GPs call for separate out of hours contract
BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.6996.7 (Published 01 July 1995) Cite this as: BMJ 1995;311:7
Britain's general practitioners have called for a separate contract for out of hours care, which for many doctors could signal the end of 24 hour responsibility. The decision, taken at last week's conference of representatives of local medical committees, stems from the frustration felt by many doctors at the increased burden of night calls. The meeting also endorsed a ballot on industrial action if the government does not move nearer to the profession's proposals for solving the problem. The secretary of state for health has now been asked to intervene.
Speakers at the conference unanimously opposed the government's approach in concentrating on fees for night visits and avoiding the main issue of a properly structured out of hours service. The meeting called for the out of hours component of pay to be separately identified and for improved funding for the out of hours commitment.
There have been three offers from the government, and last month doctors threw out the third one by five votes to one (17 June, p 1553). The offer included £45m in 1995-6 to develop rotas and cooperatives, £2000 for principals for out of hours work, and a consultation fee of £9. Doctors currently receive £47.85 if they do their own visits between 10 pm and 8 am.
The minister for health, Mr Gerald Malone, offered more talks, but said that there was no more money. He has refused to distribute the £45m to all doctors to help meet existing expenses or to allow doctors to transfer responsibility for out of hours work to other doctors without referral to the family health services authority.
Dr Ian Bogle, chairman of the General Medical Services Committee, took up the offer of further talks, but these reached deadlock two days before the conference. Before a two minute standing ovation Dr Bogle said, “Out of hours is but a symptom of a widespread malaise of British general practice--a malaise reflecting a vastly increased and inappropriate workload caused by an imposed contract, by oppressive management, and by ever increasing bureaucracy; a malaise which finds expression in disillusionment.”
Speakers emphasised that the issue was not about money; it was about quality of care for patients and for doctors. Dr Mary Payne, a general practitioner in Lothian, declared, “We cannot have a primary care led service if general practitioners are disillusioned, demoralised, and knackered.”
GPs vote for a separate contract
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The increased demand for night calls--the number has doubled in the past three years--has had an effect on daytime work. Dr Ann Morris, who practises in Bedford-shire, is married to the deputy speaker of the House of Commons. She told the meeting that she had written to her local members of parliament reminding them that they had recently reduced their working hours. “If MPs cannot function effectively day and night neither can GPs,” she said.
Two thirds want to opt out
The result of the ballot and the government's failure to address the problem led to the calls for a separate contract for night work. Dr Andy Lee from Humberside said that it was nonsense to say that separating off out of hours care would undermine general practice. Out of hours care formed less than 5% of the total of primary care.
In a nationwide survey conducted by the GMSC in 1992 nearly two thirds of the respondents said that they wanted to opt out of 24 hour responsibility.
Although the GMSC has not been negotiating a separate contract, the committee's chairman accepted that there was now a groundswell of support for such a change. There would, he warned, be knock on effects on “in hours” care and on the pool system of pay. Any changes would have to be worked through carefully to minimise the dangers to present and future doctors..
After last week's decisions Mr Malone said that he welcomed the fact that the conference had not moved straight to a call for sanctions, and he repeated that his door was always open. The health secretary accepted that patients had a responsibility to stop making unreasonable demands.
If no progress has been made by the time that the GMSC meets on 20 July the committee will consider a ballot on sanctions, which would go only to members of the BMA (about three quarters of general practitioners). The conference agreed that the profession would need to know the general scope of the sanctions but not the details. An emergency motion calling for a special conference later in the year to decide the nature and timing of industrial action was heavily defeated.--LINDA BEECHAM, BMJ
John Warden, parliamentary correspondent, writes: The initial reaction inside the Department of Health is that general practitioners have “moved the goalposts” in the negotiations about out of hours cover--with potentially important financial consequences involving the total package of remuneration, practice expenses, and allowances. Ministers were quick to imply that any departure by general practitioners from a 24 hour commitment would have to carry a considerable financial sacrifice since the existing package--covering practice records, for example--was based on round the clock cover. It would also raise discussion about moving to a system of salaried general practitioners.