Published: 14/03/2002, Volume II2, No. 5796 Page 8 9

GP negotiators fear that the new contract - due to be approved by ministers in the next fortnight - will be resisted by the profession nationally because it is too radical.

The contract proposals, negotiated between the British Medical Association's GPs committee and the NHS Confederation, representing the government, will be sent to GPs in April.

However, although the GPC negotiators are enthusiastic about the contract, sources say they are worried about resistance to the proposals from the rest of the committee and from the profession nationally.

It is understood the concern is such that a range of alternative options - including one where GPs would set up limited companies to offer services to primary care trusts - have been prepared by the GPC in the event of a 'no' vote when GPs are balloted on the contract in June.

The new contract, which will be practice-based, rather than with individual GPs, will be presented to the GPC on 18 April and to a meeting of local medical committees on 19 April, with GPs being sent details at this time. Although the GPC will not formally have to approve the contract, ministers will have cleared it before Easter.

Speaking at the National Association of Primary Care's annual spring conference last week, NHS Confederation negotiator Dr Tony Snell said: 'We are looking very much to an outcomes-based contract', which will include 'a locally assessed outcome and performance framework'.

Although Dr Snell made it clear that independent contractor status 'will remain open to all', he said: 'Let's chuck away the red book [detailing GP services and payments] and only retain those elements that are any use.'

GPC negotiator Dr Simon Fradd said if the contract was accepted he expected elements of it to be introduced quickly, but that the full contract would not be in place until 2004: 'The bulk of the contract will go live from April next year. Some will get held up in legislation, but the confederation and ministers are not trying to hold this back.'

Although Dr Fradd denied negotiators were worried about gaining acceptance for the contract from the GPC and the profession, he said there was a lot of work to do to get the message across. A series of roadshows are planned to help sell the deal.

He said: 'We will have two hours, three at most, to put the case across to the troops. The important thing about that is getting the message across, and that is different to selling it.'

In terms of the radical 'out-ofthe-box' thinking that had gone in to the contract, Dr Fradd said: 'We are outside the box, and I think the box will be thrown away.'

The contract will enable primary care to be delivered in a more flexible way, along the lines of personal medical services contracts which nearly one in five GPs are currently signed up to.

However, it is understood it will not go down the route of increasing the number of salaried GPs.

Referring to the fact that the new contracts will be practice-based, NAPC chair Dr Peter Smith said: 'GPs for the first time are going to have to be corporate.'