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CAMHS won't see you now

A seismic change for general practice

The tectonic plates beneath general practice have been shifting for several years now, as friction builds, gradually but inexorably, between partners and salaried GPs.

The tectonic plates beneath general practice have been shifting for several years now, as friction builds, gradually but inexorably, between partners and salaried GPs.

Every so often, the tension has burst to the surface in a plume of accusations of exploitation and denied opportunities, before the profession once again settles into an uneasy calm. The more foresighted of the profession's leaders, among them GPC chair Dr Laurence Buckman and RCGP vice-chair Dr Clare Gerada, have sounded dire warnings over the faultlines criss-crossing the profession. But the lack of action, of any tangible change, has made it all too easy for those warnings to go unheeded.

Our news this week that the National Association of Sessional GPs has plans for salaried GPs and locums to be represented by a rival union to the BMA will erupt through that complacency with seismic force. It is a game-changer, because if enough sessional GPs join the Medical Practitioners' Union, it will formalise and crystalise the growing divisions in the profession. GPs will never again talk with a single voice, but will be split into two camps, pitted against one another in negotiations over pay and conditions.

And it will hand the Government an opportunity to exploit those divisions by playing one union off against the other.

The BMA is only too aware of the threat to the unity of the profession, and perhaps even to its privileged position as sole negotiator on behalf of doctors. But the association seems unable to formulate any convincing plan to prevent what is increasingly looking like an inevitable parting of ways. Its leaders have rejected repeated demands from the NASGP for a new BMA committee to represent salaried GPs and locums, on a par with the GPC in status and negotiating rights. Dr Buckman has resisted calls to discuss the move in BMA board meetings, knowing it would deal a fatal blow to the power of the GPC to negotiate on behalf of all of general practice.

But if the BMA is unable to offer salaried GPs the concession of a new negotiating committee, it must do much better at negotiating on their behalf. Salaried GPs are furious at their diminishing opportunities to become partners, and the size of the financial gulf between partners and themselves. They will not accept the BMA's role in representing both employers and employees unless that dual role can be shown to deliver real negotiating muscle.

GP negotiators need to sit round the table with the NASGP and agree a model BMA contract everyone can support, and a strategy for implementing it much more widely. They also need to persuade the Government back to the negotiating table to redraw the GMS contract, to reallocate cash to firm incentives for creating or maintaining partnerships.

It won't be easy – the Department of Health has little interest in incentivising partnerships, and may indeed be relishing the split emerging in general practice. But the GPC has the perfect motivation. It knows its very existence as a body representing all GPs depends on its success.


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