The secretary of state for health in England took the unusual step this week of writing to all GPs in the country to try to convince them to accept the latest offer from the government for extending surgery opening hours. The letter goes out a week before a poll of GP members of the BMA on how to proceed over negotiations that have reached deadlock.
In the letter Alan Johnson, the health secretary, reiterated the government’s offer over extended hours, which he has previously said was misrepresented by the BMA.
The deal is for practices to provide 30 minutes of extended opening per week for every 1000 of their registered patients—or three hours for an average sized practice. It will be funded by rerouting £158m (€211m; $311m) from access incentive schemes (the Access and Choice “Directed Enhanced Services”) that come to an end this year, not from the Quality and Outcomes Framework, the letter says.
“In return for this, we have offered a 1.5% increase in investment for primary care, worth around £12 000 of new money for an average-sized practice or just over £100m nationally. The first call on this investment would be any inflationary uplift agreed through the annual Pay Review Body process,” says the letter.
Mr Johnson dismisses the BMA’s argument against the proposal as one which will take away resources from to the heaviest users, particularly elderly people.
“The QOF [Quality and Outcomes Framework] already rewards GPs for high quality care for heart disease and other vascular illnesses, as well as other illnesses that affect older people, such as dementia. Our proposals do not in any way reduce the substantial existing investment in these areas, and this sort of care is at the very heart of general practice,” says Mr Johnson.
The government has said that if the proposals are not signed by April tougher contract changes will be imposed on all GPs without any negotiations.
However, Laurence Buckman, chairman of the BMA’s general practitioners’ committee, disputed Mr Johnson’s interpretation of the government’s proposals. “The QOF points we wanted to reinvest [in the BMA’s proposal on extended hours] to improve clinical care are being used to fund extended opening hours—something the government’s own patient survey has shown is wanted by only a minority of patients,” he said.
Last month the BMA sent a letter to patients through surgeries expressing its concern that the government’s real agenda was not about improving GPs’ flexibility but about replacing traditional surgeries with large GP practices or polyclinics.
The letter urged patients to write to their primary care organisation, the local press and their MP about how much they value their local surgery and why they are against the latest reforms.
Dr Buckman has described the government’s tactics as “gun-barrel method of negotiations.” The proposal would lead to cuts in GP practice funding—to the tune of £36 000 a year for an average practice—that would have to be earned back through providing extended hours, he said.
“Despite what the government claims, their plans and the resulting loss in practice resources will destabilise many well established GP surgeries and this could have a knock on effect on daytime services, the time when our highest users—mothers with young children, older patients and those with chronic conditions—need and want to see their GP,” he said.
“GPs are worried about the future for their practices and their patients. We are being contacted all the time by GPs who are angry and upset about the bullying behaviour of the government and who fear that the government’s plans will damage general practice in this country. How else can one interpret the threat to take money away from GPs when we know primary care trusts have been told to spend money on private general practice provision by big companies?”