Published: 10/04/2003, Volume II3, No. 5850 Page 8 9

Discontent about the new GP contract has not been assuaged by the introduction of a minimum income guarantee to ensure practices do not lose out, doctors' representatives have warned.

Doctors are likely to be balloted by the British Medical Association at the end of next month, following delays caused by wrangles over the pay formula on which the contract is based.

But some GP representatives have assessed the chances of GPs backing their proposed new contract at no more than 50 per cent.

A meeting of local medical committees has been called for 14 May.

Morgannwyg LMC secretary Dr Ian Millington put the chances of a yes vote as 'no more than 50/50'.

He said: 'GPs need to sit down and discuss exactly what this contract will mean. I think there is a danger that they will be panicked into a 'no' vote.'

Doctors were offered a minimum practice income guarantee last month that would ensure they did not suffer a pay cut if they accepted the new contract.

When the contract proposals were announced in February, GPs were told they would receive an average increase of around 30 per cent. Under the proposed CarrHill formula that would be used to calculate their basic income by taking into account the age, gender, deprivation rates and morbidity levels of their patients, up to 70 per cent of doctors could lose out financially.

Somerset LMC secretary Dr Harry Yoxall said that although doctors in the south west had faith in the BMA and confederation negotiators, there was a suspicion that there may have been 'political jiggery pokery'. He predicted the vote would be 'too close to call'.

Uncertainty about the deal for GPs adds to confusion around the employment situation of almost all NHS workers. Agenda for Change proposals are at the centre of heated debates and the piecemeal introduction of the rejected consultant contract appears to have hit stumbling blocks.

The Department of Health is shortly to issue revised guidance on introducing consultant contracts after claims that trusts do not know how to administrate local incentive schemes announced by ministers in January.

Then, the DoH said the rejected contract could be introduced for all consultants in a trust if there was enough support from medics.

Failing that, the extra money to cover new arrangements could be used to negotiate local annual incentive schemes or for clinical excellence awards.

At the time the DoH said that over 50 trusts were interested in introducing the rejected contract, but some of them have told HSJ that they had expressed interest in the belief that they could introduce it for individual doctors and have now found there is inadequate consultant support to bring in trust-wide schemes.

North Tees and Hartlepool trust medical director Dr Peter Royle said his trust had been 'under the impression that it could be offered to individual consultants' when it made its original declaration of interest.When it became clear this was not the case, 'the consultants had an extraordinary meeting and voted to reject the proposals'.

He added: 'That makes it quite difficult.'

Dr Royle said he would prefer to split the money available equally between all the consultants in recognition of the hard work they had done. However, he did not believe the trust could do that. He hoped the new guidance would clarify if it was possible.

Robert Jones/Agnes Hunt Orthopaedic Hospital trust medical director Dr Josh Dixey said his trust - also one of the 50 - had been told to send its recommendations for progress to the strategic health authority last month, but had only been able to say discussions were ongoing.He added: 'I think the difficulty is that no one quite understands how it is going to work.'

BMA junior doctors committee chair Dr Paul Thorpe said anecdotal evidence suggested that trust chief executives and medical directors did not want to antagonise consultants by introducing the rejected contract.