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Changes to GP contracts will endanger lives, doctors warn

By Lisa Smyth

Proposed changes to the way GPs deliver services in Northern Ireland will put patients’ lives at risk, doctors’ leaders have warned.

GPs here have claimed their new contract, which is due to come into force at the beginning of April, will mean they will spend all their time ticking boxes rather than caring for patients.

A major row is brewing between doctors and health bosses, who have drawn up the controversial proposals and plan to implement them even without agreement from GPs.

Dr Tom Black (right), chair of the British Medical Association’s GP committee in Northern Ireland, said: “This new contract will harm patients. For example, we are being asked to ensure patients with diabetes have a certain blood sugar level.

“We will be able to keep the level sufficiently low to meet the targets but it is going to mean the blood sugar level of some patients actually drops too low, and you are going to end up with people falling over and injuring themselves.

“It is the same with blood pressure levels. We are going to have patients fainting because their blood pressure drops too low.

“Another thing we are being asked to do is ask every single male diabetes patient on our lists if they suffer from erectile dysfunction, even though there is very little we can actually do for them.

“It is just a box-ticking exercise and in many cases we are being asked to treat our patients in a ‘one size fits all’ approach, which will effectively put them at risk.” An increasing number of GP practices across Northern Ireland have been warning they are reaching breaking point regarding their ability to cope with demand and treat patients.

However, if the Department of Health, Social Services and Public Safety (DHSSPS) imposes the terms of the new contract, doctors believe their workload will increase by up to 15%.

The new contract will come into force at the same time as additional work as a result of Transforming Your Care (TYC) — a review of healthcare in Northern Ireland in which GPs will be expected to deliver more care in the community. “Essentially, it is just not going to be possible for GPs to meet the demands of the new contract and TYC, so the department is going to have to decide which is more important,” continued Dr Black.

“We have been telling them for a long time that we are work-saturated so it makes no sense for them to dump all this additional work on GPs, who have been working extremely hard in recent months to keep patients out of hospitals.”

Dr Black said the proposed contract that has been put forward by the DHSSPS is worse than the one offered to the three other health departments in the UK.

GPs in Scotland and Wales have already agreed their new terms and conditions, while negotiations in England are ongoing.

The removal of a payment made to GP practices in rural or disadvantaged areas will also result in a £35,000 a year loss for some medics, warned Dr Black.

A DHSSPS spokesman confirmed Health Minister Edwin Poots had written to the GPs committee highlighting proposed changes to contracts.

“The department acknowledges that services must continue to evolve to keep in line with the changes ahead through Transforming Your Care.

“The department remains willing to continue dialogue with General Practitioners' Committee NI about the proposed changes in an effort to reach an acceptable agreement,” he said.

Questions and Answers

Q What is the General Medical Services contract?

A The General Medical Services (GMS) contract is the UK-wide contract between general practices and the Health & Social Care Board (HSCB) for delivering services in the community.

NHS Employers, a UK-wide body, leads negotiations with the British Medical Association (BMA) on changes to the GMS contract.

These negotiations take place annually and every year an agreement is reached between the two organisations over the services that GPs will provide.

Q What has happened this year?

A The GMS contract was introduced in 2003 and until now the annual negotiations between the NHS Employers and the BMA has been successful.

However, negotiations broke down before Christmas.

As a result, the governments in England, Scotland, Wales and Northern Ireland developed their own terms and conditions for the GP contract.

The Department of Health, Social Services and Public Safety (DHSSPS) was the last to issue its proposals, which were released on Tuesday.

Q Why are GPs so |angry?

A Family doctors in Northern Ireland have been saying they are struggling to cope with demand and they are already concerned they will be unable to deal with the increased workload being proposed under Transforming Your Care (TYC).

This is a review of the way healthcare is delivered in Northern Ireland which is currently under way.

Under TYC more care is to be delivered by GPs, resulting in a 20% increase in workload.

The proposals in the GMS contract will mean an additional 15% increase, and doctors believe there is no evidence to suggest many of the proposals will improve patient care.

Q So what will happen |next?

A A consultation on the proposals, involving officials from the DHSSPS, HSCB and BMA (NI) will take place until March 22.

The DHSSPS has said it will impose the changes, beginning on April 1, 2013, if it fails to reach an agreement with GPs.

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