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Buckman braces himself for annual visit to lion's den

As GPC chair Dr Laurence Buckman prepares for a grilling at this week's LMCs conference, he looks back over a turbulent 12 months.

By Steve Nowottny

As GPC chair Dr Laurence Buckman prepares for a grilling at this week's LMCs conference, he looks back over a turbulent 12 months.

At 9:50am this Thursday morning, GPC chair Dr Laurence Buckman has to give a progress report to his boss. Or rather bosses. All 400 of them.

GPs from across the country will convene in central London for the annual LMCs conference. They will watch Dr Buckman open proceedings with a 20-minute keynote speech.

And then over the course of the next two days they will furiously debate the key issues facing general practice, shaping as they do so the course of the coming year.

It's a daunting prospect. But in an exclusive interview with Pulse on the eve of the conference, Dr Buckman seems relaxed - and for a man with a heaving in-tray, relatively upbeat.

‘It's been a better year than last year,' he explains. ‘It couldn't have been much worse.

‘Some things have been good, some things not so good. We got a pay rise. That was good. It was very tiny. That wasn't so good. We got our expenses recognised for the first time in years. That was good. We didn't get very much for them. That was bad.

‘So you win some, you lose some.'

No single issue has dominated his second year as GPC chair in the way extended hours came to define the first. But a series of practice funding crises – QOF prevalence, MPIG and now the latest row over the patient survey - have left GPC negotiators struggling to justify why agreements they signed up to have resulted in some practices gaining money, and others losing it.

Indeed, one motion to be debated tomorrow afternoon specifically takes the GPC to task on the point – instructing it ‘to ensure future pay rises must be paid equally to all practices to avoid the creation of further lists of winners and losers'.

The patient survey debacle, which will see almost all practices lose money and some lose tens of thousands, despite no apparent change in overall patient satisfaction, is more cock-up than conspiracy on the part of the Government, according to Dr Buckman. ‘I think it was an accident,' he says.

But he is adamant that practices which believe they have unfairly lost money should try to get it back.

‘I think that has to be tested through court, through the judicial process,' he says. ‘Do I, as a non-lawyer, believe there will be any practices that could have a case? Yes absolutely.

‘For a central plank of Government policy to be defunded - when the rest of the NHS puts more money in when things don't go right, here we take money away when things don't go right – that seems remarkably perverse.'

But while he's more than willing to go toe-to-toe with the Department of Health in the negotiating room, when LMC representatives turn to debating motions of no-confidence in Gordon Brown, Dr Buckman turns to the same mantra he preached at last year's conference: ‘We don't do personal.'

‘While it's a nice kneejerk reflection of anger, after the pleasure of two minutes, then what?' he asks.

‘I think he probably couldn't care less either way – but it certainly isn't going to make it easier to talk to the Prime Minister.'

What of the QOF prevalence changes and scrapping of the square root formula, which split the GPC and will see university practices and many in London lose thousands in funding?

When the full impact of the changes became clear – in February, having previously pledged that ‘no practice will go under', Dr Buckman speculated that ‘tens, maybe hundreds' could close – it prompted a raft of protests from GPs, particularly in London.

A key motion to be debated tomorrow ‘regrets moving towards a true prevalence formula because of the unintended negative consequences' and ‘regrets LMCs being asked to find a local solution to a national problem.' So, with the benefit of hindsight, did the GPC get it wrong?

‘No, not at all. I don't regret it at all,' insists Dr Buckman – who as a GP in the capital personally lost out from the changes, albeit by a smaller margin than many. ‘If I had to do it again, I'd do it again.'

‘The prevalence changes were inherently unfair, by virtue of being deliberately discriminatory. They were unfair. And as a London doctor, I step back from my personal position and I say the reward ought to go to those people who see more diseases.'

After all, he points out, switching to a formula based on true prevalence was LMC conference policy.

‘Conference year after year has said it was unfair,' he says. ‘It's all very well standing up to conference, but standing up to conference on something that is unfair is very mistaken.'

On other topics, however, the GPC is clearly willing to be less bound by the way LMCs vote. One of the key decisions from last year's conference, settled on a knife-edge vote, was a resolution for the GPC ‘to consider resumption by GPs of the responsibility to commission out-of-hours services'

But at a meeting earlier this month, the GPC very quietly ditched the idea.

Likewise, reform of the seniority payment system, which was called for in a motion carried as a reference at last year's conference, is being considered very much in secret by the GPC.

In April, Pulse reported that the GPC was in the process of drawing up plans to reform seniority pay as one way of helping tackle the divide between partners and salaried GPs. But Dr Buckman refuses to discuss the report, or the meeting or how it might be done.

‘That was a private debate,' he says frostily. End of topic.

He's more forthcoming on other ways of tackling the GP jobs crisis – a cause he's frequently spoken passionately about, and which he described last year as a ‘cancer in our midst'.

‘I think it's very important we take these doctors off the streets and give them proper jobs that they want to have,' he says. ‘Pay them properly, with decent terms and conditions of service.

‘It's better to have them as partners than as sessional doctors, because it makes economic and operational sense. And we should be looking at how we do that.'

Other than reforming seniority pay, there's also been talk this year of revising the BMA's model contact for salaried doctors. And Dr Buckman has also got firmly behind calls for a return to central workforce planning: ‘We've spoken to ministers about it. They're not hostile, but they're not terribly interested either.'

Some of his constituency remain unconvinced by the progress so far– a motion from Merton, Sutton and Wandsworth LMC, for instance, ‘deplores the lack of action by the GPC in respect of last year's conference resolution 25 calling for the strengthening of the partnership basis of general practice'.

‘Well, they're quite right,' admits Dr Buckman. ‘It's very difficult in the current economic climate to persuade people to expand their practice. And it is remarkably difficult to do, so I'm not kidding myself.'

Despite the inevitable criticism, however, he remains convinced he's given a good account of himself.

‘In the end, you have to produce the maximum good for the maximum number of people,' he says. ‘That means a minority will not benefit from what you've done.'

‘I don't walk around complacent, I just think the health service has moved forward without most GPs taking significant damage. And some GPs have earned more money.'

Does he think GPs are better off now than when he was elected GPC chair two years ago? He pauses, and then smiles, refusing to be drawn.

‘I think it would be too complacent for me to answer that question. I think that would be cocky,' he says. ‘Ask me 10 years from now.'

Some GPs will be asking him it this week.

GPC chair Dr Laurence Buckman GPC chair Dr Laurence Buckman LMCs Conference preview: votes to watch

Opposition to the Government
The motions: Calls of no confidence in both PM Gordon Brown and health minister Ben Bradshaw
How they'll vote: Dr Buckman insists LMCs delegates ‘don't do personal', but they do – a motion of no confidence in Lord Darzi was carried last year, so Gordon Brown and Ben Bradshaw will probably suffer the same fate

The motions: A series of motions on the RCGP's revalidation plans will be considered in a themed debate, with one insisting the plan for 250 learning credits in five years ‘should be replaced with a more reasonable system'
How they'll vote: Likely to be more of an informative debate than hard-fought battle, and outright opposition to revalidation, which is firmly supported by the GPC, is extremely unlikely. But expect real murmurs of discontent over learning credits and the potential cost

Electronic Care Records
The motions: Calls for an ‘opt-in approach' to care records and greater safeguards of patient confidentiality – in an important early slot in the LMC conference agenda
How they'll vote: As in previous years, expect widespread concern about confidentiality. But given the new ‘consent to view' model and the fact the rollout is now underway, a vote for an ‘opt-in' could place the GPC in a sticky position.

QOF prevalence
The motion: ‘That conference regrets moving towards a true prevalence formula because of the unintended negative consequences'
How they'll vote: Given there have been many winners as well as losers, the motion may not pass. But watch out for some very angry speakers

Salaried GPs
The motions: Conflicting – some condemn certain employing practices which are offering ‘unfair working conditions for salaried doctors', while one warns ‘some of the provisions in the model contract for salaried doctors are totally unrealistic'
How they'll vote: Could go either way – if partners are as willing to engage with the debate as their salaried colleagues, it could be a fiery

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