The last resort of the scoundrel is being used by our somewhat lack-lustre and shortsighted negotiating team. Blackmail.

Harsh words but, in reality, that is what GPs are faced with. By the way, Chambers Dictionary defines blackmail as "to force by threats into doing something"

The contract must be signed by all GPs by the end of the first week in March yet there are still several important issues unresolved and more seem to be appearing weekly. A number of them are mentioned below.

So, the wire is approaching and whilst agreeing that there are unresolved issues what does Dr Chisholm’s team tell GPs to do?

They tell GPs to sign it, of course and, if there are any issues with which they disagree, then the individual GP should annotate them in the margin for later resolution.

Even if that was a legal protection for the GP it would make a mockery of the national GP contract which would become a mish-mash of unfathomable nonsense from one part of the land to another.

But is it legal? Well, Mr Barrett of Hempson’s thinks not and that GPs should take legal advice. Hempson’s are, of course, arguably the leading firm of medical lawyers.

But, never mind, doctor, Dr Peter Holden, whose claim to fame is that he is a negotiator (does he have legal training?) utters the not very veiled threat that "If you take legal advice, the PCT will, too". By this he means, that even if you have a case, the PCT has deeper pockets than you and you’ll lose. He also means "Don’t expect GPC or the BMA to support you".

But appalling though that is, it is but a minor threat.

The major threat/blackmail to sign arises when GPs are told by the unpleasant but united front of GPC and the government, that if they do not sign they will be forced into the "default contract".

So, what is so terrible about the default contract?

I. If you don’t sign then out-of-hours will remain your problem — even as

commercial deputising services close down.

2. Many payments would not be made — quality and aspiration, for instance

3. You would have similar payments to the Red Book scheme.

4. If you don’t "sort it out", official-speak for "give in" within six months you

will be thrown out of the NHS without any contract.

To sum it up, if you don’t sign the new contract, like it or not, then you will be out-of pocket and maybe out of a job — with the blessing and connivance of your trade union.

That is, in my opinion gross negligence and blackmail from GPC and an example of their failure in their duty of  care to their "members".

After all, would there be so many areas of contention if the negotiating team had done their job properly and behaved responsibly to the general practitioners who have no choice but to depend upon them?   Preferably before forcing GPs to vote on the incomplete, unresolved and uncosted contract last year.

At the beginning I mentioned that a number of the current problems would follow, so here they are.

One of the major ones is that the contract is one-sided because only one side can vary it at will. The only step you as an individual contractor can do to vary it after signing is to resign from it completely and to a large extent lose your liveliehood

On the other hand, the Secretary of State has been allowed to keep the power to make any changes he considers in the best interests of the NHS — or not — by simply notifying the GPC of what he is about to do a few weeks before he actually carries the measures out.

To my mind that is not a contract but a diktat.

Then there are specific items.

Global sums delayed again, leaving just two weeks to sort it out. Hamish Meldrum (HM) says, somewhat complacently, "No problem if there aren’t too many surprises.    You’ll just have to get on with it". If there aren’t any problems it will be the first time!

Premises funding frozen, causing chaos to practices. HM’ s response? "It’ll be alright by the end of the month". Dear boy, you should have had this sorted months ago.

PCOs can refuse enhanced services for practices with closed lists. HM’s response? "Don’t worry, we inserted the word ‘reasonable’ in the contract". Actually, old man, you haven’t. What it says is something quite different. "...the PCT may reasonably decide not to offer such contractors..."

Set-up costs for enhanced services are in dispute. Don’t worry, HM’s got the answer. "Set-up costs should not be included in enhanced services retainer. But you can’t be dogmatic"

Clause 473, the open-ended GP liability clause, found by alert GPs, was removed but HM has an answer: ."... . the intention was never to extend GP liability".    Indeed, so why was the clause allowed in?

Unfunded enhanced services are becoming a problem as compassionate GPs carry on serving their patients and HM "understands and sympathises". Why, then, does GPC not take a national position on this with the government?

Clause 38 of the contract demands GPs submit confidential patient data to PCTs. Clause 47 orders GPs to provide "appropriate" disease management. What does ‘‘appropriate’’ mean and to whom?

Clause 465 prevent private practice even after the contract expires.

No doubt, doctor, you can add to that incomplete list but you have only a limited time to read this!

A final condemnation of the contract she helped negotiate has been written in this week’s BMA News (14/2/04) by negotiator Dr Mary Church:

"The delivery of the new GMS contract depends on the regulations. These are written in turgid legalese. I don’t know about you but. . . it makes my brain scream in protest"

"OK guidance has been created but even words of one syllable cannot avoid the meaning being distorted to fit the reader’s point of view"

"Sometimes I wonder whether some amongst us have forgotten he whole point of the whole contract negotiation: to reward GPs for the quality of work, to allow some control of their workload and to improve recruitment and retention. PCOs and GPs would be forgiven whether the latter will ever be achieved."

Quite!

She finishes her item by wishing GPs "good luck".

Her boss, the proud but somewhat naive Dr Chisholm, has penned a letter to GP (16/2/04) which astoundingly admits that all these faults were negotiated in, and, one must assume, all the others discussed over the months previously:

"The contract documents published by the DoH accurately reflect the negotiated contract. No new concepts have been introduced. No detriment to GPs or PCTs has been introduced either. No one has been out-manoeuvred."

If ever there was a complacent admission of failure that is one.

So, it has come to "sign or else!".   Is it not intolerable that a group of intelligent professional people should have placed their colleagues in such an invidious position?

God help general practice and general practitioners.

(14/2/04)