According to Jeremy Hunt, GPs will have to reveal their salaries from next year, and a new deal that he has struck with the British Medical Association will rectify the errors of the contract agreed for doctors under Labour in 2004. According to the BMA, no agreement has been reached on disclosing salaries, and the 2004 contract has not driven the rise in A & E admissions that threatens an “NHS crisis” this winter. That at least is the claim of Richard Vautrey, deputy chair of the British Medical Association’s GP committee, who is quoted in the Guardian. However, Chaand Nagpaul, the Chairman of the committee – and the man who has led for it during the negotiations on the new contract – concedes in the Daily Telegraph that “the 2004 contract brought unprecedented bureaucracy and chasing of targets and box-ticking”.
What is certain is that the Health Secretary wants to see the return of the family doctor, who has a relationship of trust with his patients, is available outside surgery hours, and is the first port of call in the event of medical problems – rather than A & E Departments, which have seen the number of attendees rise from 18 million before the 2004 contract to 22 million last year. The new contract gets him (and, more importantly, patients) some of the way there. All over-75 year olds are to have a personal doctor and access to a 24 hour helpline. Writing in the Daily Mail, Hunt says that that “this is because around two thirds of over-75s are living with a long-term condition such as diabetes, asthma, or dementia. This can lead to preventable problems in A&E. One third of A&E visits are from over-75s, for example.”
The Health Secretary is stressing that the new contract will mean the end of many of Labour’s targets. The BMA is claiming that it will mean the end of some of the Government’s – for example, being required to ask people with hypertension “whether they could walk or whether they had enough exercise”. Hunt, meanwhile, insists that some salary details will be published next year and some the year after, and the Times report suggests that, at least in principle, the BMA has conceded that he will get his way. It says that “no salary details would be published before 2015”, which suggests that some will be published during that year and subsequently. The new deal apparently comes without new money, but will be funded by a scheme to prevent patients being inappropriately admitted to hospitals.
The cash will therefore come from reduced spending on wards. Will that actually happen? But whether it does or not, Hunt evidently plans to work from the oldest patients outwards, so to speak. He says that he hopes a similar service will eventually be offered to millions more people, such as children or those with long-term conditions – presumably extending, in due course, to all patients. So what will happen when frail, vulnerable and elderly people phone their “family doctor” out of hours, and find instead a shift system staffed with doctors and practice nurses? That is where the Health Secretary’s new Ofsted-type inspection system will come in – the one that he wrote about on this site earlier this week. Those surgeries that contract their out-of-hours cares to locums will come under it.
Amidst the fog of claims and counter-claims about what the new contract will mean, two points are clear. First, the BMA itself evidently views the 2004 contract as deeply flawed. And, second, Hunt isn’t a smooth-talking public relations man – though he is undoubtedly skilled at presenting – but, rather, a purposeful politician with a rational plan. Some of those close to him don’t like to compare it to Michael Gove’s, but the Health Secretary himself draws the parallel in the Times. “I’d make an analogy with the school system. Michael Gove [the Education Secretary] is bringing in schools and giving them freedom and then total transparency for outcomes and consequences,” Mr Hunt said. He hopes to ease the pressure on A & E departments through a combination of autonomy, inspection and transparency.
The Health Secretary has struck a faster deal than I and many others expected. He says that there is a new wave of leadership at the top of the BMA, and that “Chaand is a reformer and he recognises the status quo is unsustainable”. But since the new contract will be implemented from next April, it may not come quick enough to avert that winter “NHS crisis”, complete with ward closures, ambulances parked outside A & E departments, protesting doctors and nurses – and Labour, which actually proposes to spend less public money on healthcare than the Government, hypocritically complaining about a lack of resources. In the Mail, Hunt also praises Sir Bruce Keogh’s ideas for overhauling urgent and emergency care. I wish him good luck with that one. There is nothing more certain to agitate MPs, regardless of party, than the closure or downgrading of their local A & E department.