In his over-delayed valedictory speech to the LMC Conference Dr Chisholm spoke of the “magic and mystery of general practice”.   Well, there certainly is a lot of mystery about the new contract he and his team have negotiated and a lot of magic will be needed to make it work to increase retention and recruitment.

The mystery started in an early document of February 2003 quaintly called “The new GMS Contract”.

GPs were told that their pay would be related to the Carr-Hill formula:

"Practice list size adjusted for inflation * ((48.1198 + (0.23676 * SIR,65) scaled back to the UK population".

Dr Chisholm could not explain this to me when I questioned him in Council.

A few magical changes later Dr Chisholm and the negotiators announced to the world at a major BMA Press Conference that all GPs would have their pockets stuffed with NHS gold.

But even before that embarrassing affair thousands of GPs contradicted him.

Far from being quids in, the vast majority of GPs were ten of thousands out.   The negotiators hadn’t a clue what they had negotiated.

A monumental folly of the highest order which would have seen any respectable company or trade union chairman vacate his seat.  But doctors leaders don't do that sort of thing.

And so, out of the chaos was born the MPIG.  A kind of indicator of original Chisholm incompetence meant to ensure that nobody would lose out from the new contract, after all.  In fact virtually every GP now receives MPIG.

In his farewell speech Dr Chisholm roundly blames the government for failing to invest in the global sum thus making vast hordes of GPs dependent on MPIG.

The words "deal-breakers" were bandied about many times as a sop to the masses but there was never anything the government could have done that would have caused a breakdown in negotiations just as there never was a Plan B.    How you shied away from that when I pressed you in Council, John.

And excuse me, John, but who were the negotiators and who had an 80% resignation backing behind them if they were disatisified?   From your speech it looks as though you were unhappy about the global sum, weren't you?

And now even the originator of the formula, Dr Carr-Hill, doesn’t believe his own formula is right. 

God help us, still the negotiators have accepted all this.

And what about the enhanced services?   Even John Chisholm doesn’t think they are much cop because far from enhancing GP income he complains in his speech that the “PCOs aren’t commissioning sufficient practice based enhanced services”.  In fact,  John, they are seeking cheaper sources of service. Nurses and chemists.

John, that was common sense and to be expected.

However, I’ll be fair.

GPs can earn a lot from this contract but must sort out their life insurance first and I’m not sure whether they should inform their insurers of the greater risk to their life caused by the new contract.

Now they must sweat over the still unlimited work to achieve the global sum, then they have to carry out whatever enhanced services there may be and finally, notch up all the heavily policed Quality and Outcomes beanie points.

There is only more pay for more work.   Fine for the government but bad for GPs and a catastrophic failure of their trade union.

But Dr Chisholm knows all about the extra work because in his speech he calls for the transfer of more and more from secondary to primary care whilst quaintly regretting that there are not sufficient GPs to undertake it if the PCOs do follow his lead.

Sorry, John, but you were not negotiating a contract for 10 or 20 years hence, you were negotiating for today when, by your own admission, there aren’t sufficient GPs.

So, who’s being stuffed by this contract? 

Anyway, what were the team supposed to achieve?

Less work – there’s more

Less PCO interference – there will be twice annual forays into every practice

More pay – but only with more work and after gymnastic exercises collecting points.

No forced allocations – they continue

Complete out of hours transfer – patchy and incomplete

So despite what various negotiators write on the back pages of the newspapers, this is not a good contract.   It is a thoroughly bad contract, ill-thought out and rushed, with threats, to the vote,  before it was complete.

Large numbers of GPs are worried, confused and angry as they attempt to calculate with some sort of accuracy the mysteries and magic of Dr Chisholm’s valedictory pay system – not to mention the work load.    Thousands have been left in the lurch to negotiate with the PCOs for themselves.

The evidence comes from Dr Chisholm himself who has said there are more than enough faults and complaints about the contract to keep his ex-team going for another year.

How many of the 80% of misguided and trusting colleagues who voted for it would vote for it again?

What a shambles.

John, it gives me great personal pleasure to wish you a happy, uninvolved and, preferably, unrewarded retirement.    General practice was in a mess when you took over GPC chairmanship.    It is now in a deeper mess.

  (19/6/04)