GPs seek to define new `core contract'

Prescription for change: Profession asks Government to redefine its role amid growing concern over criminal investigations
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Family doctors' leaders want to define a new "core contract" with extra payments for some work which many GPs do already.

Their move comes as Stephen Dorrell, the Secretary of State for Health, is offering family doctors an expanded role - taking more work traditionally done in hospital into general practice.

Agreeing a definition of core GP services is "absolutely crucial" to progress towards the new GPs' contract which Mr Dorrell has implied is on offer, Dr Ian Bogle, chairman of the British Medical Association's General Medical Services Committee said in an interview with the Independent.

He said that over the past decade, large amounts of extra work had "slid into" general practice. The dramatic expansion of nursing homes had placed heavy demands on GPs from high-dependency patients who used to be in long- stay beds, he said. They had brought in work "that is not general practice work".

GPs were being expected to monitor a growing range of treatments; from complex anti-coagulent treatments for patients to treatments for arthritis, under consultant care and supervision. Drug treatments for infertility or cancer of the prostate and some other cancers had moved into general practice, initially to shift the drug costs from hospitals, but with the effect of adding work formerly done in hospitals to the family doctors' load. Other GPs had taken on drug and solvent abuse work.

Much of this was work "that we would say was specialist work, outside of core general practice", he said.

The BMA could also mean a demand to split the contract into day and night services, with some GPs shedding their 24-hour responsibility for patients while others provide night cover only

The BMA's stance points to a battle ahead between GPs and the Government, with ministers resisting doctors' moves to establish a restricted definition of their job, while at the same time GPs seek contracts from health authorities for what they define as "non-core" services.

Dr Bogle said that with morale amongst family doctors collapsing and fewer junior doctors opting for general practice because of the workload, it was "vital" that family doctors "clearly defined what the current job was and what should be excluded".

Doctors' negotiators would define the core job and it would be up to individual family doctors whether they continued doing work beyond it or sought extra payment from health authorities.

GPs also want to drop some of the "crazy" aspects of health promotion in their present contract - simply counting the number of smokers on their list, or screening over-75s annually - for which there was no evidence of an improvement in health care.

Defining the core was "an immensely difficult task", Dr Bogle conceded, and it would have to change over time.

A document defining the core is to be put to the BMA's family doctors committee later this month.