Samir Dawlatly: When is a deal not a deal?

One of the questions I was taught to ask as a GP trainee when someone came to see me with symptoms that had been ongoing for a while was, “Why now?” What is it that has tipped the balance for the patient to make an appointment about something that has been bothering them for weeks and months?

The same question springs to mind with Jeremy Hunt’s latest “New Deal” for British general practice. Why now? Why make some big pronouncement weeks after the general election. I’m not sure I fully understand why he felt the need to make an announcement in the first place. After all the General Practitioners Committee of the British Medical Association negotiate the GP Contract with the Department of Health each year. Part of me wonders if this is the first sign that this is going to be more public than usual.

A quick glance at the dictionary reveals that possible definitions of the word “deal” are:

  • a contract
  • a mutually beneficial agreement
  • a business transaction

As already alluded to, GPs already have contracts, with enhanced services, and the occasional impromptu optional additional service from time to time. What Hunt has discussed can’t be a deal, as GPs already have a deal—it is called a contract. However, it is a contract that can be altered unilaterally with three months’ notice, which leads me to believe that this new deal is nothing more than a warning shot about upcoming contract changes.

What Hunt has offered doesn’t appear to be mutually beneficial. He has merely reiterated the need to provide more GPs, offered to make us some adverts, delay the training of the aforementioned new GPs by a year so they can prop up struggling secondary care services, and provide us with some funding that was needed anyway for our buildings. In return, we get to work weekends, or at least form co-operatives, thereby not providing patients with any more continuity of care than they already get with out-of-hours services. This offering doesn’t appear to be mutually beneficial, not just because of extended working hours for existing GPs, but because it is not clear it will decrease the strain on A+E.

No mention is made of payment for extra service provision. There is only talk of some money for areas struggling to recruit and building funds. When a practice opens during unsociable hours it will need to pay extra running costs and staff wages. No mention is made of consistent funding being made available. It is worth noting that the Prime Minister’s challenge fund bankrolled the pilots that were the inevitable forerunner to this announcement, which cannot be classified as a business transaction, so is not a deal.

It seems this new deal is not a deal, nor is there anything new. So no surprises there then.

Samir Dawlatly is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly.

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.