hoolet Issue 47 - Winter 2005

Chris Johnstone Intro.
Faith
GP Workforce
Appraisal Appraised
Appraisal Defended
Post Traumatic
Out of Practice
A Christmas Caper
Swimming up the Aisle
Hunting Pink Elephants
Cannon Fodder
Review: Bathsheba's Breast

The Old New Contract

By Chris Johnstone
Contact the the editor by e-mail at christopher.johnstone@ntlworld.com

Welcome to the quarterly quota of whinging, whining and general moaning. Before I start I'd like to offer some hope and cheeriness in these dark days. Things could be worse. I jest not. You may believe that we are all going to hell in a handbasket and it couldn't be worse, but it could. You could be a GP in Turkmenistan.

Turkmenistan is a central Asian country, once a Soviet republic. It is mainly desert, has a population of five million and is gas and oil rich. However it is a one-party state and ruled by one man without any opposition of note. His personality cult has few modern parallels, even beer is named after him; he is Turkmenbashi, or the "Father of all Turkmen". I have just listened to a radio 4 documentary on health care in his country and it sounds awful. He has closed all provincial hospitals; "What is their purpose when we have such good hospitals in our capital?", he asks. The hospitals are still running, but with little state aid. If you have a serious illness you can either travel huge distances to the capital for treatment or cross the border to neighbouring countries. The punishment for crosssing the border without permission is to be shot on sight. He also does not value health professionals. He has made 15,000 doctors and nurses resign and has replaced them with conscripts. Rather like an exaggerated first wednesday in August that never ends. It does not sound like a good place to be unwell.

These problems make our own seem very insignificant, but they are real enough to ourselves. We are in the last half of the second year of the new contract. Boy, have we done ourselves proud. I have never been busier and our practice staff expands almost exponentially. Not only are we implementing evidence-based guidelines as never before, but still we offer the old-fashioned, caring general practice which I, and I hope my patients, value so highly. We offer same day appointments and you can book in advance. I even got a pay rise of some note. Though now I have tax bill which seems disproportionate to what I earned, as usual, and a superannuation bill which I forgot I voted for.

So am I happy? Yes. I have less spare time, there is still too much paperwork and computer time, but I feel I do a good job and am happy in my little coccoon.

Am I appreciated? By my patients? Yes in the main. By our political masters? Apparently not.

Despite doing all that we've been asked, it appears that we are not the flavour of the month in our respective departments of health. We have done too well in the QoF, there are undercurrents suggesting we have cheated somehow and that the NHS financial crisis, looming larger all the time, is due to greedy GPs. On top of this we are also portrayed as lazy. We only work between eight and half six and no longer work weekends. Not only are we now workshy, but it is costing a fortune to fill the out of hours sessions. Suddenly GPs are the villians of the NHS pantomine and it is perfectly acceptable to hiss and boo us when we are mentioned at management meetings.

So, despite agreeing a contract, which was signed by both sides, despite providing cheap out of hours cover for years, despite still providing the cover for out of hours, despite meeting difficult targets for ten chronic diseases as well as what we did before, we are being vilified. We kept our side of the bargain and we are being punished for it. Why would anyone behave like this? Why would anyone sign a contract with GPs and then pillory them for implementing it? Why indeed?

I have always thought the contract was designed to make general practice more attractive to private investors. Our previous contract, with 24 hour cover 365 days a year, no measurable outcomes, personal lists was too open-ended to be sold off. So a contract with limited working hours, patients registered with practices, not individuals and a series of management friendly targets is much more attractice. Perfect for companies to take over, but there is a fly in the ointment. The practices are still been run by GPs and run very well. Targets are being met (too well met according to some), access is almost sorted in many areas and GPs do not want to be taken over. So the GPs will have to be forced out and the public must approve.

GPs are now being blamed for a variety of NHS problems, they are portrayed as lazy and greedy and not providing what patients want. This is confirmed by a series of public meetings where we are told the public want longer opening hours, lots of choice, immediate appointments within ten minutes of when they demand them. GPs are shown to be not responding to their patient's wishes and therefore they do not deserve to keep their practices.

However it could be worse, Tony Blair could be the Father of all Britons and we could be living in Scotsmenistan.

Seasons greetings to all our readers and all our contributors. Have a peaceful holiday season. Everyone at hoolet wishes you all the best for 2006.

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