GPs will not negotiate with government “with a gun to their head,” GP leader says

BMJ 2012; 345 doi: (Published 13 November 2012) Cite this as: BMJ 2012;345:e7694
  1. Gareth Iacobucci
  1. 1BMJ

The UK government was “holding a gun to the head” of GPs by saying that they must negotiate on changes to their contract, even though it was determined to introduce them regardless, a GP leader said last week.

The Department of Health for England has offered GPs a 1.5% uplift to their funding if they agree to changes to the general medical services (GMS) contract for next year. These changes would include a range of new indicators in the Quality and Outcomes Framework (QOF), the incentive scheme that rewards GPs for achieving targets in a range of treatment domains, and a raising of the achievement thresholds for all indicators in the framework.

But it has threatened to impose the deal if the BMA’s General Practitioners Committee rejects the changes, provoking anger in the profession and prompting the committee’s chairman, Laurence Buckman, to accuse the government of displaying “contempt” for GPs by disregarding months of negotiations with NHS Employers.1

The committee’s deputy chairman, Richard Vautrey, told the BMJ that the profession was not being offered a real chance to negotiate, as the health department would impose its will regardless of the outcome.

He said, “It is completely disingenuous for the department to say that they are expecting us to negotiate on something they are telling us must happen. Effectively, it is negotiating when you’ve got a gun to your head and a knife to your back, [and asking,] ‘Which one do you want them to use?’

“We thought we were involved in negotiations over the last five months—and have been—with NHS Employers. It was only at the last minute that the Department of Health made it clear that this was what their expectations were and there was no option for negotiation around that. It was effectively ‘take it or leave it.’

“What we are clear about is that we are not negotiating under a threat of imposition,” he said.

He added that GPs had been left “stunned” by the intervention, and he urged doctors to respond to the consultation so that the department was “under no illusions as to what the profession is thinking.”

Doctors’ leaders have warned that some new QOF indicators—such as tougher targets for monitoring patients with hypertension, and rewards for referring patients to education programmes that may not be available in some areas—may be “unachievable” for practices. They could damage general practice in the United Kingdom by creating unsustainable increases in practices’ workload.2

The plans would also include a reduction in the variability of funding for GMS and personal medical services (PMS) contract practices over a seven year period; removing organisational indicators from QOF and reallocating the money to fund new enhanced services; and changes to the Carr-Hill formula for calculating practices’ funding.

The health department is to begin formal consultation on its plans later this month but insisted this week that it was not too late for the General Practitioners Committee to return to the table.

A department spokeswoman said, “The consultation is set for a date in November, but we are still open to negotiations. If GPs come back to the table in the meantime there will be no need to go out [for consultation].”

The General Practitioners Committee is currently assessing the changes but has hinted strongly that it was likely to reject the offer, saying that it would not negotiate “under a threat of imposition.”


Cite this as: BMJ 2012;345:e7694