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At the heart of general practice since 1960

Dr Laurence Buckman on a year of living with the flak

On his first anniversary as GPC chair, Dr Laurence Buckman brushes aside critics, insisting it's his patients who matter.

By Steve Nowottny

On his first anniversary as GPC chair, Dr Laurence Buckman brushes aside critics, insisting it's his patients who matter.

As we're about to start the interview, the mobile phone of Dr Laurence Buckman, the most senior GP in the country, rings twice.

The first caller – civil servant, journalist or BMA mandarin perhaps – receives short shrift. ‘Busy now. Call me back. An hour and a half,' he barks.

But the second is a patient. Dr Buckman – a single-handed GP in Finchley, north London – often has patient calls diverted to his mobile, and this one he's happy to take. If the pain's bad, speak to the practice, he says. Get an appointment today with the doctor who's covering. Tell reception you spoke to me.

Say what you want about Dr Buckman, but the message is clear. Doctor first. Politician second.

And they have been saying what they want. Since he took over as GPC a year ago, Dr Buckman has faced a barrage of criticism from all sides.

Ministers have been furious at his hardball negotiating tactics, accusing him of ‘misrepresenting' their extended hours deal and lambasting the BMA's Support Your Surgery campaign as ‘misleading and mendacious'. In February the editor of the Lancet, Dr Richard Horton, launched an astonishing personal attack on him, claiming ‘insulting cynicism about politicians and their constituents from one of the most senior doctors in the country is both extraordinary and shameful'.

Dr Buckman, though, is firmly in the sticks-and-stones camp when it comes to dealing with his critics.

‘On occasion people have said things which have been personally unnecessary and that's up to them,' he shrugs. ‘If you don't like people saying nasty things about you, don't become the chair of the GPC.'

Relations with ministers are still cordial, he insists, although there is ‘a subset of them who've chosen to make it personal'.

‘Do I believe we can do business with Alan Johnson? Yes, I do, I still do,' he says. ‘A sign of maturity is you deal with policies and you attack policies. You don't attack individuals. So I'm not having a go at individuals who are doing their job even if I don't agree with what they're doing.'

But there is no doubt he has been stung by friendly fire. After the GPC offered GPs only two options in its poll on the extended hours contract offer – accept the Government's offer or a worse imposition - grassroots GPs appeared to be in open rebellion, accusing their leaders of ‘caving in'.

Dr Buckman wrote a heartfelt letter pleading with the profession to understand the GPC's stance. ‘You cannot imagine how hard it is to do my job when I am reading this level of venom directed at us,' he said.

Six months on, he is unrepentant. There was no third option, he insists, and allowing GPs to reject both options would have been ‘mad'.

‘What I couldn't do is offer people a pseudo choice which was obviously a con,' he says. ‘We would have ended up with a profession deeply committed to something that was never on offer.'

‘You can't overthrow a democratically elected Government. If it has chosen to pursue a particular policy you can't stop that.'

So could the same kind of imposition happen again?

‘Sure – once the Government has got the idea that it can impose.' he says.

‘Look the Government has always been able to impose. People are very upset that it turns out the GP contract can be got round. Well, since we've had a parliamentary democracy, politicians have been able to overthrow any arrangement they had.'

With ministers seemingly able to circumvent the negotiation process at will, the GPC has been forced to change tack. The BMA's Support Your Surgery campaign, which collected 1.2 million signatures in just three weeks, showed the potential of enlisting the public's support.

‘We've been talking to patients, we've been talking to opposition politicians, we've been talking to Labour MPs about this,' he says.

‘There are some who are very hostile. I can understand why - they're scared for their constituencies. Particularly in a situation where huge Labour majorities can be overturned very quickly. But that's not my problem. What we're doing is explaining to the public what is happening to the health service.'

The second phase of the campaign is now ‘imminent', he says - and while he remains tight-lipped on the detail, it will clearly be significant. The BMA spent £300,000 on the first stage, paying for national newspaper advertisements and campaign packs for every practice, and the second stage will receive ‘similar' funding.

The campaign will be expanded to the whole of the UK, with a focus on combating anti-GP spin across the four nations, while in England patients will be encouraged to appeal to local councils over polyclinic plans.

Dr Buckman, whose own surgery is earmarked to become part of a so-called hub-and-spoke polyclinic - with a central HQ and network of surrounding practices, including his own - has no doubt about the havoc polyclinics will wreak.

‘A surgery where it's not needed produces a doughnut of death around the outside,' he says. It's a typically Buckmanesque way of describing what he claims will be the fatal impact on surrounding practices, which he says will lose patients and resources.

As a result, the BMA – despite voting at last year's ARM to ‘actively oppose' APMS – is now encouraging local GPs to bid for the contracts.

‘If local GPs get together they can make sure – well, they can try at least partly to make sure - that there isn't a doughnut of death,' he says.

Top of the in-tray for the moment, though, rather than deadly doughnuts, is that other controversial beast, the MPIG. The Darzi review confirmed in June what had been whispered for months – that it is to be axed. The question now is not if, but when.

Teams of economists from the BMA and the Department of Health are currently poring over the ‘fearsomely complicated' figures, examining different models for the phase-out.

‘The amount of money they put in determines how fast the MPIG goes away,' says Dr Buckman. ‘If you give everyone a 100% pay rise it disappears tomorrow morning – that isn't going to happen. We're talking about how long this particular piece of string is, how it works and the mechanisms involved.'

He is surprisingly upbeat about the discussions, particularly compared with last year's drawn out dispute.

‘Negotiations are amicable and productive, and I don't sense there will be the same thing as happened last November,' he says.

‘The Government now understands the catastrophic threat that an imposition away from the correction factor would have on 90% of practices, including mine.'

But there is a line in the sand.

‘I am determined no practice will be destabilised and no practice will lose cash,' he says.

‘We're making sure we don't make a mistake and don't suddenly find there's a new generation of losers. Because we can't have another Black Wednesday. I was there then; I don't want that again.'

‘The criticism that we didn't model it carefully enough – I will not have that levelled against me.'

We're back to the criticism again, and Dr Buckman is clearly mindful that the next few months will be a political minefield. As he picks his way through polyclinic procurements, the MPIG phase out and another round of pay negotiations, the job isn't going to get any easier after a rollercoaster first year.

But he claims to be able to keep it in perspective.

‘I must tell you the only people that really matter are my 2,000 punters in Finchley,' he says. ‘If they don't like me, that would hurt. But if they think I'm OK, then that's OK.'

Buckman on...

The chain of command: ‘The GPC line is not El Buckman's thoughts. This isn't some sort of dictatorship.'

Polyclinics: ‘A surgery where it's not needed produces a doughnut of death around the outside.'

The MPIG phase-out: ‘People are saying if the MPIG goes, I'm going to go bankrupt. Well, I personally won't go bankrupt but boy will I have a difficult life.'

The Summary Care Record: ‘I think we're very nervous – not hostile, just nervous.'

Accreditation: ‘To be an accredited practice and not have to go through a million hoops will save an enormous amount of time and energy.'

Dispensing doctors. ‘I think market town dispensers at best are in for a period of competition and at worst they are going to be under some threat.'

The Government: ‘Do I believe we can do business with Alan Johnson? Yes, I do.'

Dont look back in anger: Dr Buckman reckons he can still work with Government Dont look back in anger: Dr Buckman reckons he can still work with Government

A surgery where it's not needed produces a doughnut of death around the outside.

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