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A faulty production line

BMA chair: GPs' arguments for 11% share of funding are 'artificial'

Exclusive A split in the BMA has emerged as the Labour party calls for more funding, with BMA chair Dr Mark Porter saying GPs should not be given a greater share of the NHS budget, Pulse can reveal.

In an exclusive interview with Pulse, Dr Porter said that while general practice does need ‘proper resourcing’ he would ‘not care to nominate’ the other areas of the NHS that would need to give up resources to shift funds into general practice, adding that RCGP and GPC arguments for an 11% share of NHS funding did ‘not go into detail’ of how health services should ‘responsibly’ be funded.

Dr Porter was speaking to Pulse at the Labour party conference in Manchester, before party leader Ed Miliband’s speech, which is expected to outline plans for a ‘mansion tax’ on properties worth more than £2m in order to provide greater funding for the NHS.

The RCGP launched its campaign for general practice to receive at least 11% of the overall NHS budget at the end of last year, after new estimates showed it was receiving just 8.4%, while GPC chair Dr Chaand Nagpaul today reiterrated his comments that the NHS is in ‘danger of collapse’ unless the share of funding given to general practice is increased to 11%.

But Dr Porter criticised the calls for the percentage of funding to increase, stating that this would negatively affect other areas.

He said: ‘I think the problem with thinking in the individual figure is, if you said to me specifically “if the [overall NHS] resource stays the same, should [GP funding] go to 11%?”. Well, if that is the case, the 93% that is available to everybody else, if we assume that figure were correct, then the 93% available to everybody else becomes 89% and that is another 4% worth of cuts elsewhere.

‘Would you care to nominate the areas that they should be cut from? I wouldn’t, and that is why I think there is a little bit of artificiality about campaigning on an individual number that is not based on a specific need. What is unarguable is that general practice needs proper resourcing and that proper resource lies somewhere north of where we are at the moment.’

It comes as Labour leader Ed Miliband is widely expected to announce increased spending on the NHS on the whole, in a speech at the conference later today, as a pledge ahead of the general election next May.

Both the BBC and the Guardian have reported that Mr Miliband will propose that Labour tax increases for the wealthy – including a ‘mansion tax’ on homes worth more than £2m announced by shadow chancellor Ed Balls yesterday, and a tax on tobacco companies – should be used to increase NHS spending, with the BBC reporting that this would by £1bn a year.

However, Dr Porter said that if the next Government did raise the overall NHS resource, then the calls for general practice to receive an 11% share would still be ‘problematic’ because ‘11% would be 11% of a much larger cake’.

He said: ‘That is the problem with pegging to a percentage. It is a good way to have an individual headline but what it doesn’t do is go into the detail of how we should be responsibly funding the service that patients so closely depend on.’

But responding to those comments, Dr Nagpaul said this target was ‘the rightful way’ to ‘manage a pressured health resource’.

He told Pulse: ‘I mean 11% isn’t some arbitrary target in its own right. Ten years ago, 10% of the NHS budget was spent on general practice so we are not talking about something that is an unreal expectation.’

He added that ‘every political party’ was now ‘totally committed to expanding care in the community’.

Dr Nagpaul said: ‘The figures speak for themselves when you pause and reflect that a GP is given just over £73 for seeing a patient an unlimited number of times, including home visiting, for a whole year. How can that not be efficient compared to the fact that about £150 is spent for an average outpatient tariff appointment, one single contact in hospital?

‘I think there is a compelling argument and it is not an argument based on some target, it is an argument based upon recognising the rightful way of managing a pressured health resource.’

Readers' comments (26)

  • With friends like Dr. porter, Who the FUNK needs enemies. This our BMA doing its best, creating unity and looking after its own doctors. Thank god I resigned the BMA 3 years ago. Saving my £400 rather than giving it to unhelpful doctors who are meant to be on our side.

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  • I'm not sure of the logic behind Porter's comments. All the work is moving into the community, surely that should be where the money goes to as well?

    Of course, he also forgets the context of a time of a GP recruitment and retention crisis.

    Either way, his comments lead to two major problems.

    1. He is clearly acutely unaware or uninterested in the problems in General Practice at present.
    2. His comments have large negative impact on the GPC's mandate for GPs, and sabotages Nagpul's own authority.

    Either way, my resignation from the BMA is looking more and more likely. If I retain my membership, I would hope to see some much needed new leadership at the top of the pyramid.

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  • Bob Hodges

    Thus spake the Gas Man.

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  • Without increased funding then we should reject all unfunded secondary care work as they should have the resources to do it themselves.

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  • I suspect Dr last.Watch the NHS collapse Dr Porter when the firewall around hospitial disintegrates.
    When it next comes to renew my BMA subscrition they can whistle.

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  • This comment has been moderated.

  • I see where Mark Porter comes from. TI am not aware of any evidence that 11% of NHS budget to Primare care would make a difference. We need a much higher funding for primary care than at present and 11% of present NHS budget has been a ball park figure by GPC/RCGP. The raison de etre of the 11% would be lost if the total funding shrinks drastically. Also he has to listen to more numerous Hospital doctors -more proportion of which pay BMA fees as robbing Paul to pay Peter doesn`t help.

    That said this is something he should have discussed with GPC and RCGP in private and saying this in public is in my opinion a great disservice to the GPC and the GP`s who are squeezed from all angles with secondary care work being dumped on us.

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  • What isn't artificial is the patients I'm seeing today and I'm booked through to 7.30pm and have just stopped to have a cup of tea; the patients can wait as I haven't had lunch.. Yesterday was 50+ and tomorrow I know not what.
    Any shift in fund should come to me as I'm doing all the friggin work!
    I suspect I am ot alone in this!

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  • I've said it before and I expect I will get countless more opportunities to say it -
    There is never a shortage of doctors willing to shaft their colleagues in public.
    If this is what Porter believes he should have had it out with the GPC in private.

    Never, never, NEVER betray your colleagues in public Dr Porter. This would be a resigning matter for a man of respectability.

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  • To the person above who is waiting for his BMA renewal, why wait? Leave now and save your money. It worthless where you are putting it.

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  • I have no problem telling Dr Porter where the money should come from - the NHS is again overspent, £2 billion less is being spent in primary care, that £2 Billion has gone somewhere, take a look at where budgets have increased and funding has increased, and cut it from all the areas that were happy to increase their resource at the cost of primary care - they've has a few good years out of it, now they can live as primary care has lived, in penury due to their greed and failure to committ to maintaining or reducing their costs!

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  • Finally.. the problems with the BMA are being laid bare. The sad truth is that most of our secondary colleagues couldn't care less what happens to primary care staff so long we as there as a dumping ground for more work.

    Dr Porter's statements suggest that he does not value or respect the work done by GPs and other primary care staff. If the chair of the BMA feels this way you can be sure the organisation is not going to fight for the welfare of GPs or their teams.

    There are simply too many differing agenda amongst all doctors for us to fight the government agenda to privatise primary care.

    GPs should be in no doubt that the BMA does not support our cause or speciality as a whole. Mass exodus from the NHS into private practice is the really the only viable way forward for general practice.

    While we are at mass exodus from the BMA should also be high on the agenda. Think about it... if GPs all went private Dr Porter need not worry arguing for 7, 8 or 11 % of anything for primary care... secondary could take the entire NHS budget!

    Secondary care might just need the extra boost in funds once the free-for-all of commercially-driven private porviders kicks in to gear.

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  • And that my friends is why the BMA has never been or will never be an effective 'union'. The leadership always seem to lose contact with the grass roots and start coming out with weasily politico speak. I would add to the comments suggesting all doctors leave this ineffective organisation. Perhaps only when there is a rapidly dwindling membership may they actually wake up and starting act in their interests.

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  • I think it's time the GPC "devolved" from the BMA. If this comment does not make the GPC consider this option, nothing will!

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  • GPs see 90% of the consults in the NHS.
    Forget about %, and let us move to a fee per appointment system. Otherwise GPs will leave as the work increases and we get less and less per each item of work. At least, that will make it clear the amount of work we are doing.
    Recruitment and retention is going to be an ever increasing problem in a list based capitation system.

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  • Bob Hodges

    What's so 'artificial'?

    In a system when the overall resources are fixed (aka a zero sum game), and you move a huge chunk of the work somewhere.......why should some of the resources not follow the work?

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  • Azeem Majeed

    Hospitals are funded by tariff based systems (i.e. funding goes up when workload goes up) in contrast to general practices which receive their funding largely through capitation (i.e. funding remains fixed even if workload goes up). It's time to consider modifying general practice funding so that workload is also included in the formula for allocating budgets to practices.

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  • Perfect timing BMA UP FOR RENEWAL , BY BYE !

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  • Why wait to dump the BMA when renewal is up! I stopped direct debits from being processed and contacted them to say adios.

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  • His CV reads:
    "Dr Mark Porter is a CONSULTANT anaesthetist at the University Hospitals Coventry and Warwickshire (UHCW) NHS Trust.
    His previous roles in the BMA have included being the chair of the CONSULTANTS Committee from 2009-2012."

    For 32 years I keep asking myself: When will GPs realise that the BMA is a consultant-led organisation?

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  • short sighted and poor leadership shown by Dr porter

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  • BMA membership cancelled - I hope others will follow to send a message

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  • (Salaried GP not other healthcare professional)

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  • Is this an accurate report?
    Even for the Chair of the BMA it seems a bit inept!
    There has been a progressive - and recently increasingly rapid - decrease in the funding for general practice and in the proportion of the NHS budget received by general practice.
    When this is combined with the stated desire of all political parties to shift work out of hospitals (which, logically, ought to mean shifting of the payments for such work) into primary care (meaning general practice) why does Dr Porter think it is unreasonable for either the GPC or the RCGP to say that a higher proportion of NHS funding needs to be invested in general practice?
    Should it be up to GPC or RCGP to suggest whose budget should be reduced? I never noticed hospitals demanding higher finances being asked to decide or suggest who else should be penalised to provide them...

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  • I recently went to a meeting where the speaker was Maureen Baker. Very nice GP and her case for increased funding is simply based on increased consultations. I made the point that unless money actually followed the patient in an item of service way none of the meddlings would be practical. The RCGP and GMC should be concerned with patient safety and General Practice is unsafe due to workload pressure. We are a "boom" industry in terms of demand and any other area of business would be jumping for joy - but would definately not accept the suicidal capitation based contract that we try to adhere to. Clearly Mark Porter has a Consultant's view. Ironically the only reason why we do not get more work dumped on us is the financial incentive of fee per item hospital care.
    Time to lose the post war contract and actually have money following workload, any thing else is pointless. Noting comments above I never joined the BMA as they have never been worth it and I have just resigned from the RCGP for not ensuring safety in General Practice. I would resign from the GMC if possible! All have abjectly failed in my opinion

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  • Dr porters comments are about protectionism of his lot. I wouldn't expect anything less from such a selfish organisation. Poor chaand and Co at the gpc are fighting a losing battle. I can see what una coales had to put up with. Only one solution to this and that is for the GPC to break away from the BMA and for a union/ organisation with the LMCs for primary care. Nothing will be achieved for primary care through the BMA due to competing agendas of primary and secondary care and the contempt shown by consultant colleagues for general practice.

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  • I agree with the above. The BMA is not representative. They have been unsuccessful in negotiation with the government. The industrial action on pensions was a mess. We need an organisation that has the balls to use appropriate levers such as mass resignation from NHS contracts if unilateral 'negotiation' continues. I think I will save my £400 odd pounds next year.

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