General Practice is in a serious crisis.

For reasons mystifying to most GPs, we have found ourselves in a situation of unprecedented external control by forces over which we have no influence. I am referring to fee control, imposed in the last PHO contract without any agreement by the GPs it affects, despite a meeting in 2006 of North Shore GPs rejecting fee control.

The effect of this is that most GPs are "flying under the low cloud" ceiling imposed without real negotiation by DHBNZ. This, despite the 20% nurses wage rise, 4 week annual leave requirement which have not even been considered by the infamous LEGG report.

Most GPs find the "fees review" process repugnant and are avoiding it. Our practices have been instantly devalued and the prospects of selling our practices and attracting locums have diminished as a result.

Talkfests about recruitment and retention are just that in the face of this imposition. PHOs have moved away from being GP focussed and are primarily interested in their own survival.

As GPs, we simply cannot rely on existing PHO mechanisms to protect our interests.

There are two major issues to be addressed.

1. Remove the fee control that has been imposed
2. Institute a rigorous negotiable contracting system with genuine GP representation.

Removing Fee control

The July "rollout" is being presented as a fait accomplit. What this will do is put fee control on the last fee we currently do have control over (25 to 44 year olds). GPs should boycott this "rollout" until fee control has been removed. In addition GPs should boycott the fees review process. We should charge a fee we feel is fair and reasonable under the circumstance and ignore the DHB and PHO protestations. Unity is paramount.

Rigorous contract process

Currently GP conditions are being negotiated with the DHBs by PSAAP, a body which does not have the interests of GPs at its core. NZMA is allowed there as an observer only. Our legitimate industrial concerns are being ridden roughshod over. In our negotiations with the nurses union, any agreement must be ratified by both the employers and the employees. It is vital that a similar robust process must underpin contract negotiations with the MOH/DHBs.

As PHOs are legislated and driven by the MOH away from an IPA model, my suggestion is that the NZMA work in between the GPs and the PHOs. There should be a robust contract between GPs and their PHO, and this should be ratified by 75% of GPs for it to proceed. If there is no agreement the contract falls over. This will stop the DHBs assuming that what they negotiate with PHOs will just happen regardless of its effect on general practice. Once again unity is paramount.

I call for an urgent meeting to progress these issues, which impact so seriously on General Practice.

Yours faithfully

Richard Hursthouse
General Practitioner
Browns Bay