Government Has Put GPs In An Impossible Position, Says BMA, Re-Issue With Further Details, UK
"The GPC has come to the conclusion that Option A1 is less damaging for general practice, because the alternative option will harm the underlying fabric of NHS general practice and patient care more quickly and more lastingly."
Commenting on the resolution, Dr Laurence Buckman, Chairman of the BMA's GPs Committee said:
"GPs have been put in an impossible position and will have to choose between two unacceptable alternatives. We have been asked which of these two is less bad and we have responded to GP demand that we do that. We are not recommending any course of action and GPs are free to come to their own decision on how to vote. This is neither a climb down nor a U turn but a recognition that between two bad alternatives, one is worse than the other.
"The two deals on the table from the government haven't been negotiated, they are inflexible and do not take into account the differing needs of populations around the UK. It's this method of 'negotiation' that has angered GPs and it's why we felt we couldn't accept anything without first consulting the profession. We have been studying the detail of the two impositions and have provided GPs with our analysis. We still have huge concerns that patients will get neither a meaningful service in extended hours nor will the quality be of a level they deserve.
"We believe the impositions as they stand will be unsafe for doctors as they will have to work on their own late at night. Patients also won't get the full range of services. GPs are willing to do extended hours, we put forward our own proposal in December - we just don't think the government's plans as they stand at the moment will be good for general practice or patient care."
The BMA's GP Committee will be polling the entire profession in mid-February.
Notes:
1 Option A refers to the government deal put to the GPC on December 20 2007. On December 21 the GPC received first details of the imposition. Since then the GPC had been conducting a detailed analysis of both options. The GPC meeting yesterday was the first time the committee had met to discuss this analysis. The details are as follows:
The following details are for England are as follows:
Option A:
The government's proposals:
- £158 million of funding recycled from the 2007/08 Access and Choice and Booking DESs (in England) would be reinvested in extended opening as a DES including £2.80 per patient per annum for providing extended access
- 58.5 QOF points (38.5 from the holistic and organisation domains, plus 20 points from the patient experience domain) would be reallocated to support access arrangements
- Extended opening would be for 30 minutes per week per 1000 registered patients - this would need to be in blocks of 1.5 hours after 6.30pm or for one hour prior to 8.00am or on Saturday morning and would depend on agreement between the practice and the PCO reflecting local patients' wishes. This would be provided through a nationally agreed Directed Enhanced Service (DES), and practice participation would be voluntary
- Part of the funding available for access (35p per patient) would be dependent on the results of access questions contained in the QOF patient survey. This would include targets for 24/48 hours access and booking
- There would be 1.5% uplift in the contract value, although it is unclear how this would be allocated and what additional work on top of the DES further practices would have to do to achieve this.
If the profession did not agree with Option A, the government has said that Option B would be imposed, details are as follows:
- Extended opening funded via £158m from the 2007/08 Access and Choice and Booking DESs but locally agreed arrangements
- There would be 135 points permanently removed from QOF including clinical areas such as influenza vaccination and management areas such as computer security. The overall impact would be a QOF with only 865 points instead of the current 1000.
- All lower QOF thresholds would be uniformly raised to 50%. The upper threshold would be raised to the national achieved average. In general, practices will lose money as the range gets narrower unless they are scoring above the higher threshold for that indicator
- There will be no QOF achievement payment until the end of the first quarter
- The funding, as described above, would be allocated to PCTs for them to agree local contracts for extended opening with any practices - including those newly set up private APMS practices. Experience has shown that it is likely that only a proportion of the funding would end up with any general practices if allocated to PCTs.
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