Friday 18 July 2014

2004 UK GP contract

The last time morale in general practice hit a low point was prior to the 2004 contract, which served to turn the profession around.

What were the two main planks of the 2004 contract?

  1. Out of hours cover
    GPs were given the option to relinquish responsibility for treating their patients after 6.30pm, before 8am and at weekends. For the almost 70% of the week that falls outside of these hours, GPs had each been paid £6,000 per year.
    Bizarrely, society was surprised that attempts to provide an alternative out of hours service for the same price resulted either in overspend or a less satisfactory service. Too late, the value of a service that had been taken for granted was understood.
  2. Performance-related pay
    In a massive experiment, a large proportion of GP pay was tied to successful surrogate treatment outcomes, widely agreed then to represent good Medicine. As promised, the bean counters made this tougher and tougher, adding as they did so more and more controversial measures (such as inflicting questionnaires on people suffering nervous breakdown, interrogating many about their memory and men about their erections).
    GPs persuaded government that new money would be required to employ staff to carry out this extra work. In the event, many GPs chose to work harder rather than take on so many extra staff.
    The vast majority of GPs rose to the challenge, hit the new targets and were rewarded as promised. We should be proud that to make this happen, some GPs chose to work harder and achieve better income.
The 2004 deal has since been described as generous, but it encouraged a generation of doctors to stay in UK general practice.

As general practice faces another crisis, how can we learn from 2004 to find solutions?
  1. Value appropriately those services best delivered by general practice before accepting less satisfactory substitutes
  2. Resource primary care adequately for the work required of it, without imposing arbitrary restrictions on how that work is delivered. Or, conversely, employ all primary care staff centrally and set their salaries directly (and accept the consequent increase in costs and reduction in productivity).

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