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Have you reached your tipping point?

According to Oxford Dictionaries, a 'tipping point' is the point at which a series of small changes or incidents becomes sufficiently significant to cause a larger, more important change.

In the past few weeks, I have seen two practices pushed to the tipping point by the impact of rising patient demand on appointments, coupled with the prospect of reduced income under the 2014/15 contract. This is the point at which they, as independent contractor GP partners, earn no more than their salaried GPs, and are not prepared to continue with their GMS or PMS contract.

The interesting thing to highlight here is that the income stream for both practices is strong. The problem is that both will be spending a greater-than-affordable proportion of their resources on meeting patients’ needs, paying locums and on salaried GPs.

This is a not unfamiliar problem and the solution is not necessarily to walk away from the GMS/PMS contract but instead to provide a service that the income stream justifies. This might mean offering fewer appointments, or even telling patients they have to go to the walk-in centre or A&E to be seen – an anathema to most GPs, but a move that might prevent a practice collapsing over its tipping point.

On a macro scale, there would be no better way of signalling to health ministers and experts at the DH that proper health care requires proper funding.

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