Lost in the global sum? Professional and practice development in primary care after the new general practice contract.

Professional and practice development in primary care after the new general practice contract The problematic arrangements for primary care teams and the often lack of coordination had been identified in the Chief Medical Officer's 1998 report on continuing professional development in primary care. 4 The report advocated 'professional development plans' to help deliver the 'modern, accountable and efficient health service' promised by the Labour government. 5 The report's vision for multidisciplinary continuing professional development married to practice needs was never widely adopted. 6 The new GP contract and the global sum Under the new organisation-based contract, 1 partnerships (or other contract holding organisations) 7 have been given a global sum to cover a range of fees and services, calculated partly using the size of the overall practice patient list. Budgets for training and development activities have been subsumed into the global sum. There was apparently a lack of clarity about how to calculate the correct figure for 'training and development': for instance, some PCTs based allocations on previous-year spend. Because of this new arrangement, responsibility for training and development now rests with the contract holders. There is uncertainty about how strategic direction should be maintained and how employees or professionals should access independent advice about professional and personal development issues. To add to the complexity, many general practices are evolving into organisations that have an increasing distinction between employees and profit-sharers. Where partnerships remain as the contract holders (still the typical model), it is common to find individuals taking executive and managerial roles, perhaps reducing their exposure to clinical work or seeking external opportunities to diversify income. To enable this, salaried doctors and other health professionals are being employed, often in part-time roles, increasing the difficulty of providing personal continuity at the patient level. In other words, at a time when professional development needs and team coordination are increasing, the new contract is deficient. Practice nursing provides a good example. Freed from traditional NHS constraints, practice nurses, when supported to do so, have been able to develop their clinical repertoire rapidly. Note the recent change in diabetes care and similar developments in the monitoring of chronic diseases, such as hypertension, asthma, and epilepsy. On the whole, GPs have facilitated this process, encouraging nurses to undertake training in areas of interest and of benefit to patients. PCTs, and family services health authorities before them, have often provided or funded staff to …