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A faulty production line

Don't cut grassroots GPs out of talks on general practice reform, Nagpaul warns Hunt

The new GPC chair has warned ministers against marginalising the BMA as they draw up major reforms to primary care, and urged them to engage grassroots GPs as well as ‘enthusiasts’ and those representing ‘a small subsection’ of the profession.

Dr Chaand Nagpaul said the Government’s reforms would fail unless the majority of GPs were signed up to them, after health secretary Jeremy Hunt unveiled his latest plans for new GP responsibilites.

Yesterday Mr Hunt announced that he plans to change the GP contract to include a responsibility for practices to provide a ‘named GP’ responsible for coordinating all out-of-hospital care for vulnerable older people from next year. Mr Hunt discussed the proposals at a roundtable last month attended by GPs from the NHS Alliance and the National Association of Primary Care - an event to which the GPC was not invited.

Dr Nagpaul told Pulse: ‘One thing that I am trying to do is to get the Government to recognise that the changes that it wishes for depend upon the engagement of grassroots GPs, everyday GPs, the 95% of GPs who are not clinical leaders. GPC represents the body of GPs who are actually on the ground making general practice function on a daily basis - if the Government wants to achieve changes to improve general practice then GPC is the right organisation that it should be turning to.’

He added: ‘Changes to general practice can only occur through engagement with the vast majority of GPs via their main representative body, not via GPs representing a small subsection. This isn’t going to work based just upon the enthusiasm of enthusiasts. It will only work if you have sign-up and involvement of grassroots GPs, and that is where the GPC is the only legitimate body representing all GPs.’

Dr Nagpaul said the GPC did not disagree with the idea of GPs taking on a ‘named clinician’ role, but said he had yet to be told what exactly the plans would entail.

‘I think we need to understand what Jeremy Hunt means,’ he said. ‘The last thing we want is a box-ticking exercise of being a named GP as an end in itself. What matters is that patients receive quality, personalised care. Having a named GP as an end point doesn’t deliver that. What is really important is that patients can get personalised care from the right professional which in many cases will not be the GP, for example on the weekend.’

Dr Nagpaul also warned that Mr Hunt’s plan would require a shift in resources.

He said: ‘At the end of the day it is a core duty of GPs and a part of our work to look after vulnerable patients but we need to be enabled and given the breathing space and the time and resources to look after patients in the way that they deserve.

‘What we need to do is reduce some of this pressure on GPs and a part of that will need to be to reverse some of the damaging effects of the [contract] imposition, so we want to reverse some of the imposition changes. There needs to be a proper dialogue of how general practice can be expanded to have the infrastructure to provide this expanded model of care. That is the dialogue that needs to occur. So the concept is fine but it is not going to be possible until we address the obstacles of workload pressures and actually expand general practice.’

The Department of Health was last night tight-lipped on the detail of Mr Hunt’s announcement. It failed to invite Pulse to a DH press briefing held yesterday to explain the plans, and DH officials declined to give more details on what ‘named GPs’ would be expected to do or how the additional work would be funded until after a public consultation on the care of vulnerable patients ends on 27 September.

But GP leaders at the NHS Alliance and NAPC suggested some of the additional work could be funded by a shift of resources from the QOF, which is widely expected to be shrunk as part of next year’s contract negotiations.

NAPC chair Dr Charles Alessi said: ‘The named clinician is essentially what general practice should be all about, which is a sense of community and ensuring population health. But for that to happen we will have to remove a lot of bureaucracy from general practice including parts of the QOF. We have been encouraging a decluttering of primary care so that GPs can deliver this.’

‘We support this as part of a package of changes, because on its own it is not going to work.’

Dr Michael Dixon, chair of the NHS Alliance, added: ‘I think that there is a recognition that general practice is under a lot of pressure and Jeremy Hunt will want to ensure resourcing of his particular priorities of having accountable GPs and looking after vulnerable elderly.’

‘I think what [Mr Hunt] is suggesting is that in order to focus on these things we will need to quite radically reduce what is in the QOF so that releases time and resources to these new imperatives.’

Readers' comments (22)

  • Business as usual -- tried and tested politicians' method for running the NHS (kick the GPs harder every year, simultaneously label them as the problem and the solution) -- the funding for this proposal will simply be removal of funding for existing work from qof (no doubt that work will have to continue) and then recycled if we hit targets under the new 2014 contract. Because of course we will not be able to achieve all the targets, the usual outcome of more work and less money will apply. The politicians will also achieve effortless scapegoating of GPs when anything goes wrong with care of elderly patients, regardless of resourcing and wider system failures -- brilliant.

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  • If the government are now refusing to negotiate with the GPC then the sensible thing would be to look at how the dentists successfully managed to walk away from government control and manage themselves. It has now been proven that a section of healthcare providers can go it alone so it should be relatively straightforward for us to engineer a similar compromise.

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  • There is now a proven model for leaving the NHS. I think it would be more rewarding to work outside of the constraints of government interference.

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  • Warnings and threats don't work if there is no concrete action to back'em up.At the end of the day if the government wants to push ahead with its reforms there is very little the grassroot GPs can do.I don't see mass resignations because practical realities of supporting oneself and family take precedence.

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  • Vinci Ho

    Reminder to GPC before you guys sit down the negotiation table: ask yourselves :
    Do you think the government is credible?
    Do you think the government respect people and professionals?
    Do you think the government is trying to blackmail and threaten people using money ? After all , it is money that it cares the most ...........

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  • The next time the government will speak to the GPC will be in October/November in order to tell them what will be imposed next year givng no time to organise any response.There will be much huffing and puffing but no houses will be blown down,certainly not in Westminster.Job done.

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  • Anon 859 Do you really believe we will earn less privately ? Then we are over paid. We should resign from imposed Contracts, discriminatory pension changes and bullying workloads. Let us see what the free markets value us at. Increasing multi morbidity and life span and population means our workloads will rise and rise. the world is short of doctors. I think we should leave the NHS like the dentists did.

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  • I agree with the suggestion(s) that we need a fully worked up proposal from the BMA for resignation, for those who wish to do so in the event there is another contract imposition.
    Surely that should include realistic planning for a range of outcomes, for example if the government does not offer any concessions and the threat is implemented by BMA/profession?
    We saw what a damp squib the ill judged strike over pensions was, the GPC was spectacularly incompetent so that doctors were not even given clear legal guidance and to my recollection threats were issued that they would be subject to legal action, if they were not available for patients, in the days before the strike by the Department of Health.
    I would suggest that realistic canvassing of the grass roots is done by the BMA/GPC with regard to the proposal for mass resignation, including contingency planning for the likelihood that only a proportion of those who tick the box offering their resignation will actually go ahead -- resignation may in fact work to the advantage of some GPs who are effectively trapped in their practices, unable to find replacement partners. Obviously that would depend on the legalities regarding redundancy payments etc and also on the feasibility of turning one's practice into a private venture instead, as many dental practices have done -- it would be helpful if all that managerial and financial planning could be disseminated to the profession as part of the resignation proposal.

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  • Anon 859 Do you really believe we will earn less privately ?

    The the problem is getting a critical mass of GPs to do it at the same time. Whilst NHS provision exists, it is difficult to compete privately because, despite all of the moaning, NHS GP is so comprehensive.

    The other issue is the prescription fee - it's fine for some things but I think the average punter will be surprised by how much a serevent inhaler etc costs and will seek out another NHS GP (no matter how inconvenient or busy) for this alone.

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  • How can a single named GP with 24/7 responsibility fit with a workforce where GPs work part-time and/or are salaried (with contracted hours of employment)?

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  • The fact that Pulse have not been invited to the meeting highlights the fact that grassroot GPs ARE being excluded.

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  • Does NAPC have a legitimate authority to negotiate on behalf of the profession?

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  • Anon 11:53

    Why would you invite representatives of a magazine to a contract negotiation meeting between the NHS and thousands of private businesses?

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  • No-one is suggesting that the DoH should invite Pulse to any contract negotiation. As far as I am aware there have been no " negotiations" so far, and the appropriate people to negotiate any new contact would be the employers ( NHSE) and representatives of GPs such as the BMA/GPC.

    The point is that there was a " press briefing" to which Pulse were not invited which is at the very least odd, bearing in mind that Pulse is one of the major GP newspapers.

    "It ( the DOH) failed to invite Pulse to a DH press briefing held yesterday to explain the plans"

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  • "Dr Nagpaul said the GPC did not disagree with the idea of GPs taking on a ‘named clinician’ role"

    This short statement has made me feel even more depressed than I am already.

    How many grass roots partners working their butts off actually agree with this statement. My guess would be very few. So why are our representatives rolling over and complaining about lack of engagement rather than the principle itself?

    None of this makes any sense. We are hitting a workforce crisis, losing full time male GPs to part time female GPs, and the answer seems to be to give us even more round the clock responsibility.

    Why is no-one taking the government to task on this contract imposition? I am all for radical militant action but it seems our leaders don't have the appetite for it.

    I could fight from within, get political, try to become a leader but I guess my fatigue and morale will lead me to what many will do......look for an exit route.

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  • What is needed is some common objective that shows the government we can act in concert. It should not harm patients in any way . Refusing to co-operate with revalidation would be a useful first step. If we can't act on something that would be simple to organise and not damage clinical care then we might as well wait for the axe to fall.

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  • Obviously there is likely to be little appetite for mass resignation from the NHS but clinging to GMS is actually looking increasingly risky. This is proven by the arrival of AQP and the continual attacks on QOF and pensions, particularly if we are being asked to provide 24/7 cover in the context of a workforce crisis that is happening right now. I think it would be an extremely sensible first step to work out credible business plans for a variety of private GP models. This could easily be done by one of the large accounting consultancy firms and would lend weight to any further negotiating positions. Other private health sectors have a good track record of maintaining liquidity and service, I have every confidence that ordinary GPs could still feed themselves and afford their mortgages without an NHS contract (when did you last see a starving dentist?). The devil as ever is in the detail but I think it's worth a good look as an alternative to Dr Gerada's plan to make us all salaried.

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  • Moan, moan, whinge, whinge ....For crying out loud man up and leave the NHS. The dentists did so for what amounted to a 5% cut in pay (according to my Google research). You don't need to have a mass resignation. Just act like grown ups and do it yourselves. Ex pat GP.

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  • Patients would much rather go to A&E and be treated within a few hours than wait, than, as I have had to, over a month for a GP appointment, which are only available in a large number of practices, uselessly, during normal working hours.

    Only to be seen on numerous occasions by a “Doctor” who ignores your description of symptoms, has not read your history and, without fail, prescribes a wide spectrum anti-biotic as the solution – regardless of efficacy.

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  • Why not allow GPs to have private practice and pharmacy and sale of goodwill of the practice like all other businesses?

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  • It is like this. If continue to work in the NHS then we have to accept everything - imposed Contracts [ there is a logical impossibility], pension cuts [us , not MPs , judges and others], bullying 24 hour working.
    We have to ask this of ourselves ? Do we continue in imposed systems? Or are we professional enough to go the free market route ? And that means all GPs.

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  • Martin Breach ... the idea is to push GP's into a corner so that the government cannot privatise the NHS!
    This government doesn't care about GP's or patients, it is grabbing money from where eve r it can to balance the books, or so it thinks!
    When the next election is due, see how quickly they suddenly work with GP's and everyone, and make promises they won't keep to win the next election.

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