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Abuse directed at GHA management unworthy of a professional body, GHA tells BMA
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The Gibraltar Health Authority says it deeply regrets "the discourteous and unprofessional manner" in which the BMA (GP Branch) spokesmen are conducting the negotiations on the GP's huge pay claim.
Negotiations cannot proceed in this fashion, and will not do so until the BMA agrees to adhere to conventional negotiation processes.
A long statement from the GHS adds: The abuse directed by the GP spokesman at GHA management is unworthy of a professional body. There are however two points raised by the GP spokesman that GHA cannot allow to pass unanswered. They are that GPs have only claimed 16% pay rise and that the GHA has therefore misinformed the Chief Minister, and secondly that the GHA is trying to save money on prescription medicine at the expense of patient safety and quality of care. Both of these statements are demonstrably false.
Despite the conciliatory attitude adopted by GHA management following the BMA's last statement, the BMA (GP Branch) has not returned to the negotiating table and has instead once again breached the agreement to keep negotiations confidential by issuing a negative and emotive media statement which is inflammatory and false. The GHA will not conduct these negotiations through the media so the onus is on the GPs to make new written proposals to GHA Management if they wish the pay negotiations to start again.
In the meantime, it adds, the GHA considers that it is necessary in the public interest to correct the self serving inaccuracies in the latest media statement by the BMA (GP Branch).
As the following figures demonstrate, it is simply not true that the GPs are only claiming a 16% increase in pay. The GPs claim is for an effective increase in base pay ranging from 38% to 59% depending on seniority.
These excessive increases range from an extra ?24,600 per annum for the most junior GP to an extra ?37,900 per annum for the most senior. The current salary of all GPs is ?63,887. In exchange for these claimed increases the GPs do not offer to provide the GHA with any additional service benefits.
Our patients would see no improvement in quality, access or prescribing practice at the Primary Care Centre. This is not acceptable to the GHA which is seeking to negotiate substantial pay rises in return for better value for money and service improvements.
PAYMENTS
In addition, to the above pay increases the GPs are seeking further payments for Specialist Clinics, Evening Clinics and administrative work associated with their clinical activity which would further increase the above percentages pay rises still further. The GHA maintains that this work is and will remain an integral part of their work in contracted hours.
The GHA says it once again refutes the claim that the GPs work after hours without receiving remuneration. The GPs have been providing this service as part of their contractual responsibilities since 1974, and with regard to after hours and on-call work, the GPs get the following day off. This has an additional cost to the GHA of ?130,000 annually, while at the same time providing GPs with free time which some use for private practice.
And adds: In the Review of GP Services, the Healthcare Development Team was critical of current prescribing practices. Their report points to local GPs writing prescriptions at almost twice the rate of their counterparts in UK, quoting a figure 21 pharmaceutical items prescribed per year per person in Gibraltar, compared to 12.3 items per person in UK. The Healthcare Development Team also highlights the great variance in prescribing practice amongst GPs with the most active prescriber prescribing almost three times more than the average of all the other GPs combined.
The GHA is with good reason very concerned about certain aspects of current prescribing practices. Excessive prescription of medications is not an acceptable alternative to sound medical primary care. The GHA's goal is to achieve best prescribing and dispensing practice for Gibraltar. The Healthcare Development Team Report on General Practice stated that "Gibraltar is one of the highest cost consumers of pharmaceuticals in Europe".
It went on to say that in 2003/4 this amounted to ?217 annual per capita spend in Gibraltar. This compared to ?150 in the UK, ?50 in Germany, ?66 in Switzerland and ?170 in Spain. The report identified a wide variation in prescribing practice between GPs and recommended standardisation of prescribing practice and stated that there is evidence of both over and under prescribing by some GPs. The GHA is seeking the introduction of European style, standardised prescribing practices protocols.
The GHA goes on to say that it makes no apology for the fact that it is seeking to reduce the amount of medication which is unnecessarily prescribed, at very substantial cost to the taxpayer, with no medical benefit to the patient and very possibly to the detriment of the patients health. However, for the GPs to state that this would mean that they would need to "starve" patients of drugs is not only untrue and unprofessional but it is also mischievously calculated to cause alarm among the public in general and patients in particular.
SAVINGS
The GPs also claim that the GHA wishes to link the GPs pay increase directly to making savings in the prescription budget. They say this is totally unacceptable to them ethically and professionally. This is news to the GHA, and not credible. What is more, the GP's have already indicated that this acceptable to them. In their own claim the GPs themselves offered to link reductions in the expenditure on prescription drugs with an increase in their pay. The GHA totally rejects, and is appalled by the insinuation that the
proposed approach would lead to a reduction in the quality of patient care.
GHA is not asking for any compromising in good clinical practice, but rather the contrary that is to improve prescribing practices.
As a consequence, the GHA says it is determined to use the negotiation process to secure best practice prescribing for patients of the GHA and Gibraltar taxpayers alike.
The GPs also assert that GHA Management wishes to break "analogue/parity" with Consultants. It is important to distinguish between "analogue and parity".
The GHA does not accept that there has ever been a parity link with either the GHA Consultants or with GPs in the UK. It is true that up to recently the GPs salaries were analogued to the mid point of the then applicable Gibraltar Consultants annual incremental scale (less ?2). However, the Consultants pay system was restrictive and that scale ceased to exist in 2004 when the new Consultants salaries were agreed. It is therefore not possible to continue to analogue GPs pay to a non existent Consultant pay scale.
The GHA reiterates that "it continues to hold the BMA (GP Branch) entirely and solely responsible for the breakdown in these negotiations. The spokesmen for the GP's appear to believe that manipulating public opinion on their understandably emotive issues is a substitute for reasonable and proper negotiation, and that they can oblige the GHA to submit to their excessive claim. They are mistaken. The GHA is making contingency plans to minimise inconvenience to the public in the event that GPs should take industrial action."
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