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Buckman...on ministers, spin and a pay freeze

The new GPC chair talks at length to Steve Nowottny about his first few months in the post, the big issues ahead and his view of the new Government team. And as you would expect from Dr Buckman, he pulls no punches.

This is the first of four installments, making up the complete transcript. You can also find an edited version in this week's Pulse.

The new GPC chair talks at length to Steve Nowottny about his first few months in the post, the big issues ahead and his view of the new Government team. And as you would expect from Dr Buckman, he pulls no punches.

This is the first of four installments, making up the complete transcript. You can also find an edited version in this week's Pulse.

How have you found your first few months since you moved up from deputy chair to chair of the GPC, and what do you see as the major issues over the next year?

Well I knew what was coming because having been the deputy and being a negotiator for ten years, you know roughly what to expect. As the deputy chairman for the last three, you know you've stepped into the role often enough.

It is quite different being chairman, the buck really does stop with you, there's no one else to blame but you. When I was deputy chairman I was always thinking ‘ah, I'd better not decide this because Hamish might think something different' – well now I do make the decisions. If I decide we have a particular make of coffee, or we're doing this or we're going to say that, it's my choice – not that I'd act without the rest of the negotiators, I wouldn't dream of it.

So how is it going? It's different, but it's the same, if you see what I mean. It's very exciting, it's quite time-consuming. It certainly means I now have things to do in the wee small hours of the night, whereas before I used to be bored wondering what to do and now I know what to do, I don't sleep much, and that's not new, and now I've got something to do with it rather than wander across the various cable television channels deciding why I don't like any of them.

Looking ahead over the next year, what are the two or three key issues?

The key issue is to damp down the anti-GP rhetoric, to rebut every inappropriate criticism of GPs and their practices, every attempt to denigrate and de-legitimise GPs. I intend to be there, and I want to encourage GPs to take action themselves.

It's not just me. ‘What's my union doing about it? What are the BMA doing about it?' Well actually, what are YOU doing about it? What are they doing? Let them stand up for themselves, with our help – I'm not suggesting we'll abrogate responsibility, it's most definitely my responsibility to rebut this stuff. But I think it's theirs to work in partnership with us, and their LMCs , to actually say ‘this stuff we've heard about in the papers, or on the telly or on the radio, it's not true, this is the truth.'

There are several different people we've got to talk to – our patients, the public; opinion-formers, whatever that means; and people who control the health service, both politically and operationally – and we've got to persuade all of these different groups, who all have to hear different messages, that GPs are not a bunch of lazy wasters, that actually we work jolly hard, we are entitled to a reasonable pay settlement, and if you attack and deride enough, GPs will just not be there. If you make it impossible for GPs to work, GPs will not be there, and I don't think that's a situation that many patients want. So that's one area, the sort of anti-GP barrage…

The next thing is I want GPs to be paid properly for the work that they do. That means making corrections in the current GP contract to make it do the things it's meant to do, and also to get GPs a reasonable pay rise. I appreciate what some GPs will regard as reasonable and what is deliverable may not be the same thing, but I think GPs have to understand that faced with a barrage of criticism, which some might argue was deliberately started to make sure that we got a poor pay rise, I think we have to work from that position

It's all very well people writing to me and saying to me ‘unless you get n% - where n is quite a large figure - this won't be good enough' or ‘you've got to explain to people more carefully'. I had a letter today telling me that I had to take newspaper editors out to lunch and if I'd only thought of that, I'd have then been able to solve all the problems with the NHS.

And with the anti-GP rhetoric that we're hearing at the moment, I'm glad that somebody's written to me, because I never would have thought of that before. Equally, I might have thought, stupidly, that newspaper editors had actually made up their own minds, whereas now I've been told by somebody that actually if I'd reacted properly and taken editors out to lunch then they'd all have said ‘oh I didn't realise what it was like and now I'll change my views, my editorial policy completely.'

If only that were true. I wish it were but it's not.

So I've got to get people to be realistic both about their pay and about their ability to hit back, but I do believe they should hit back. A passive, docile workforce that just says we're quite OK, we're happy to be slagged off, well, we're not happy to be slagged off, and nobody should think that we'll let anybody get away with it.

So those are the two key things, and if I had a third thing I would say I want to encourage GPs to lift their eyes to the horizon and say ‘how could I make my practice better' because generally what's good for the patient is good for me. So we're not talking just about making patients happy, I'm not in the happiness business, I'm in the needs business.

If you help patients achieve what they need, as opposed to necessarily what they want, if you help them achieve what they need, you will actually benefit your practice, both in reputation terms and ultimately I believe in money terms. So it's an illusion to think these things are not compatible with each other because I believe they are.

Coming back to the spin thing, every two or three weeks you get a whole raft of anti-GP headlines based on apparently misleading statistics. Do you believe that ministers or special advisers are deliberately leaking information?

I believe there are those inside government - I don't think they're ministers - who it suits, or who genuinely believe that GPs are a busted flush and why would you have a GP?, what's a GP for?, get rid of them, what we need is any old doctor, any old nurse, any old place, as long as it delivers to the people who matter, who are the people who voted, in particular constituencies that are marginals… I think there are those who believe that.

So there are those that have genuine belief, and there are those who cynically believe that if we soften up the public, they'll cope with private healthcare being delivered on the NHS. So there are two separate groups, and I don't believe that ministers necessarily are in either of those two. And I'm not saying this is a rampant view in government, but it happens to be fairly common among certain critical government-associated people.

You've talked about the new ministers – how have you found the new team since they took over?

Well it took them a jolly long time to come and talk to me, or to invite me to come and talk to them, and that's because they seemed to find it difficult to pick up the phone. But I've now met both of the key ministers, sorry, the three key ministers, Johnson, Darzi and Bradshaw, and we've had very amicable meetings. They've put their point of view, I've put ours, they're compatible some of the time, and I think I can work with these people. I've pointed out to all of them that I thought that their tardiness in contacting me was most unhelpful

Did they say why they'd taken so long?

Well we've been faced with the Government telling us that they wanted extended access, for example, without ever having discussed it with us, ever. Without ever having written us a letter, sent us an email, dropped us a note, phoned, nothing. And suddenly it's the big issue on the agenda when it never was before, and we knew that a lot of GPs would do it.

We have a survey now that tells us exactly how many GPs will do it, but why did they not ask us, why did they not agree to meet? So the answer to the question ‘are GPs prepared to do extended access' is: some are and some aren't. Do GPs think it is cost effective? Most GPs think it is a waste of money, but OK that's what the Government wants, you know…

...on stepping up from being a deputy ...on stepping up from being a deputy

When I was deputy chairman I was always thinking ‘ah, I'd better not decide this because Hamish might think something different' – well now I do make the decisions.

...on the spin campaign ...on the spin campaign

I believe there are those inside Government who genuinely believe that GPs are a busted flush and why would you have a GP?, what's a GP for?, get rid of them...

Dr Laurence Buckman

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