GPs accept plans for extended hours

This week saw the not altogether unsurprising news that, after initial opposition, GPs agreed to accept Health Secretary Alan Johnson’s plans for extended hours.

The British Medical Association’s history of confrontation with the government looked set to continue when the BMA criticised Mr Johnson’s proposals, claiming that the government’s real agenda was the privatisation of services and the undermining of traditional GP practice. It threatened that GPs would be forced to leave the NHS under the proposals. The government in turn responded by claiming that the leadership of the BMA was out of touch not only with the public but many of its own members.

Distrust of the BMA was evident in Mr Johnson’s decision to approach GPs directly over the issue, rather than through their union. Such distrust was not confined to government benches, with Kenneth Clarke, the former Conservative Health Secretary labelling the BMA the toughest union he had dealt with. Even the editor of medical journal “The Lancet” criticised the BMA for “scaremongering” and constructing a “tissue of lies”.

Mr Johnson’s apparent willingness to force through a “tougher settlement”

if the BMA rejected his plans made the climbdown virtually inevitable, with

GPs describing the option as “the lesser of two evils”. However, this does

not necessarily represent a victory for the government which will now have

to deal with evident hostility from many GPs over its handling of the issue.

The fraught relationship between the government and the BMA is likely to

pose significant problems for Mr Johnson in the immediate future –

especially in relation to the Darzi “polyclinic” reforms.

In spite of initial anger from the BMA, it soon became clear that it had no

real willingness to take on the government. Fears of industrial action were

unsubstantiated. The principal reasons for this are perhaps a feeling that

current practices must change to reflect expectations in addition to the public perception that the GPs’ contract, negotiated in 2004, rewarded the profession handsomely while patients have not benefitted.

There is little doubt that GP’s have done well from the contract, which effectively allowed GPs to opt out of evening and weekend work for a 6% pay cut. The contract saw average GP pay exceeding the £100,000 barrier and attracted criticism for the fact that it appeared to reward a lack of productivity and paid generalists more than specialists. Reports of GPs earnings lost them the support of many of the public and, while the £100,000 figure is not entirely typical – the basic pay for a GP is £55,000 – a new target related bonus scheme allows plenty of opportunity to earn well above that salary.

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