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Independents' Day

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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