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‘Old fashioned’ doctors in new GP contract

Published on 15/11/13 at 11:40am
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The government is changing GPs’ contract with the NHS in a bid to “bring back old-fashioned family doctors” who will be personally responsible for the care of millions of elderly people.

The government consulted on the idea earlier this year, which is aimed at ensuring that the four million patients aged 75 or over will have a named GP looking after them from April 2014.

“We are bringing back named GPs for the vulnerable elderly,” said health secretary Jeremy Hunt. “This means proper family doctors, able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital.”

The new contract is designed to fix the long-term pressures on our A&E services, “empowering hard-working doctors and improving care for those with the greatest need”.

In essence, the government’s narrative is that Labour’s change to the GP contract in 2004 “broke the personal link between GP and patient”.

Hunt explained: “It piled target after target on doctors, took away their responsibility for out-of-hours care and put huge pressure on our A&E departments. This government has a plan to sort this out and today’s announcement of a new GP contract is a vital step.”

However, The Guardian quotes Richard Vautrey, deputy chair of the British Medical Association’s GP committee, as saying the idea that inadequate out-of-hours care is the main factor in more people going to hospital A&E units is ‘nonsense’.

“This has been shown not to be the case by many experts including the King’s Fund,” said Vautrey. “There’s no link between contract changes in 2004 and what we now see in A&E. The reality is that the changes happened in the last few years with the most significant concerns to practices relating to recent contracts.”

In a statement today the BMA, which negotiated the contract with NHS England, reiterated this point.

The BMA’s General Practice Committee chair, Dr Chaand Nagpaul, said the government had listened to the BMA’s concerns and reversed the impact of last year’s contract which he said “resulted in the introduction of unnecessary targets and excessive paperwork”.

GPs will now be able to “use their clinical judgement, not a checklist, when treating their patients” and will have more time to do so and have more resources put into frontline care.

“From the outset of this year’s contract talks, the BMA has sought to positively engage with the government to address the difficult financial and workload pressures facing general practice to find new ways of improving patient care, while at the same time freeing up GPs and practice nurses from pointless bureaucracy,” Nagpaul said.

The agreement overturns many of the changes imposed by the government last year, including three out of four of the enhanced services, the BMA said, although the dementia enhanced service will remain.

The NHS Alliance has been broadly supportive of Hunt’s plans for GPs but has warned that primary care will need to be ‘reinvigorated’ to make it work.

“There will have to be greater resource in general practice, with, as Mr Hunt has acknowledged, at least 50% of doctors becoming GPs, and we will need to prioritise what’s important, ensuring that we stop doing the unnecessary tasks such as QOF ‘tick-boxing’, and instead really focus on whole person care,” the group said in a statement in September.

However, Dr Michael Dixon, chair of the NHS Alliance, said of the new contract today: “This is the much-needed return of the family doctor.”

Adam Hill

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