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GPs have an 'obligation to follow their contracts'

Coalface tales

James Booth

Thursday, 02 November 2017

contract_AdobeStock_285333.jpgIt is always surprising to me that a Conservative government that seeks to portray itself as a champion of free market economics in almost everything it does, starts to sound a bit totalitarian in the dealings it has with GPs. Just this week, at the Commons Health Select Committee, Jeremy Hunt told colleagues that we have an “obligation” to follow our contracts. This was in response to a question arising from a proposed motion at the England LMCs Conference next week, calling for practices to be “supported to operate within a private, alternative model”. I’ve always had my suspicions that this is exactly what the man who once wrote a pamphlet calling for the NHS to be replaced by an insurance system was after in the long-term, but it actually seems to have got him a bit rattled. Much as he wants to “listen very carefully” to concerns about our workload, he was at pains to point out that we have a “contract with the state”. 

There has always been a disconnect here, of course. On the one hand, as a holder of a GMS contract, I run a small business, and have to be acutely aware of the challenges that brings. It means that I can decide how I wish to run my surgery, how I meet my contract with the resources I have, and I will always firmly believe that it is the efficiency and innovation that this has allowed for years now is why primary care is done so very well in the UK. However, I’m not a genuinely independent contractor. I have one big client, and that client prevents me from offering my services privately even if my patients wish it. I can’t advertise my services. My contract is open-ended in terms of the offer of service, and yet the income is fixed to my list, not the number of contacts. 

And, let’s look closer at that contract. Is a true contract one that can be changed unilaterally by one side, with no recourse? Those colleagues who held PMS contracts until recently might have some views in that regard. Imposition of change has been an ongoing concern since I started as a GP 11 years ago, and that imposition can only ever flow in one direction. It’s perhaps also worth bearing in mind that whilst it is very challenging for an average GMS contract to be ended by the contractor, those difficulties haven’t seemed quite as acute for the private providers who have found that running general practice isn’t quite as easy as all that.

There’s been a bit of a change in tone from our Health Secretary of late. He’s beginning – at last – to acknowledge that primary care is in crisis, and that so many of us are reaching the end of our tethers. He was brilliantly challenged by a good friend at the RCGP last month on this. I’m sure he’s also aware that as I type this, I have learnt that Good Morning Britain ran a major piece on GP burnout this morning, in which one of our colleagues spoke very bravely indeed about the challenges that led him to quit. Ultimately, though, telling us that he knows we are on “the hamster wheel” is empty unless it’s backed up with ideas for solutions that reflect an understanding of where we are. I’m not sure conjuring an image of indentured service to the monolith of state is the right way to do this.

Here’s a suggestion. Perhaps he would do better to remember that the responsibility to provide healthcare to a population rests with government – although, the Health and Social Care Act did try to remove that – and we as individuals choose to work for that government to deliver it. The undertone that he likes to deliver is one that cynically mixes the professionalism of my GP colleagues with an unsavoury implication that this can only be present if we are shackled to the wheel of service and go wherever it rolls. Yet again, his answers betray a fundamental lack of understanding of the problem, and no real solution for the here and now. 

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the named GP for Safeguarding Children locally. All views expressed are his own.
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