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GPs want core services defined

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7046.1559a (Published 22 June 1996) Cite this as: BMJ 1996;312:1559

British general practitioners have overwhelmingly supported the principle of core services and instructed their leaders to negotiate a new contract “based on an acceptable definition.” A special conference of representatives of local medical committees last week called for the contract to be nationally negotiated and based on individual practitioners.

The conference disagreed that finding a definition was the most important priority for the next 12 months but voted by 160 votes to 102 that out of hours work should remain a core service.

The 1995 conference had asked for the core element to be defined (BMJ 1995;311:131), and earlier this year the General Medical Services Committee sent a discussion document, Defining Core Services in General Practice—Reclaiming Professional Control, to all general practitioners.

This document identifies the work for which doctors are paid through intended average net remuneration and the work which could be classified as non-core services. This includes work which is separately paid for or done without payment (for example, audit, commissioning, and education and training); work which should be the subject of an explicit contract (for example, preoperative assessment and treatment of minor injuries); shared care (for example, dialysis and hospital at home activity); and work that requires specialised training (for example, acupuncture or vasectomy).

Dr Ian Bogle, chairman of the GMSC, said that the document was intended to protect the role of the generalist, “the job that we all signed up to initially, caring for people who are or believe themselves to be ill.” He said that the document empowered doctors to say yes if they wanted to carry out non-core work if it was adequately funded or to say no.

In support of defining core services, Dr Andrew Dearden, who practises in south Wales, told last week's conference, “It is time for us to say what we are good at and what we want to do, not what the government wants us to do.” This was even more important if there were to be different contracts—a suggestion hinted at in the government's document Primary care: the Future (15 June, p 1500).

Just defining core and non-core services did not go far enough, according to Dr Stephen Illingworth from Bristol. “General practitioners are at breaking point and cannot continue with the present workload.” He wanted doctors to list the tasks they did, prioritise them, and then say which they could deliver within the resources available.

Other speakers were more cautious. Dr Michael Ingram from west Hertfordshire warned that if doctors limited their services other people would bid for the things they did not want to do and the government would take advantage of cracks in the profession.

As a result of the conference's decisions the GMSC will produce a further document in the autumn setting out core and non-core services in more detail. This is likely to coincide with a successor to Primary Care: The Future, promised as a result of the health minister's continuing listening tour on general practice. The GMSC's document will be debated at a special conference and the profession will be balloted to decide which policies should be pursued in negotiations. (See also p 1613.)—LINDA BEECHAM, BMJ

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