1. It is vital the GPC’s negotiators ensure negotiations regarding pension provision are completed satisfactorily, incorporating all the concerns outlined in the document before the profession considers the framework.

2. The GPC must retain the negotiating rights on behalf of all GPs working under whichever contract type in the whole of the UK. The profession should only consider the framework document once the GPC has established negotiating rights on behalf of GMS and PMS GPs.

Looking further into the contract it is clear the relationship between GPs and PCTs in England will become much closer, with local performance management. PCTs will have considerable authority to performance manage GPs both as practices and as individuals.

The longer term progression of PCTs to Care Trusts (engaging Social Services etc) could lead to the devolution of GP performance management to new more remote organisations, and may rest with managers with minimal experience or understanding of the pressures of general practice and who are used to a more corporate style of service delivery. It will be vital that General Practice teams maintain their autonomy, their flat management structures to enable the delivery of quick ground level improvements. Successor organisations should not stifle innovation and development by imposing their corporate ways of working on general practice .

It is essential therefore that the new framework clarifies the LMCs role, representing GP interests to PCTs around issues such as quality, performance targets, service delivery, reimbursement, resourcing and performance management Furthermore the requirement for PCTs to simply consult the LMC must be replaced with a requirement to both consult, take note of and act on guidance received from LMCs.

There will be considerable issues around workforce planning and skill mix for general practice and once again the role of the LMC in ensuring equity of access to resources for doctors and nurses requires clarification.

Allowing GPs to opt out of out of hours is indeed radical and it will be vital that the GPC ensures that the DDRB pricing of this element of the current contract is the only sum of money withdrawn from current funding arrangements. The additional costs of providing out of hours will need to be met elsewhere. I anticipate PCTs will need to spend considerable management time delivering out of hours in the absence of general practitioner input, as most GPs will withdraw from providing out of hours services altogether once allowed to do so.

There must be clear recognition that the management requirements of the new contract framework will be significantly greater than at present. Funding will need to be enhanced considerably to enable practices at different levels of development to deliver the quality agenda quickly and maintain their improvements.

The new framework also suggests there will be changes to the manner in which we are paid for our current workload, for example it would appear that target payments for cervical cytology will disappear in their current form, although targets for child immunisations will continue for the time being. Funding arrangements for provision of vaccines will still need to be clarified along with arrangements for prescribing incentive and commissioning incentive scheme monies.

However, it is unclear to me how the new contract will directly address the issue of workload, and it remains to be seen whether the pricing of the new contract will allow for the additional staff required to manage the current workload enabling GPs to focus on the quality agenda.

After reading this week’s BMA news you may think that the conference was enthusiastic about the document, which was presented, this was not the case. The mood was one of moderate scepticism, indeed there was an attempt to give John Chisholm a standing ovation ( plants???), but all that was received was polite applause from a seated audience.

My own feeling is that the contract is not worth diddly-squat without proper and adequate pricing. I note that the new consultants contract is further advanced than ours and is about to be priced; our lifetime earnings must not be less than our consultant colleagues. In the BMJ this week OFSTED are looking for occupational medical advisors at a rate of £500/day for a 7-hour day. This is without any responsibility for running a practice or managing other health professionals. If this is a benchmark GPs are worth considerably more than this, and we should charge our negotiators to aim for a higher figure.

The whole of the document reads as if it has been drafted by the NHS Confederation and not by GPs. One cannot help having the feeling that our amateur negotiators have been led by the nose by the professional managers fielded by the NHS Confederation. There is a shortage of doctors, specifically GPs, we cannot be replaced by nurses, health visitors, social workers or anyone else, all research evidence suggests the public rates their GPs very highly, why are we not dictating the terms!

In spite of what it says, I think it describes a bureaucrat’s playground and a clinician’s nightmare. A large proportion of any payment is to be based on Quality Payments. The systems to monitor this and to demonstrate you are achieving them simply do not exist in the majority of practices. A very high level of IT and some very sophisticated management will need to be put into practices to say nothing of the Herculean task of persuading GPs to consistently code data during their consultations. This degree of practice management does not exist, and will not exist until it becomes a degree level occupation. Not only will the monitoring systems have to be created in each practice but also they will have to be maintained. I doubt whether the PCT will have the manpower or expertise to help.

Enhanced clinical services will still be commissioned locally, which basically means that GPs will have no autonomy in the development of new services. The PCT will be able to say what they say now, all the money has gone to secondary care and you cannot have any!

I would urge every GP to read the document several times and pick holes in it, after all it is our future and I would urge as many GPs as possible to attend the presentation at Old Trafford.

There are several positive aspects in the draft contract such as the commitment for the provision of child care, the eventual ability to opt out of out of hours care, the practice list being the unit and the commitment to base resources on a weighted capitation formula.

Before I decide about voting yes or no I would want