract “to transform their lives”
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7344.994 (Published 27 April 2002) Cite this as: BMJ 2002;324:994
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There appears to be a predominance of uncritical, unbalanced pro-
contract spin in the BMJ. What is going on?
Competing interests: No competing interests
Dear Sir:
GPs are bound by their terms and conditions of service to refer
patients to different subspecialties.
Overbooking is a tradition in primary care clinics. When GPs are able
to hand over about a third of their duties and to choose the level of
service they wish , this will improve their quality of the service they
provide.
Focusing on a balance between the stressful GP’s workload, GP’s
experience and the backup from expert colleagues is the best tool to
improve patient’s care.
Competing interests: No competing interests
The New GP Contract 2002, ‘Your contract Your future’, brings hope to
general practice (1,2). There is the promise of more time on patient
clinical care and less time on unnecessary bureaucracy. It is hoped that
the new quality targets will heed the accepted principles of screening and
reflect actual clinical practice (3). An end perhaps to the black market
of unproven national screening policies, such as isolated annual peak
flows for every single asthmatic or a dipstix urine test for every single
person over age 5yrs. The quality targets need to be very well designed to
avoid the pitfall of becoming next decade of bureaucratic hoops to jump
through.
The biggest change in the New GP Contract 2002 is not the loss of
24hour responsibility, since that is already happening. It is the loss of
the registered patient list per general practitioner. This has been one of
the fundamental reasons why primary care in the UK has been ahead of other
countries. The understanding that you relate to one GP, in daytime hours,
provides a basis for building a continous relationship over the years so
that each consultation builds on the next.
Fortunately the concept of a registered patient list for a whole
general practice will be retained, but the risk is that the responsibility
for co-ordinating the care of each patient then falls between several
members of the practice. The personal list of general practitioners has
been the bedrock of continuity of care, something which general practice
has excelled at. Steps will need to be taken to ensure that both backstage
(administrative and IT) continuity and frontstage (face to face)
continuity is maintained (4). This reduces duplication of care, overuse of
resources and harm from unnecessary tests. Loss of continuity aggravates
doctors’ stress (5).
The current drive to rapid access to any doctor for minor illness has
already reduced continuity for more chronic complex illness by delaying
routine appointments up to several weeks. General Practices will need to
ensure each patient is allocated and encouraged to see a “usual” doctor
for any illnesses that will require care over time.
The New GP Contract 2002 does not mention continuity of care and this
should be emphasised in future versions as the contract moves towards its
final publication (2).
1) Kmietowicz, Z. GPs get a new contract "to transform their lives".
BMJ 2002;324:994
2) General Practitioners Committee Your contract Your future 2002
London: BMA publishing.
3) Wilson, J.M.G. and Jungner, G. Principles and practice of screening for
disease. 1968 Geneva: WHO.
4) Krogstad, U., Hofoss, D. and Hjortdahl, P. Continuity of hospital care:
beyond the question of personal contact. 2002 BMJ 324, 36-38.
5) Freeman, G.K., Horder, J., Howie, J.G.R., Hungin, A.P., Hill,
A.P., Shah, N.C. and Wilson, A. Evolviong general practice consultation in
Britain:issues of length and context. 2002 BMJ 324, 880-882.
Competing interests: No competing interests
Just what do GPs think of the new contract?
Rapid responses to the BMJ on the new GP contract (some of which are
published in paper form in this week's journal) suggest that many GPs are
sceptical about the new contract. But yesterday I met one of the
negotiators from the NHS Confederation side, and he told me that his
impression from meetings around the country was that 80% were in favour.
The fact that we have had so many responses against the contract and
few in favour might, he suggested, be because a handful of opponents have
been very active with writing to various publications. Some of the authors
are, he said, "the same old names."
But, I speculated, if 80% were in favour wouldn't a few more have
written to support the proposals?
Perhaps the reality is that there is no reality until the contract is
priced. Until then it's all posturing.
Richard Smith, Editor, BMJ
Competing interests: No competing interests