GPs have been attacked by a minister for operating "gentleman's agreements" whereby they promise not to accept other doctors' patients.
GPs have been attacked by a minister for operating "gentlemen's agreements" whereby they promise not to accept other doctors' patients.
In an interview with the BBC website, Ben Bradshaw accused family doctors in some areas of blocking patient choice.
In an interview with the BBC website, Ben Bradshaw accused family doctors in some areas of blocking patient choice.
The government's latest review of the NHS in England promises more patient choice in primary care, with incentives for GPs to take on new patients.
The government's latest review of the NHS in England promises more patient choice in primary care, with incentives for GPs to take on new patients.
Doctors' leaders said Mr Bradshaw's comments were "absolute nonsense".
Doctors' leaders said Mr Bradshaw's comments were "absolute nonsense".
The attack is threatening to open up a new rift between family doctors and the government.
The attack is threatening to open up a new rift between family doctors and the government.
Mr Bradshaw has already clashed with doctors in recent months over extending opening hours and polyclinics.
Mr Bradshaw has already clashed with doctors in recent months over extending opening hours and polyclinics.
But he has now turned up the heat on doctors as the two sides discuss ways of revamping the funding of GP care to encourage them to take on new patients.
But he has now turned up the heat on doctors as the two sides discuss ways of revamping the funding of GP care to encourage them to take on new patients.
For the last few years the government has encouraged patient choice for hospital treatment in England, to foster competition as a way of raising standards of care. Now it wants to do the same with GPs.
For the last few years the government has encouraged patient choice for hospital treatment in England, to foster competition as a way of raising standards of care. Now it wants to do the same with GPs.
At present, GPs are paid between £54 and £125 for each patient depending on how complex their needs are.
At present, GPs are paid between £54 and £125 for each patient depending on how complex their needs are.
But Mr Bradshaw said this should be increased by phasing out the lump sum doctors are given in their contract.
But Mr Bradshaw said this should be increased by phasing out the lump sum doctors are given in their contract.
GP pay is essentially divided into two parts.
GP pay is essentially divided into two parts.
There is the basic pay, which for most includes a lump sum plus the money for each patient on their list, while the second part is effectively a bonus for offering a range of extra services such as diabetes care and their overall performance as measured against targets.
There is the basic pay, which for most includes a lump sum plus the money for each patient on their list, while the second part is effectively a bonus for offering a range of extra services such as diabetes care and their overall performance as measured against targets.
Dampened incentives
Dampened incentives
The lump sum element is given to nine in 10 GPs and is worth £580m - 7.5% of the funds invested in family doctor services.
The lump sum element is given to nine in 10 GPs and is worth £580m - 7.5% of the funds invested in family doctor services.
It varies greatly from doctor to doctor as it was introduced with the new GP contract in 2004 to protect them from losing out under the deal.
It varies greatly from doctor to doctor as it was introduced with the new GP contract in 2004 to protect them from losing out under the deal.
Mr Bradshaw said the lump sum "dampened the incentive" to attract new patients and meant some doctors were able to survive with very few patients.
Mr Bradshaw said the lump sum "dampened the incentive" to attract new patients and meant some doctors were able to survive with very few patients.
He said government research had found one practice in the south of England with just two patients, but he refused to say exactly where that was. Nor could he say how widespread the issues were.
He said government research had found one practice in the south of England with just two patients, but he refused to say exactly where that was. Nor could he say how widespread the issues were.
He added the introduction of choice in GP care could drive up standards in the same way it had for hospital care.
He added the introduction of choice in GP care could drive up standards in the same way it had for hospital care.
It is absolute nonsense to suggest there are gentleman's agreements - it just doesn't happen Dr Laurence BuckmanBritish Medical Association
It is absolute nonsense to suggest there are gentleman's agreements - it just doesn't happen Dr Laurence BuckmanBritish Medical Association
But he warned the current system was working against that.
But he warned the current system was working against that.
"There is no doubt there are some areas where gentlemen's agreements operate that mitigate against lists being open to new patients and therefore work against real patient choice."
"There is no doubt there are some areas where gentlemen's agreements operate that mitigate against lists being open to new patients and therefore work against real patient choice."
Mr Bradshaw made the comments ahead of publication of the government's primary and community care strategy on Thursday.
Mr Bradshaw made the comments ahead of publication of the government's primary and community care strategy on Thursday.
The strategy, which builds on the Darzi review published on Monday, is expected to set out a vision for a more personalised GP service.
The strategy, which builds on the Darzi review published on Monday, is expected to set out a vision for a more personalised GP service.
It will call for more use of e-mail and telephone GP consultations - these only happen in rare cases currently - and a greater focus on preventing ill-health by creating closer links between practices and a host of community services such as smoking cessation and exercise classes.
It will call for more use of e-mail and telephone GP consultations - these only happen in rare cases currently - and a greater focus on preventing ill-health by creating closer links between practices and a host of community services such as smoking cessation and exercise classes.
The British Medical Association, the doctors' trade union, is already in talks with government negotiators about the funding issue.
The British Medical Association, the doctors' trade union, is already in talks with government negotiators about the funding issue.
Laurence Buckman, chairman of the BMA's GPs committee, said he was not opposed to phasing out the lump sum and putting more weight on the size of GP lists.
Laurence Buckman, chairman of the BMA's GPs committee, said he was not opposed to phasing out the lump sum and putting more weight on the size of GP lists.
But he added: "It is absolute nonsense to suggest there are gentlemen's agreements - it just doesn't happen.
But he added: "It is absolute nonsense to suggest there are gentlemen's agreements - it just doesn't happen.
"Nor are we going to compete for patients, that is not the way general practice works."
"Nor are we going to compete for patients, that is not the way general practice works."
Are you a GP? Are you aware of the "gentlemen's agreements" to which Ben Bradshaw refers? Are you a patient who has had trouble finding a doctor? Send your comments using the post form below, or text 61124:
Are you a GP? Are you aware of the "gentlemen's agreements" to which Ben Bradshaw refers? Are you a patient who has had trouble finding a doctor? Send your comments using the post form below, or text 61124:
