The government will still be desperate not to see another staff group set itself against reform, particularly given the crucial role primary care will play

As we reported last week, the leak of the Department of Health pay and workforce strategy sets the scene for a year of strife between government, employers and the professions. The first salvo has now been fired over renegotiating the GP contract. See news story here.

GP representatives say they have withdrawn from negotiations about the new contract until pay is settled - a stance clearly provoked by the proposed 1.5 per cent settlement. This seems set to push agreement about the contract into the new financial year.

The biggest focus in the original document was on consultants and fears of fierce opposition (and possible industrial action of some sort) from the British Medical Association.

Individual contractors like GPs do not have the same kind of options but the government will still be desperate not to see another staff group set itself against reform, particularly given the crucial role primary care will play. The government will be gambling that there is little public sympathy for the concept of underpaid GPs - something the BMA itself seems aware of.

The coming months will also be a test of the confidence that NHS Employers feels in its own independence from the government and the extent to which it can craft and pursue an agenda as it sees best. After all, it was NHS Employers that proposed a 2 per cent pay settlement for 2007-08.

And that means not just independence from the DoH but from a Treasury (and then Number 10) that is determined to keep public sector pay rises down, particularly for professions which it feels have been rewarded hugely in recent years.