Speech from the Chairman of the General Practitioners Committee, Dr John Chisholm
Monday 30 June 2003
This is a momentous time for general practice. We stand on the brink of radical change – change that will improve the working lives of doctors and improve patient care.
A year ago, the ARM was held during the ballot on whether the framework of the new contract was an acceptable basis for further negotiations. GPs endorsed that framework by three to one. Now I am speaking to you just after the overwhelmingly supportive ballot on the acceptability of the contract itself.
The new contract delivers on the objectives defined by the National Survey of GP Opinion and the principles of the framework document. GPs told us they wanted less work, the ability to say no to new work, demand management, career development, fairer resourcing, better pay, better pensions, practice-level flexibility and increased investment in general practice. We have delivered.
The ability to opt out of out-of-hours work and responsibility at an affordable cost; the possibility at last of saying no to new work; the deserved average rise in net incomes of 26 per cent over the next three years; even larger rises in GPs’ pensions over the same period; a 33 per cent increase in investment in primary care over the next three years; opportunities of salaried service for those who wish; much greater flexibility and autonomy at practice level for GPs and practice teams to decide how services will be delivered within a practice-based contract, to make their own choices as to how they organise the care of their patients; and an evidence-based Quality and Outcomes Framework which is unique in the world, which guarantees very substantial rewards to those practices delivering high quality patient care and which is likely to lead to improvements in health outcomes and reductions in premature deaths – all these are successes worth having in anyone’s book. The reality is that all practices will have the opportunity to gain substantially through the introduction of the new contract – not just financially but through improvements to GPs’ working lives.
Because the initial allocations to practices of the global sum – the basic funding for core services – risked destabilising and threatening the viability of some practices, a Minimum Practice Income Guarantee was introduced, which ensures that all practices will gain financially under the new contract. The guarantee is permanent and protects practices’ income.
Following a Special LMC Conference on 14 May, a number of further improvements to the contract were negotiated. The global sum will be based on registered lists. There will be no deduction of the value of 100 or 150 quality points from practices using the Income Guarantee. Preparation for a review of the allocation formula will begin immediately. Factors to be considered during that review have been specified. Clinical quality payments will be based on disease prevalence, and all quality payments will be delinked from the allocation formula. Improvements to the seniority payments scheme have been agreed. Additionally, we obtained greater clarity about the benefits and implications of the new contract for doctors working under Personal Medical Services contracts. All of those late changes are significant and substantial, are in line with the wishes of the LMC Conference, and were achieved as a direct result of the unity and strength of purpose displayed at that Conference.
However, all this progress has been achieved primarily because of the fantastic efforts of the GPC negotiating team, and of the GPC and BMA staff with whom I have had the enormous privilege of working. All have been unstinting in their support, their creativity and their industry. I truly could not wish for a better team to work with. General practitioners are in their debt. I hope you will join me in thanking my colleagues and friends.
The GPC decided at a special meeting on 29 May to initiate a ballot on the acceptability of the new contract. GPC members believed that GPs’ major priorities had been addressed over the past nineteen months of negotiations and that many of GPs’ final remaining concerns had been addressed in that last fortnight. They were also very much aware that balloting then was definitely our last chance of retaining the protection of a UK-wide contract.
The ballot opened on 2 June and closed on 20 June. There was a 70 per cent turnout, and of those voting, 79.4 per cent, eight out of ten GPs, voted ‘yes’. An absolute majority of GPs – 55 per cent – voted in favour.
That vote is a turning point. It signals a new era for general practice. The profession has given a clear and decisive mandate for change. The significance of that result for GPs, their patients and for the BMA cannot be overestimated.
The GPC negotiating team will now turn its efforts to achieving a successful implementation of the contract. Primary and secondary legislation will be introduced in all four countries of the UK, and practices and Primary Care Organisations will urgently need to plan for the future. The new contract may not be perfect, but it is enormously better than the Red Book contract it is replacing. A contract is a live, dynamic, evolving entity. We are now in a position to negotiate its revision and improvement from within, through sensible, evolutionary change in the light of experience.
The past few months have been difficult for all of us. There has been anger, confusion and despair. Following the ballot result, we now have an opportunity to begin to heal these divisions, to dispel the anger, to remove the confusion and to counter the despair. There is far more that unites us than divides us, and we must never allow temporary difficulties to blind us to the fundamental values that I know we all share.
I passionately believe that the new contract represents the best future for general practice. It truly has the potential to regenerate general practice and at last produce long-overdue improvements in morale, recruitment and retention. It is the right way forward.
Throughout these negotiations, we have been guided by a clear vision. We have been determined to focus on our long-term goals, by our view of what is best for our profession and our patients. We have lifted our eyes to the horizon. We now at last have the future within our grasp.