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Last Updated: Friday, 20 June, 2003, 12:12 GMT 13:12 UK
GP contract: Impact on doctors
GPs have voted overwhelmingly in favour of a new NHS contract.

BBC News Online examines how the changes will affect doctors.

Do doctors want a new contract?

Yes. The BMA has been calling for a new contract for GPs across the UK for years. In 2001, doctors voted overwhelmingly in favour of resigning from the NHS if ministers failed to start talks.

GPs say changes are needed to curtail what they say is an ever-growing workload and to cut the amount of time they spend on paperwork. They also want more money, saying their salaries are falling behind similar professionals.

The BMA has warned that GPs will continue to leave the NHS and other doctors will refuse to work in general practice unless their terms and conditions improve.

What will be the biggest changes for GPs?

The new contract aims to significantly reduce GP workload. Under the deal, doctors will be expected to work five days a week from 0800 to 1830 hours.

By far the biggest change will be in terms of their out-of-hours work. Under the current contract, GPs are legally obliged to provide 24-hour care to patients.

In years gone by, this meant the local GP was constantly on call. In recent years, GPs clubbed together to set up out-of-hours cooperatives to share the burden.

Under the new deal, GPs will be able to shed this responsibility at an average cost of 6,000.

Primary care organisations will take over responsibility for providing medical care to patients in the evenings and at weekends. They could employ other doctors specifically for out-of-hours work or could use nurses or paramedics to provide care.

Will the role of GPs change?

The answer is potentially yes. GPs will be able to use the extra money to employ more nurses and other health professionals. This will in theory enable them to transfer responsibility for many patients to other staff, enabling them to concentrate on those in most need.

GPs will also be able to opt out of providing some services, such as cervical screening, contraception or immunisation clinics, under certain circumstances.

Others may decide to offer extra services, such as specialist clinics, normally provided by hospitals.

Will GPs get more pay?

Yes but it is difficult to say exactly how much more money individual GPs will take home.

This is because GPs are effectively self-employed and the government uses a complicated formula to decide how much they should be paid, based on the number of patients on their list and the number of treatments they carry out each year. The average GP currently earns 61,218 although many earn substantially more.

If GP pay increases in line with overall spending in primary care, the average salary could rise to 80,000 per year.

Will GPs get financial rewards for working harder?

Yes, under the deal a larger proportion of GP pay will in future be linked to the quality of care they provide to patients.

Practices will earn more income for delivering better quality services in line with well researched evidence on the pest patterns of care and follow up for 10 different disease areas, including coronary heart disease and mental health. The quality scheme is based on a points system with money attached to the points earned.

For instance, they will receive extra money if they improve the overall health of patients with chronic diseases.

GP will also be offered better pay bonuses to encourage them to stay in general practice.

In addition, they will be offered the opportunity to ditch their independent contractor status and become an NHS employee receiving a regular fixed salary.

Will GPs accept this contract?

GPs are a notoriously independent group. The BMA has said it will not recommend doctors accept this deal but rather ask them to take the time to make up their own minds about the proposed deal.

The BMA will be mindful of what happened when they urged consultants to accept a new contract last year.

The rejected the deal and plans to reform the way senior hospital doctors work are now in a mess with the BMA and government at odds over how to proceed.

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