This new contract has certainly caused great dismay amongst rural doctors. There are several reasons for this. Firstly and most importantly the contract is perceived as a step on the road to incorporating general practice fully into the NHS, removing independent contractor status and GPs becoming salaried employees. The setting of a base salary of ~ £80k, the insistence that attached MDT colleagues be HB employees rather than be recruited and employed by practices and the progression towards all GP surgeries being in NHS premesis all point towards the loss of the autonomy which makes general practice so efficient and innovative.
Secondly the removal of areas of core work continues the fragmentation of general practice which started with the removal of our 24/7 responsibility in the 2004 contract. This erodes the ethos of holistic cradle to grave care which is at the heart of many GPs' love for their profession.
Thirdly most urban colleagues are getting a rise in resource allocation, a reduction in workload and the offer of additional staff (i.e. pharmacists, etc). Most rural practices are getting none of those things because
1. The workload allocation formula does not give them an uplift as it takes no account of rurality, meaning that most rural practices have to exist on subsidies. This erodes our morale and makes it even more difficult for us to recruit or retain doctors.
2. There is no one else to do the work which urban colleagues will shed, but no mechanism to resource rural doctors for doing this work, and
3. There are few additional staff available in rural areas so rural GPs will not benefit from MDT colleague support and again there is no mechanism for this to be compensated for.
Rural doctors have been left feeling that this contract was negotiated without adequate thought being given to how to support us to continue to provide the holistic, person centered, realistic medicine to the patients we serve in the communities where we live and work. We feel let down by our BMA negotiation team. The promised short life working group looking at rural practices should have reported before the contract poll, not as an afterthought and only after intensive lobbying by RGPAS, Highland LMC and others. We urgently need active collaborative engagement with the rural general practice community to restore trust and reassure us that we will be able to continue to provide first rate care for our patients.
Rapid Response:
Re: GPs in Scotland vote to accept new contract
This new contract has certainly caused great dismay amongst rural doctors. There are several reasons for this. Firstly and most importantly the contract is perceived as a step on the road to incorporating general practice fully into the NHS, removing independent contractor status and GPs becoming salaried employees. The setting of a base salary of ~ £80k, the insistence that attached MDT colleagues be HB employees rather than be recruited and employed by practices and the progression towards all GP surgeries being in NHS premesis all point towards the loss of the autonomy which makes general practice so efficient and innovative.
Secondly the removal of areas of core work continues the fragmentation of general practice which started with the removal of our 24/7 responsibility in the 2004 contract. This erodes the ethos of holistic cradle to grave care which is at the heart of many GPs' love for their profession.
Thirdly most urban colleagues are getting a rise in resource allocation, a reduction in workload and the offer of additional staff (i.e. pharmacists, etc). Most rural practices are getting none of those things because
1. The workload allocation formula does not give them an uplift as it takes no account of rurality, meaning that most rural practices have to exist on subsidies. This erodes our morale and makes it even more difficult for us to recruit or retain doctors.
2. There is no one else to do the work which urban colleagues will shed, but no mechanism to resource rural doctors for doing this work, and
3. There are few additional staff available in rural areas so rural GPs will not benefit from MDT colleague support and again there is no mechanism for this to be compensated for.
Rural doctors have been left feeling that this contract was negotiated without adequate thought being given to how to support us to continue to provide the holistic, person centered, realistic medicine to the patients we serve in the communities where we live and work. We feel let down by our BMA negotiation team. The promised short life working group looking at rural practices should have reported before the contract poll, not as an afterthought and only after intensive lobbying by RGPAS, Highland LMC and others. We urgently need active collaborative engagement with the rural general practice community to restore trust and reassure us that we will be able to continue to provide first rate care for our patients.
Competing interests: No competing interests